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Uncovering drug bargains

You may have read last week about an agreement struck by Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, to reduce the cost of some drug purchases by 50% for many seniors who participate in the Medicare drug program, Medicare Part D.

If enacted, the deal would be good for the 3 million or so Medicare Part D participants who don’t get assistance from the federal or state governments when they reach the so-called doughnut hole. The doughnut hole starts when the consumer plus the drug plan the consumer selects (which pays much of the cost of qualified drugs) have together spent $2,700 on prescription drugs. The hole only ends after the consumer alone has spent $4,350 out of pocket. (Those caps will likely rise in 2010.)

During the doughnut hole, Part D participants pay the full price of their medicines.

The Baucus half-off plan would take effect within the doughnut hole. Not only would the cost of the drugs be halved, but Medicare Part D plans would give credit for the full cost -- helping people with high drug costs get through the doughnut hole period faster.

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But don’t count on those savings yet. Though the drug trade association PhRMA, members of Congress and President Obama have signed off on the deal, the earliest it could go into effect would be July 2010.

And it may not even happen. The drug savings would be just one piece of the health reform legislation beginning to wend its way through Congress, and the fate of that legislation is uncertain.

What about dealing with the hole right now?

Many people are wrestling with this issue: The advocacy group California Health Advocates of Sacramento says that 15% to 26% of phone calls to its hotline last summer were about the doughnut hole.

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If you’re just turning 65 and now eligible for Medicare Part D, read our story from November to learn how to sign up: articles.latimes.com/2008/nov/24/health/he-medicare24.

And if you are facing the doughnut hole right now, there are ways to cut costs. Our suggestions:

Start with one-on-one counseling with your county’s Health Insurance Counseling and Advocacy Program (HICAP) office. Call (800) 434-0222 to speak with a consultant. In Los Angeles, the office is called the Center for Health Care Rights. Reach them at (800)824-0780 or (213) 383-4519.

Check the California Health Advocates website ( www.cahealthadvocates.org) for an exhaustive list of resources. Go to the home page, click on prescription drug coverage, then click “resources.” We’ve listed the ones we think are easiest to access and use below.

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A word of caution: Assess savings schemes carefully. Some resources, such as some discount cards for pharmacies, come with a monthly fee. They can still save you money, but you will want to factor in those costs.

Talk to your doctor about switching to generic or less-expensive brand-name drugs. Many pharmacies offer generics for about $4 a month or $10 for a three-month supply. Medtipster.com, a website launched this year, compares prices for generics at several pharmacies in a single ZIP Code.

For Los Angeles ZIP Code 90210, for example, CVS charged $9.99 (plus an annual sign-up fee of $10 for the chain’s discounted generic program) for a 90-day supply of generic cholesterol-lowering drug lovastatin; Rite Aid charged $15.99 but had no sign-up fee.

Ask your doctor for free samples of your prescriptions. (Doctors are often happy to help in this way.)

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Find out if using your plan’s mail-order pharmacy would cost less. Call your plan for details -- the number should be on the back of your card or on paperwork the plan sent you. Call the plan’s toll-free number to avoid accumulating phone charges if there’s a wait.

Contact patient assistance programs that cover your drugs. Call Medicare to find out about the plans at (800) MEDICARE, (800) 633-4227. Or consult a comprehensive list of such programs at www.medicare.gov/pap/ and on the CHA resources page above. If you qualify, the plans are probably well worth it. But remember that money received from assistance programs does not count toward your out-of-pocket cap.

Check drug prices at multiple pharmacies. Costco, for example, often has competitive prices on drugs and does not require you to be a member to buy prescription drugs from the store’s pharmacy. But think before switching pharmacies to save a few dollars, says Paul Precht, head of policy and communications for the Medicare Rights Center, a consumer-assistance group based in Washington, D.C.. If you’ve been with the same pharmacy for a while it will have your drugs on file and can alert you to possible interactions when new drugs are prescribed.

If another pharmacy offers a better price, ask your pharmacy if it can match that price. And keep your eyes open for deals. CVS, for example, gives customers who sign up for their free ExtraCare card $1 of store credit for every two prescriptions filled. Ask pharmacists at any pharmacy, chain or independent about current deals and how to get savings alerts.

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Finally, coupons provided by drug companies are a good resource for anyone paying full price for drugs. These can give you free prescriptions or discounts at the pharmacy counter. Find listings for current offers at www.internetdrugcoupons.com.

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health@latimes.com


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