An online pharmacy from billionaire Mark Cuban, Cost Plus Drugs, is aiming to upset the market by selling prescription drugs at a steep discount. This is made possible by eliminating advertising and intermediaries – known as pharmacy benefit managers – while limiting markup to 15%. Some of these discounted drugs may even rival Medicare Part D prices—though they’re limited to generics at this time.
But are online pharmacies safe for those who take multiple medications? And can they or other prescription savings programs actually save seniors any money? Seasons spoke with pharmacist Nicole Winnen, RPh, to find out.
Are potential savings worth it?
Most older adults spend hundreds of dollars on prescription drugs every year—more than $450 on average for seniors under the age of 80 but far more for those with chronic conditions like diabetes and heart disease. So, it can be tempting to look beyond Part D to save a few dollars here and there. That can backfire, however, as Winnen explained:
“Sometimes with Medicare, it may be cheaper for a prescription but you can shoot yourself in the foot by not having it applied to the deductible.”
She suggested that individuals can look at what their total cost per year will be in different scenarios to decide what makes the most financial sense for them, but most people are better off having their prescription costs applied to their deductible.
“Unless they don’t have significant costs and won’t meet the deductible anyway,” she explained, “I advise people to shop around based on the full package price and go with a general pharmacy.”
Safety of online pharmacies
Currently, Cost Plus Drugs carries only generic prescriptions—although the company is working toward adding name brands as well. For older adults with multiple prescriptions, this can be an important reason to use a brick-and-mortar pharmacy for all their drugs. While it might be tempting to order generics online and pick up brand-name drugs from a general pharmacy, there are risks in doing so. Plus, keeping all prescriptions in one place means a pharmacist can properly review them for allergies and interactions.
“Drug interactions could be a concern,” Winnen warned. “Monitoring has always been an issue when more than one pharmacy is used.”
There could be other issues, too, especially for older people who are still managing their own medications.
“One of the drawbacks they may have with online pharmacies is technology challenges when the pharmacists are only available for chat or phone calls. It’s important for them to have someone they can reach in person.”
Prescription drug savings plans
Another option for seniors looking to save is a prescription drug program like GoodRx, WellRx or Rx Saver, but these come with their own caveats as well. Winnen explained she doesn’t accept GoodRx because the company does not protect patient information.
“I try to match the GoodRx price if they bring it in,” she said, but she notes that customers get into the same situation using these programs as they do with Medicare. “If it’s being billed to GoodRx, it’s not going through insurance. So, you might save a little, but it won’t be applied to the deductible.”
So what programs can Medicare recipients utilize?
“There aren’t any discounts or coupons that can be combined with Medicare,” Winnen explained. “It says on the coupons that they cannot be combined with government funds, and Medicare is a government-funded program.”
Still, sometimes the cash price will be cheaper than the Medicare price.
“If our customary price is less than the insurance price, it will default to the lower of the two,” she said (with the stipulation that it won’t be applied to the deductible in that instance). “There are so many caveats, it’s really a complicated issue.”
Patient assistance and “Extra Help”
That doesn’t mean older adults are completely out of luck when it comes to savings on their Part D costs.
“The exception is patient assistance programs from the manufacturers: Those can be used in conjunction with Medicare,” Winnen added.
Just call 800-MEDICARE or visit Medicare’s patient assistance program page for more information.
Many Medicare recipients also receive “Extra Help” from the government to pay for Part D deductibles, coinsurance, premiums and other costs. While this is often automatic depending on one’s Medicaid, SSI or Qualified Medicare Beneficiary status (assistance paying Part B premiums), individuals who bring in less than $20,385 per year in 2022 ($27,465 for couples) and meet the resource limit may qualify as well.
The State Health Insurance Assistance Program (SHIP) may also be able to assist seniors in accessing and understanding their Medicare benefits, Medicare Advantage Plans and Part D enrollment to maximize their savings. Part D formularies can vary greatly, which means finding the right plan for an individual is imperative. Assistance can be accessed by contacting your county or state SHIP office.
State Pharmaceutical Assistance Programs may be another option for some seniors, depending on where they live. However, many of these programs stopped operating after the Affordable Care Act was implemented. A list of programs still operating can be found here.
Who can benefit from online pharmacies and Rx savings plans?
While online pharmacies and prescription drug savings plans may primarily be helpful for younger people without insurance and those who take very limited medications, some older people and their caregivers could still benefit, including:
- Early retirees and younger seniors who don’t qualify for Medicare yet
- Older immigrants who haven’t been in the country long enough to qualify for Medicare (Note: According to the CDC, there were roughly 400,000 uninsured people over the age of 65 in the U.S. in 2020. Many of these people were immigrants or covered only by Indian Health Services.)
- Undocumented older immigrants who cannot qualify for Medicare
- Caregivers who lost their employer-based insurance to care for a loved one
- Caregivers whose employer does not offer prescription coverage
There is hope that Cost Plus Drugs could still end up having a profound effect on prescription drug costs in general—if the online pharmacy is able to break into the brand-name market. There’s also speculation Medicare could follow the online pharmacy’s business model in order to generate savings for the program. Whether this will trickle down to beneficiaries remains to be seen.