How I Saved $2,000 a Year on My Prescriptions by Switching My Part D Plan

How I Saved $2,000 a Year on My Prescriptions by Switching My Part D Plan

The Plan I Thought Was Good Was Costing Me a Fortune

For years, I just kept the same Medicare Part D drug plan. I figured they were all about the same. Then, one of my brand-name medications got much more expensive. A friend told me to use the official “Medicare Plan Finder” website. I entered my list of prescriptions. The tool showed me that my current plan was one of the worst for my specific drugs. A different plan, with a similar monthly premium, would save me over $2,000 a year in co-pays. I switched during open enrollment. That one hour of research was my highest-paying job of the year.

The “Donut Hole” Explained: A Simple Guide to Surviving the Part D Coverage Gap

The Gap I Learned to Navigate

The “donut hole” used to terrify me. It’s a temporary limit on what my drug plan will cover. Here’s how I think of it: At the start of the year, my co-pays are low. Once my plan and I together have spent a certain amount on my drugs, I fall into the “donut hole.” In the hole, I have to pay a bigger percentage of the cost. But once my out-of-pocket spending hits a certain high limit, I exit the hole and my drug costs become very low again. Understanding this flow has helped me budget and not panic when my costs change.

My Guide to Using the “Medicare Plan Finder” Tool to Find the Cheapest Drug Plan

The Government Website That Is Your Best Friend

Choosing a Part D drug plan feels like a random guess. The Medicare Plan Finder tool on Medicare.gov turns that guess into a math problem. It’s your single most powerful tool. You create an account, enter your exact list of medications and dosages, and select your preferred pharmacy. The tool then analyzes every single plan available in your zip code. It shows you a ranked list of the plans with the lowest total annual cost—your premiums plus all your co-pays—for your specific drugs. It does the hard work for you.

How to Win a “Formulary Exception” and Get Your Non-Covered Drug Paid For

The “No” We Turned Into a “Yes”

My doctor prescribed a new medication for me, but when I went to the pharmacy, they said it wasn’t on my Part D plan’s “formulary,” or list of covered drugs. My doctor’s office helped me file for a “formulary exception.” My doctor wrote a letter to the plan explaining that I had already tried the other “preferred” drugs and they didn’t work for me. He stated that this specific drug was “medically necessary” for my condition. The strong clinical justification from my doctor was the key to getting the plan to make an exception and cover it.

The Unspoken Power of a “Tiering Exception” to Lower Your Co-Pay

Moving My Drug Down a Ladder

My most important medication was placed on “Tier 4” of my drug plan’s formulary, which meant it had a very high co-pay. My doctor told me we could ask for a “tiering exception.” We filed an appeal with the plan. In it, my doctor explained that the other, cheaper drugs on the lower tiers were not effective for me. We argued that because this was the only drug that worked for my condition, it should be covered at a lower co-pay. The plan agreed and granted the exception, moving my drug down to Tier 3 and cutting my co-pay in half.

My Story: My $800 Eliquis Prescription Became $47. Here’s How.

The Program That Slashed My Biggest Bill

I was prescribed Eliquis, a common but very expensive blood thinner. The monthly cost was going to be over $800. I was in a panic. The pharmacist told me to immediately go to the manufacturer’s website. I found a “patient assistance program” and a co-pay card. But the biggest help was a non-profit called the “PAN Foundation.” Because I met their income guidelines, they awarded me a grant that covers the majority of my out-of-pocket costs for the medication. Between my Part D plan and the grant, my portion is now just $47 a month.

The “Extra Help” Program: How to Get Your Part D Premium and Deductible Paid For

The Government Subsidy That Changed Everything

I am on Medicare, and my income is very low. Paying for my Part D premium and the co-pays for my eight different medications was a huge struggle. A social worker helped me apply for a federal program called “Extra Help,” also known as the Low-Income Subsidy (LIS). The application was simple. Once I was approved, it was like magic. My monthly Part D premium was eliminated. My annual deductible disappeared. And all my prescription co-pays were reduced to just a few dollars. It’s the single most important program for low-income seniors on Medicare.

A Pharmacist’s Guide to Lowering Your Drug Costs (That Your Doctor Doesn’t Know)

The Person Who Knows Both Drugs and Dollars

I thought my doctor knew everything about my prescriptions. But my pharmacist, Sarah, is the real expert on cost. She knows which brand-name drugs have cheaper, authorized generics. She knows if a 90-day mail-order supply is cheaper than a 30-day local refill. She even knows if a different drug in the same class has a lower co-pay on my specific plan. I now have an annual medication review with my pharmacist. Her knowledge of the intersection between medicine and insurance is invaluable, and it has saved me a lot of money.

How to Use GoodRx and Other Discount Cards INSTEAD of Your Part D Plan (And When You Should)

The Day I Didn’t Use My Insurance

I went to the pharmacy to pick up a generic prescription. My Part D co-pay was $15. The pharmacist gave me a great tip. She said, “Let me check the price on GoodRx.” She typed it into her computer. The price with the free GoodRx coupon was only $6. She told me we could just run the prescription outside of my insurance. I paid the lower cash price. I learned that for some cheap, generic drugs, a discount card can actually be cheaper than your insurance co-pay. It’s always worth asking, “What’s the cash price?”

The “Catastrophic Coverage” Phase: Your Ultimate Safety Net for High Drug Costs

The Finish Line I Was Grateful to Cross

I have a very expensive specialty medication, and my drug costs are high all year. I learned about the phases of Part D coverage. After I spent a certain amount out-of-pocket and exited the “donut hole,” I entered the “catastrophic coverage” phase. This is the ultimate safety net. Once I’m in this phase, for the rest of the year, all of my prescription drug costs are either zero or a very small co-pay. It’s a protection that ensures that no matter how high your drug costs are, there is a yearly limit on what you will have to pay.

My Guide to Appealing a Part D Denial for a High-Cost Medication

The “No” I Fought, The Medicine I Got

My Part D plan denied coverage for a high-cost drug my specialist said I needed. I didn’t just accept it. My doctor’s office and I launched an appeal. Step one was the “coverage redetermination” form, which my doctor filled out with a strong letter of medical necessity. They denied it again. Step two was to appeal to an “Independent Review Entity,” an outside company that reviews the case. With my doctor’s clear evidence, the independent reviewer overturned the plan’s denial, and I was finally able to get my medication.

The Unspoken Difference Between a “Standalone” Part D Plan and a “MAPD” Plan

My Drugs, Bundled or Separate?

When I enrolled in Medicare, I had to decide how to get my drug coverage. I could choose a “Standalone” Part D plan that just covered prescriptions and pair it with Original Medicare. Or I could choose a Medicare Advantage plan that “bundled” my medical and drug coverage together (an MAPD). I learned that the drug formularies and co-pays can be very different. The best MAPD plan for my medical needs might have terrible drug coverage for my specific prescriptions. It’s crucial to evaluate the drug coverage separately, even when it’s bundled.

How to Get a “Vacation Override” to Refill Your Prescriptions Early

The Pills I Needed for My Trip

I was getting ready to go on a three-week trip to visit my grandchildren. I looked at my pill bottles and realized my refills would come due right in the middle of my vacation. I called my Part D insurance plan. I explained that I was traveling and needed to get an early refill. They were able to put a “vacation override” on my prescriptions. This allowed the pharmacy to dispense my refills early so I would have enough medication to last my entire trip. A simple phone call solved the problem.

My Guide to Choosing a Plan Based on Its “Preferred Pharmacy” Network

The Pharmacy That Saved Me Money

When I used the Medicare Plan Finder tool, I noticed that some Part D plans had a “preferred pharmacy” network. This meant that if I used one of their preferred pharmacies—like Walgreens or CVS—my co-pays would be significantly lower than at a “standard” in-network pharmacy. My local, independent pharmacy was not preferred. I made a choice. By agreeing to switch my prescriptions to a preferred pharmacy down the street, I was able to enroll in a plan that saved me over $500 a year in co-pays.

The Unspoken Trap of a “$0 Premium” Part D Plan

The “Free” Plan With the $2,000 Deductible

I was tempted by a Part D drug plan that had a $0 monthly premium. It sounded like a great deal. But then I looked at the details. The plan had a high deductible, meaning I would have to pay the full price for my drugs—over $500—at the beginning of the year until my deductible was met. A different plan had a $30 monthly premium, but no deductible. I did the math. The “free” plan would have actually cost me more out of pocket. The premium is only one small part of the total cost.

How to Use a “Mail-Order” Pharmacy to Save Money and Time

The Pills That Arrive at My Doorstep

I take several medications every single month for my chronic conditions. Trips to the pharmacy were a hassle. I learned that my Part D plan offered a mail-order pharmacy option. Not only was it more convenient to get a 90-day supply delivered right to my door, but it was also cheaper. For many of my generic drugs, the co-pay for a 90-day mail-order supply was the same as a 30-day supply at my local pharmacy. It was like getting one month free.

My Story: The Day My “Tier 3” Drug Became a “Tier 5” Specialty Drug

The Letter That Changed My Co-Pay from $40 to $400

I had been taking the same brand-name drug for years. It was on Tier 3 of my plan, with a predictable $40 co-pay. Then, I got a letter from my insurance plan. They were moving my drug to “Tier 5,” the specialty tier. My co-pay was no longer a flat amount; it was now 33% co-insurance. My out-of-pocket cost jumped from $40 to over $400 a month. It was a shocking reminder that drug plan formularies and tiers can, and do, change every single year.

The Guide to Finding Out if Your Plan Has a “Deductible” (And for Which Tiers)

The First Bill of the Year Is Always the Highest

In January, I went to fill my prescriptions for the first time in the new year. I was shocked when the pharmacist told me the total was over $500. I had forgotten about my Part D plan’s annual deductible. My plan had a deductible that I had to pay myself before my coverage kicked in. I also learned that the deductible often only applies to drugs on the higher tiers (Tiers 3, 4, and 5). My cheap, Tier 1 generics were still covered from day one.

How to Get a “Prior Authorization” Approved for Your Medication

The Paperwork My Doctor Had to Do

My doctor prescribed a new medication for me, but my Part D plan required a “prior authorization.” This meant my doctor had to get permission from the insurance company before they would cover it. My doctor’s office was amazing. The medical assistant filled out the form, attaching notes from my chart that explained why this specific medication was necessary for me. It was an extra administrative step, but their clear documentation got the drug approved without a long delay or a denial.

The Unspoken Power of Asking Your Doctor for a 90-Day Supply

The Prescription That Lasted Longer

I take a generic medication for my blood pressure every day. I used to get a 30-day refill every single month at my local pharmacy. At my last check-up, I asked my doctor if she could write the prescription for a “90-day supply with three refills.” She said, “Of course.” Now, I use my plan’s mail-order pharmacy. I only have to think about my blood pressure medication four times a year instead of twelve. It’s more convenient, and it often saves me money on co-pays.

My Guide to Safely Using “Canadian Pharmacies” (And the Risks Involved)

The Cheaper Pills from Across the Border

The brand-name drug I needed was incredibly expensive, even with my Part D plan. I looked into ordering it from a reputable online pharmacy based in Canada. The price was 70% cheaper. I knew there were risks. It’s technically illegal to import drugs, and there is a small chance the medication could be counterfeit. I chose a pharmacy that was certified by a third-party group and required a valid prescription. It was a calculated risk I took to afford my medication, but it’s a path full of potential pitfalls.

The “Step Therapy” Requirement: How to Get It Waived and Go Straight to the Best Drug

The Hoops They Wanted Me to Jump Through

My doctor wanted to put me on a new, effective drug for my condition. My insurance plan said no. They had a “step therapy” requirement. They wanted me to first try and fail on two other, older, and cheaper drugs before they would approve the one my doctor wanted. My doctor helped me file for an exception. He wrote a letter explaining that, based on my medical history, the other drugs were likely to be ineffective or cause side effects. We were able to get the requirement waived and go straight to the best treatment.

How to Find Out Which Part D Plans Have the Best “Star Rating”

The Report Card for My Drug Plan

When I was using the Medicare Plan Finder tool, I saw that every Part D plan had a “Star Rating” from 1 to 5. This is a report card from Medicare, rating the plan on things like customer service and patient safety. I made a personal rule for myself: I would only consider plans that had a 4- or 5-star rating. I figured if the government’s own system says a plan is “average,” I could probably do better. Using the star ratings helped me narrow down my choices to only the highest-quality plans.

My Guide to Using Manufacturer “Patient Assistance Programs” (PAPs)

The Drug Company Gave Me My Drug for Free

I was prescribed a very expensive, brand-name medication. Even with my Part D plan, the co-pay was hundreds of dollars a month. I was desperate. My doctor’s office helped me apply for the manufacturer’s “Patient Assistance Program” (PAP). I had to submit proof of my income. Because my income was low, I was approved. Now, the drug company sends me a 90-day supply of the medication directly to my home, completely free of charge. It’s a little-known program that has been a total lifesaver for me.

The Unspoken Problem of “Dispensing Fees” at the Pharmacy

The Hidden Fee in My Co-Pay

I take a very cheap, generic medication. The cost of the drug itself is only about $2. But my co-pay at the pharmacy was $5. I asked the pharmacist why. She explained that my co-pay includes not just the cost of the drug, but also a “dispensing fee” that the pharmacy charges to cover their time and labor. This fee is set by my Part D plan. It was a good reminder that my co-pay isn’t always about the price of the pill; it’s also about the cost of the service.

How to Use Your State’s “Pharmaceutical Assistance Program” (SPAP)

The Extra Help from My Home State

I was still struggling with my prescription drug costs, even with my Part D plan. I learned that my state has its own “State Pharmaceutical Assistance Program,” or SPAP. It’s a program specifically designed to help low-income seniors with their medication costs. I applied, and once I was approved, the SPAP started working with my Part D plan to lower my costs even further. It was an extra layer of protection offered by my own state that helped me afford the medications I need.

My Story: I Was Paying for My Drugs All Wrong for 3 Years.

The Wrong Pharmacy, The Wrong Plan, The Wrong Price

For three years, I just stuck with the first Part D plan I had ever chosen. I was paying over $1,500 a year in co-pays. My friend finally forced me to use the Medicare Plan Finder tool. I discovered that my plan was a terrible match for my specific drugs. I also learned that the pharmacy I was using was not “preferred” by my plan. By switching to a different Part D plan and a different pharmacy, my estimated annual cost dropped from $1,500 to just $400. I had been throwing money away for years.

The Guide to Getting Your “Diabetic Supplies” Covered Under Part B vs. Part D

The Two Pockets That Pay for My Diabetes

Navigating the costs of my diabetes supplies was confusing. I learned it’s a tale of two Parts. My testing supplies—the blood sugar monitor, the test strips, the lancets—are all considered “durable medical equipment” and are covered by my Medicare Part B. But my insulin and my oral diabetes medications are prescription drugs, so they are covered by my Medicare Part D plan. Understanding which part of Medicare pays for which supply is the key to making sure everything is billed correctly and that I pay the lowest possible amount.

How to Handle a “Quantity Limit” on Your Prescription

The Limit My Doctor Had to Override

My doctor prescribed two pills a day of a certain medication. When I went to the pharmacy, the pharmacist told me my Part D plan had a “quantity limit” and would only cover one pill per day. I was frustrated. I called my doctor’s office. He had to submit a special request to the insurance plan, explaining why, for me medically, the higher dosage was necessary. Because he provided a strong clinical reason, the plan approved an override of the quantity limit, and I was able to get the correct dose.

The Unspoken Power of an “Annual Medication Review” with Your Pharmacist

The Yearly Check-Up for My Pills

Once a year, I schedule a formal “medication review” with my pharmacist. It’s a free service that many pharmacies offer. We sit down for 30 minutes and go through my entire list of prescriptions and over-the-counter supplements. She checks for any potential drug interactions. She looks for any brand-name drugs that could be switched to a cheaper generic. And she helps me identify any medications that my Part D plan charges a high co-pay for. That one annual conversation is one of the most important things I do for my health and my wallet.

My Guide to the “Medicare Part D Late Enrollment Penalty” (And How to Avoid It)

The Lifelong Penalty for Being Late

When I first became eligible for Medicare, I didn’t take any prescription drugs, so I decided not to sign up for a Part D plan. “I’ll just get it later if I need it,” I thought. That was a huge mistake. A few years later, when I did need a drug plan, I discovered I had to pay a “late enrollment penalty.” It’s a small fee that is added to my monthly Part D premium for the rest of my life. The lesson is clear: even if you don’t need it now, you should enroll in a very low-cost Part D plan during your initial enrollment to avoid that lifelong penalty.

The Unspoken Reason Your Co-Pay Changes Throughout the Year

The Four Seasons of My Drug Costs

My prescription co-pays are not the same every month, and it used to confuse me. My Part D plan has four “seasons.” Season 1: The Deductible. At the start of the year, I pay 100% of the cost until my deductible is met. Season 2: The Initial Coverage. My co-pays are low and predictable. Season 3: The Donut Hole. My costs go up. Season 4: Catastrophic Coverage. My costs drop to almost zero for the rest of the year. Understanding these four seasons helps me anticipate and budget for my changing drug costs.

How to Find a Plan That Covers Your Specific “Brand Name” Drug

My Non-Negotiable Medication

I take a specific brand-name medication that I know works for me. I am not willing to switch to a different one. When I was choosing my Part D plan, this was my only priority. I used the Medicare Plan Finder tool, and I entered just that one drug. The tool showed me exactly which plans had my medication on their formulary and what the co-pay would be. It allowed me to filter out all the plans that didn’t cover my non-negotiable medication and find the one that was the perfect fit for me.

My Guide to Using a “Compounding Pharmacy” with Medicare

The Custom-Made Cream That Wasn’t Covered

My doctor prescribed a special “compounded” cream for my skin condition. It had to be custom-mixed by the pharmacist. I was surprised to learn that most Medicare Part D plans do not cover compounded medications. They are not standard, FDA-approved drugs. I had to pay for the compounded cream out-of-pocket. It was a good lesson: if your doctor prescribes a custom-made medication, it’s very likely that you will have to pay the full cash price for it.

The Unspoken “Clawback” Phenomenon: When Your Co-Pay is More Than the Cash Price

The Day I Paid Less by Not Using My Insurance

I went to the pharmacy to pick up a generic drug. My Part D co-pay was $10. Out of curiosity, I asked the pharmacist, “What’s the cash price for this without insurance?” She told me it was only $4. My insurance “co-pay” was more than double the actual price of the drug. This is called a “clawback.” I told her to run it without my insurance, and I paid the lower price. It’s a crazy quirk of the system, and it taught me to always ask what the cash price is.

How to Find the “Lowest Cost” Version of Your Drug (Generic, Authorized Generic, etc.)

Not All Generics Are Created Equal

My doctor told me to take the generic version of Lipitor. I learned there’s more to it than that. There’s the standard “generic” (atorvastatin). But there is also something called an “authorized generic,” which is the exact same brand-name pill, but sold in a generic bottle. Sometimes, my Part D plan’s co-pay is actually lower for the authorized generic. I always ask my pharmacist, “Can you check the co-pay for both the regular generic and the authorized generic for me?” It’s a small question that can sometimes save me money.

My Story: My Plan Dropped My Drug Mid-Year. Here’s What I Did.

The Formulary Change That Sent Me Scrambling

In the middle of the year, I got a letter from my Part D plan saying they were dropping my essential medication from their formulary. I was in a panic. I learned I had a few options. First, my doctor could help me file for a “formulary exception” to try to get it covered anyway. Second, he could switch me to a different, therapeutically similar drug that was still on the formulary. We tried the second option first, and thankfully, the new drug worked just as well. It was a scary situation, but we found a solution.

The Guide to Getting Your “Injectable” Drugs Covered (Like Ozempic or Insulin)

The Shot That Required a Special Authorization

My doctor prescribed Ozempic, an injectable medication for my diabetes. Because it’s a very new and expensive drug, I knew it would be a challenge to get it covered. My doctor’s office had to submit a “prior authorization” request to my Part D plan. In the request, he had to document that I had already tried and failed on other, older diabetes medications. This “step therapy” documentation was the key. Because we proved I needed the newer drug, the plan approved it.

How to Get Your “Shingles Vaccine” (Shingrix) Covered for $0

The Shot That Used to Cost a Fortune

I wanted to get the new shingles vaccine, Shingrix, but I had heard it was very expensive. I was so happy to learn about a change in the law. As of 2023, the Inflation Reduction Act made all vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP)—including Shingrix—completely free for people on Medicare Part D. I went to the pharmacy, showed them my Part D card, got my shot, and the co-pay was zero. It’s a new, powerful preventative benefit.

The Unspoken Importance of Re-Shopping Your Part D Plan EVERY Year

The Annual Check-Up for My Drug Plan

My neighbor had been on the same Part D plan for five years. This year, his plan dropped his most expensive drug from its formulary. He was stuck paying full price. His story taught me the most important rule of Part D: you must re-shop your plan every single year during the fall open enrollment period. Plans change their premiums, their co-pays, and their formularies every year. The plan that was best for you last year could be a terrible deal this year. An annual check-up is not optional; it’s essential.

My Guide to Helping a Parent Who is Overwhelmed by Their Drug Plan Choices

My Mom’s “Pill Czar”

My mom takes ten different prescriptions, and the Medicare Part D choices were completely overwhelming for her. I became her “pill czar.” I sat down with her and made a detailed list of all her medications and dosages. I then used the Medicare Plan Finder tool, entered her list, and found the top three cheapest plans for her. I presented her with the simple, one-page summary. It made the decision easy for her. For our aging parents, being an organized and patient guide through this maze is a true act of love.

The “Formulary Change Notice” Letter: What It Means and What to Do

The Letter I’m Glad I Didn’t Ignore

I received a thick envelope from my Part D plan titled “Annual Notice of Change.” I almost threw it away. I’m so glad I opened it. Inside, it detailed all the changes to my plan for the next year. I went straight to the section about my drug formulary. I discovered that one of my brand-name drugs was being dropped next year. This notice gave me a two-month heads-up. It gave me time to talk to my doctor about an alternative or to use the open enrollment period to switch to a different plan that still covered my medication.

How to Get an “Emergency” Supply of a Medication from a Hospital

The Pills That Got Me Home

I was being discharged from the hospital on a Friday afternoon, and my doctor had written me a prescription for a new, important medication. My usual pharmacy was closed for the weekend. I was worried. The discharge nurse told me not to worry. She was able to get me a 3-day “emergency supply” of the medication directly from the hospital’s outpatient pharmacy to tide me over until I could get the full prescription filled on Monday. It was a small but crucial service that ensured a safe transition home.

The Unspoken Power of Asking “Is There a Cheaper Alternative That Does the Same Thing?”

The Question My Doctor Was Happy to Answer

My doctor prescribed a new, brand-name medication for me. At my appointment, I asked him a simple question: “Is there a cheaper, generic alternative to this drug that does the same thing?” He looked at his computer and said, “You know what, there is. Let’s try that one first.” Doctors are focused on your health, not always on the cost. They are often unaware of which drugs have high co-pays on your specific plan. That one, simple question started a conversation that saved me a lot of money, and he was happy to help.

My Guide to the “Inflation Reduction Act” and How It Will Cap Your Drug Costs

The Law That’s My New Safety Net

I’ve been reading about the Inflation Reduction Act, and it’s going to be a huge help for seniors like me. It’s already made my shingles vaccine free. Soon, it will cap the amount I have to pay for insulin at just $35 a month. And in a few years, it will create a brand new, first-time-ever “out-of-pocket cap” for all my Part D drug costs. This means there will be a yearly limit on what I can be forced to pay. It’s a historic law that is creating a powerful new financial safety net.

The Best Time to Review Your Drug Plan (Hint: It’s October)

My Annual Autumn Ritual

Every year, like clockwork, I have an autumn ritual. On October 1st, I receive the “Annual Notice of Change” from my Part D plan. This letter tells me how my plan will change next year. I use that letter to start my research. The Medicare Annual Enrollment Period begins on October 15th. I use that first week of October to go to the Medicare Plan Finder website, enter my drugs, and see if my current plan is still the best deal for the coming year. This yearly check-up is a crucial part of my financial health.

My Story: The One Website That Saved Me From the Donut Hole

The Tool That Found Me the Cheapest Path

I take several expensive, brand-name drugs, and I knew I was going to hit the Part D “donut hole.” I was dreading the high costs. I went to the official Medicare.gov “Plan Finder” tool. I entered my exact list of medications. The tool didn’t just show me the monthly premium. It showed me a month-by-month estimate of my drug costs for the entire year. It showed me exactly when I would enter the donut hole and when I would exit. It allowed me to choose the plan where my total, year-long costs—including the donut hole—would be the lowest.

The #1 Mistake People Make When Choosing a Part D Plan

The Premium That Looked Too Good to Be True

The number one mistake I see my friends make is choosing a Part D plan based only on the monthly premium. They’ll pick a plan because it has a low, $10 premium, without looking at the details. Then, they go to the pharmacy and find out the plan has a high deductible and that their most expensive drug isn’t even on the formulary. The monthly premium is only one, small piece of the puzzle. The most important thing is the plan’s coverage and co-pays for your specific list of drugs.

The Unspoken Complexity of “Specialty Tiers” and Co-insurance

The Tier That Changed All the Rules

Most drug tiers have a flat, predictable co-pay. But my most expensive drug was on the “specialty tier,” Tier 5. This tier works differently. I don’t have a co-pay; I have “co-insurance.” This means I have to pay a percentage of the drug’s total cost, usually between 25% and 33%. For a drug that costs thousands of dollars, that percentage can be a huge, scary number. Understanding the difference between a co-pay and co-insurance, especially for specialty drugs, is crucial for budgeting your healthcare costs.

The Ultimate “Part D” Toolkit: Websites, Phone Numbers, and Strategies

My Arsenal for the Drug War

My fight to lower my drug costs required a toolkit. My number one tool was the Medicare Plan Finder website—it’s the source of all truth. My second was my local SHIP counselor’s phone number for free, unbiased advice. My third was GoodRx.com, to check cash prices just in case. And my final tool was the direct phone number for my Part D plan’s member services, for when I had to ask for an override or an exception. With this simple toolkit, I was armed and ready to conquer the Part D drug maze.