Medicare Part D vs GoodRX

I often get questions from clients about using GoodRx on medications rather than using their Part D prescription drug coverage. Let’s dive into how this works.

What is GoodRX?

GoodRx allows people to shop around for the best prices on prescriptions and find discounts. Customers can find their medication and check out lower-priced options from local pharmacies via the website and app.

GoodRX is one of the most popular discount drug programs; however, below are some alternatives:

• Pharmstore (Canadian)
• CostPlusDrugs.com (Mark Cuban’s company)
• HoneyBeehealth.com
• CanadianMedCenter.com
• WellRX.com
• Blink Health
• Singlecare.com

Single Branded for Stores:

• Walgreens Prescription Savings Club
• Rite Aid
• Costco Pharmacy

NiceRx:  (this is a membership program to help save costs on expensive drugs, and it costs $49 per month per Pharmaceutical program/drug they help you obtain.  You can apply for Pharmaceutical programs yourself, but some people like the convenience of having an outside company manage the process for you.

Can you use GoodRx if you have Medicare Part D?

Yes, GoodRx can be an option if you are on Medicare. It gives an alternative to Medicare when it comes to the prices of prescriptions. When Medicare doesn’t cover a medication, won’t let you reach your yearly insurance deductible, or when you fall in the coverage gap section (“donut hole”) of your Medicare plan, then using GoodRx is helpful. In most cases, GoodRx’s prescription costs are more reasonable than the ones through Medicare copays, so it’s worth considering.

When using GoodRx with Medicare, there are a few things to keep in mind. GoodRx cannot be used in conjunction with Medicare; it must be used as an alternative to Medicare. Before using GoodRx to get discounts on medications, you should consult your doctor and pharmacist to ensure it’s available for the medication you need. Always compare prices on GoodRx with other sources, such as insurance providers or pharmacies near you, to ensure you get the best deal.

Using a discount Drug service should not be used to replace Medicare Part D.

Keep in mind that when you use these alternatives, you are going outside of your drug plan, so any money you spend usually does NOT count toward your deductible or other limits such as Catastrophic Coverage. With Part D plans, you enter catastrophic coverage once your out-of-pocket costs for covered drugs reach $7,400. After you have enrolled in the catastrophic coverage phase of your Part D plan, you are responsible for a copayment of $3.95 for generic drugs or 5% of your drug costs, with a maximum of $9.85, until the end of the year. This part of the drug plan can shield you from financial ruin if you need to take exorbitant medicines.

You can learn more about the Medicare Part D coverage stages HERE

Another thing to remember is that discount programs are not creditable coverage. If you do not have creditable drug coverage and you do not enroll in Medicare Part D, you could face a penalty that you will have to pay for the rest of your life.

Can you use GoodRx coupons to avoid Medicare coverage gaps or get out of them? 

GoodRx coupons can be a great way to save money on prescription medications, but unfortunately, they cannot be used to get out of the Medicare coverage gap or “donut hole.” This is because the donut hole is a period of time when Medicare Part D beneficiaries have to pay more for their medications than they would normally. GoodRx coupons might not be accepted as payment during this period and will not help you get out of the coverage gap.

However, GoodRx coupons can be used to avoid entering the donut hole in the first place. By using GoodRx discounts instead of relying solely on your Medicare coverage, you may be able to keep your medication costs lower and prevent yourself from hitting the donut hole. Additionally, if you know that you won’t be able to afford your medications once you’re in the donut hole, it may be beneficial for you to use GoodRx discounts before entering it. This way, you can still access your necessary medications without worrying about paying too much for them.

Does GoodRx offer lower prices than Medicare copays?

GoodRx cash prices are not always cheaper than Medicare Part D copays, but they can be. GoodRx is a great resource for finding the most affordable price on many prescriptions. It is especially helpful if you have just been prescribed a new medication or your plan has changed its pricing. By comparing prices on GoodRx, you may save money on your prescription costs.

GoodRx offers discounts on thousands of medications and can be used at most major pharmacies in the United States. The discounts vary depending on the medication and pharmacy, so it’s important to compare prices before going to the pharmacy. You can also use GoodRx coupons to get additional savings. With GoodRx, you can find the best deal for your prescription and save money in the process. So check GoodRx before heading to the pharmacy – it could save you money!

 Other ways to reduce your drug spending

1. Use generic versions of your medications
2. Ask your doctor for lower-cost drugs or alternatives
3. Look for manufacturer drug discount programs
4. Apply for Extra Help

What if I have a Medicare Advantage plan?

Medicare Part D is a supplement to Original Medicare and covers prescription drugs only. Medicare Advantage, on the other hand, replaces original Medicare and becomes your hospital and medical insurance plan. Most Medicare Advantage plans include Part D, so it would work the same way as if you had a stand-alone drug plan.

Should I use a drug discount program?

There is no one-size-fits-all answer to this question. When managing your healthcare costs, the bottom line is that you should always look for the best deal. For Medicare enrollees, this means considering GoodRx as an alternative to their Part D plan. In certain cases, GoodRx prices may be lower than your Medicare copay, or you may not have met your annual deductible yet. It’s important to ensure the pharmacist runs the transaction as cash if you choose GoodRx instead of Medicare Part D.

If Medicare doesn’t cover your medication, talk to your provider about a possible alternative or getting an exception for coverage. Keep in mind that plan formularies change every year, so it’s possible that your medication might be covered in the future. By staying informed and taking advantage of all available options, you can ensure that you get the best deal on your medications and keep more money in your pocket.

For help, contact us to speak with a licensed agent at 866-445-6683 (TTY 711) M-F 9 am to 5 pm