How to Prep for Open Enrollment in Q3 with RX Savings in Mind

Prescription drug costs have risen significantly, showing an average increase of 15.2% from January 2022 to January 2023. This price surge makes open enrollment planning essential, particularly when 14% of Medicare beneficiaries skip medications or doses because they cannot afford them.

Q3 presents the optimal window to prepare for your upcoming open enrollment period. A detailed open enrollment planning checklist focused on prescription savings can significantly reduce your healthcare expenses. The financial impact is substantial—prescription drugs cost over $535 billion in 2020 alone, with prices continuing their upward trajectory.

Several cost-reduction options exist for prescription medications. Cost-comparison tools like Inside Rx offer immediate savings opportunities. Assistance programs such as RxOutreach provide additional financial relief. The Inflation Reduction Act brings further benefits, introducing a $2,000 annual cap on out-of-pocket costs for covered drugs beginning in 2025. This cap will benefit approximately 11.3 million Part D enrollees.

This guide outlines prescription coverage options and savings strategies for your next open enrollment period.

Review Your Current Plan Before Q3

Examining your current health insurance plan thoroughly before making changes during open enrollment is essential. Many individuals fail to notice critical details that directly impact prescription costs. A detailed review provides full understanding of your coverage prior to decision-making.

Check your plan's formulary and drug tiers

The formulary—your plan's covered medications list—requires priority review for effective open enrollment planning. Health plans structure formularies into tiers that establish payment amounts for each medication:

• Tier 1: These medications feature the lowest co-payments and typically include generic drugs
• Tier 2: These drugs require medium co-payments and usually include more affordable brand-name medications
• Tier 3: These medications involve the highest co-payments and often include brand-name drugs with generic alternatives available
• Tier 4: These specialty drugs treat serious illnesses and generally cost the most

Health plans update formularies monthly, potentially moving drugs between tiers or removing them completely. This means previously affordable medications might become significantly more expensive. When medications aren't listed on the formulary, patients should ask physicians about alternatives or request exceptions.

Understand your deductible and out-of-pocket limits

Deductibles and out-of-pocket maximums significantly affect prescription expenses. The deductible represents what you pay before insurance coverage begins—averaging $5,452 for ACA marketplace plans versus $1,735 for employer-sponsored plans.

Your out-of-pocket maximum (averaging $8,403 for marketplace plans) marks the point where insurance covers 100% of eligible expenses for the year's remainder. Example: with a $3,000 deductible, 20% coinsurance, and $6,350 out-of-pocket maximum, you pay the first $3,000 plus 20% of additional costs until reaching $6,350 total.

Identify any changes in coverage or premiums

Plans change yearly regarding both costs and coverage, necessitating annual reviews—even when currently satisfied with your plan. Minor adjustments often substantially impact prescription expenses.

Future healthcare needs warrant consideration when reviewing changes. Requirements for specialized care or new medications in the coming year and plans for surgeries or chronic condition management should factor into your open enrollment planning checklist and determine whether your current plan remains optimal for prescription savings.

Use Tools to Compare and Save on Prescriptions

Effective tools exist for maximizing prescription savings during open enrollment. These resources deliver substantial cost reductions and warrant priority placement on your open enrollment planning checklist.

Save with Inside Rx

Inside Rx, a prescription savings program, maintains partnerships with 60,000 pharmacies nationwide to ensure consumers can save on their medications no matter where they live. This no-cost discount card provides savings of up to 80% on generic medications and brand-name drugs.

The usage process requires minimal effort—download the Inside Rx app or your Inside Rx savings coupon at InsideRx.com, present it with your prescription to the pharmacist, and pay the reduced price. While any individual with a valid prescription qualifies for Inside Rx, certain limitations exist for Medicare, Medicaid, or Tricare beneficiaries. The program enables eligible patients to save an average of 40% off retail prices for select brand-name medications—resulting in potential savings of over $1,600 annually.

Use Medicare Plan Finder or your insurer's app

Medicare.gov's Plan Finder tool enables prescription drug plan comparisons based on individual requirements. The system calculates total annual costs—including premiums, deductibles, and co-pays—after you input your medications and preferred pharmacies.

The Plan Finder delivers estimated annual costs alongside monthly drug-by-drug cost breakdowns. The tool permits entry of up to five pharmacies to verify their status as preferred in-network options. The "Lowest drug + premium cost" sorting function quickly identifies the most cost-effective plans for your specific medication needs.

Compare mail-order vs retail pharmacy pricing

Mail-order pharmacies do not consistently offer lower costs despite widespread assumptions. Retail pharmacies typically provide more favorable pricing for generic medications. Analysis of Medicare Part D plans revealed retail pharmacies offered lower costs for 244 out of 300 top products.

Mail-order pharmacies, however, often deliver superior pricing on brand-name drugs—1% to 18% lower than retail pharmacies. Many insurance plans charge equivalent amounts for 90-day mail-order supplies as they would for three months at retail, but with reduced copays.

Your open enrollment planning checklist should include these comparison options, as they produce measurable reductions in prescription expenses throughout the year.

Explore Assistance Programs and Alternatives

Numerous assistance programs supplement basic price comparison tools. Adding these options to your open enrollment planning checklist yields significant medication savings.

Check eligibility for Extra Help or state programs

Extra Help, Medicare's prescription assistance program, delivers benefits valued at approximately $5,900 annually. Qualification requirements for 2025 set monthly income limits at $1,976 for individuals and $2,664 for couples. The program removes or decreases deductibles while restricting copays to $4.50 for generics and $11.20 for brand-name drugs.

State Pharmaceutical Assistance Programs (SPAPs) provide supplementary "wraparound" coverage that addresses gaps Medicare doesn't cover. Eligibility criteria vary by state, with some programs focusing on specific conditions such as HIV/AIDS.

Look for disease-specific aid

FundFinder, a free web application, monitors over 200 patient assistance funds from nine charitable organizations. Users receive instant notifications when disease-specific funds open for applications. The platform has distributed more than 500,000 notifications regarding assistance opportunities since its launch.

NeedyMeds serves as a connection point to Patient Assistance Programs (PAPs) from pharmaceutical manufacturers, offering free or discounted medications to eligible individuals.

Ask your doctor about generics or therapeutic alternatives

Generic medications match brand-name drugs in strength, dosage, and effectiveness at substantially lower costs. These alternatives generated savings of approximately $192 billion last year. When generic options aren't available, therapeutic alternatives—medications with different chemical compositions that treat the same condition—offer additional cost-saving possibilities.

Request formulary exceptions if needed

Medications absent from your plan's formulary may qualify for exceptions. This process requires your doctor to submit documentation explaining why covered alternatives would not provide equivalent effectiveness. Standard decisions arrive within 72 hours, while "expedited" requests for urgent needs receive responses within 24 hours.

A thorough open enrollment planning checklist incorporating these assistance options produces substantial reductions in prescription expenses.

Plan Financially with Tax-Advantaged Accounts

Tax-advantaged accounts reduce prescription costs through pre-tax contributions. These financial tools serve as essential components in your open enrollment planning strategy.

Use HSA or FSA funds for prescriptions

Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) enable pre-tax dollar allocation for qualified medical expenses, including prescription medications. Contribution limits for 2025 reach $4,300 for individual coverage or $8,550 for family coverage with HSAs. FSAs allow contributions up to $3,300.

These accounts provide 30-40% savings through tax advantages. A $2,000 contribution to either account with a 30% tax rate yields approximately $600 in tax savings.

Prescription purchases function similarly with both accounts—patients use the account debit card at pharmacies or submit receipts for reimbursement. HSAs offer superior flexibility with annual fund rollover, while most FSAs operate under "use it or lose it" policies.

Understand what counts as a qualified medical expense

The IRS classifies qualified medical expenses as costs for "diagnosis, cure, mitigation, treatment, or prevention of disease". Qualifying expenses include:

• Prescription medications (generic and brand-name)
• Insulin (prescription not required)
• Doctor-prescribed birth control
• Over-the-counter medications (with prescription)
• Copayments, deductibles, and coinsurance

Tax verification requires maintaining all receipts, proving withdrawals funded exclusively qualified expenses.

Coordinate with your open enrollment planning checklist

HSA or FSA planning must align with open enrollment timing. Standard open enrollment period typically runs from November 1 to January 15, though employer schedules may differ.

Your open enrollment planning checklist should include specific fund allocations for anticipated prescription costs. Evaluate whether combining your account with discount programs like Inside Rx maximizes tax-advantaged dollars.

HSAs require high-deductible health plan enrollment, while employers offer FSAs regardless of health plan selection.

Conclusion

Open enrollment offers a strategic opportunity to manage prescription medication costs effectively. This guide presents multiple actionable strategies to maximize savings while maintaining appropriate healthcare coverage.

Thorough review of your current plan forms the foundation of sound decision-making. Examining formularies, drug tiers, and deductibles provides clear visibility into potential costs. Comparison tools such as Inside Rx and Medicare Plan Finder enable identification of cost-effective options specifically matched to your medication needs.

Assistance programs deliver substantial savings opportunities. Extra Help reduces prescription expenses by thousands of dollars annually for qualified individuals. Tax-advantaged accounts provide significant financial advantages—HSAs and FSAs enable prescription purchases with pre-tax dollars, resulting in a 30-40% reduction in medication costs.

Preparation stands as the essential element for successful open enrollment. Escalating medication prices necessitate a strategic approach rather than defaulting to previous coverage. The combination of plan review, comparison tools, assistance programs, and tax-advantaged accounts creates a solid framework for prescription expense management.

Prescription drug costs will likely maintain their upward trajectory. Q3 planning can substantially reduce your out-of-pocket expenses for the upcoming year. Early preparation ensures sufficient time to gather information, evaluate options, and make informed decisions that protect both health and financial wellbeing.