Can I use drug discount coupons if I have Medicare Part D?
A less well-known, but still painful, limitation of Medicare Part D is that plan enrollees cannot access many discounts provided by pharmacy discount coupons. This is because using some (but not all) discount opportunities in conjunction with Medicare Part D may violate the federal Anti-Kickback Statute. Setting aside the fact that enrollees are even seeking further discounts in conjunction to their coverage is a big indicator the Part D program has its fair share of flaws, let’s see where you might find some wiggle room to obtain more discounts.
What is the Anti-Kickback Statute?
Intended to prevent fraud and abuse, the federal Anti-Kickback Statute (AKS) was introduced in 1972. The law prevents medical businesses from offering dicounts to induce patients to use their services to reap the rewards of federal healthcare coverage. Put simply, if this law did not exist, pharmaceutical companies could offer discounts on their products to Medicare Part D enrollees to induce the government to spend even more money on their products. The same goes for physicians: Physicians could, without this law, work in cahoots with Medicare enrollees to ensure that most of the federally-provided Medicare funds go directly to their business. The law is also meant to curb Medicare costs and discourage fraud. (Would you want a pharmaceutical company to lie to you so that it could obtain funds from Medicare?)
The AKS has been amended and edited over the years, most recently in 2018. In 2005, the office of the inspector general put out a special advisory regarding Patient Assistance Programs (PAPs) that are effectively coupon programs – and Medicare Part D. The special advisory noted that PAPs have the potential to violate the AKS, and gave instructions as to how these programs could avoid fines. Per this particular advisory, Medicare Part D enrollees should be able to benefit from PAPs that are 100% independent from drug companies.
SAVINGS TIP: Medicare Part D enrollees should be able to benefit from PAPs that are 100% independent from drug companies.
So, how can I get discounts if I am a Medicare Part D enrollee?
As stated above, independently-run programs can provide drug discounts to Part D enrollees. If a drug’s manufacturer is offering a discount, the discount is likely not available for those with prescription drug federal assistance. For one example: the Pfizer Savings Program, which is run by one of the biggest pharmaceutical companies around, is not available to Part D enrollees. The easy rule is: If it has the name of a pharmaceutical company any way attached to the coupon, you, as a Medicare Part D enrollee, will likely not be able to use it.
You may also use state-run discount programs which operate much like Medicare.
Finally, if you are already enrolled in Medicare Part D and are still burdened by the cost of prescription drugs, you can apply for what the Social Security website calls “Extra Help,” which lends even greater discounts for prescriptions.
Can I use a discount card in place of my Medicare Part D coverage?
Yes! You can use many discount cards even if you are on Medicare, but only if you are paying the cash price. That would include GoodRx coupons and the PharmacyChecker Discount Card, for example. Believe it or not, sometimes paying cash in conjunction with a coupon is cheaper than using your Medicare coverage. Always do your research.
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Comment below or ask a question by logging in to My PharmacyChecker.Updated December 13, 2019