What if your drug list says $972,000?
October 26, 2026
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Show Notes
Eddie and Betty's Conversation
Welcome to The American Retirement Advisor podcast. I'm Betty, and Eddie is here with me in the studio today, which means we are about to get into some numbers, and I am going to ask a lot of questions.
That's the arrangement, yes. I explain, you ask, and somewhere in there the listener gets something useful.
It works. Okay, so today's episode comes from Ian Schaeffer's piece, and it is about something that sounds boring on the surface but has a number in it that made me do a double take.
It stopped me too, and I am a numbers guy.
So the topic is your Medicare drug plan, specifically getting your drug list right before the Annual Enrollment Period closes December 7th. And Ian opens with a number that David shared on Fiscal Fridays. Do you want to just say it?
Nine hundred and seventy-two thousand dollars.
That is what one client's drug costs looked like for next year based on the prescription list she had typed in herself. Nearly a million dollars.
For drugs. For one person. One year.
Okay but here is the twist, and this is where it gets good.
Nothing was wrong with her plan.
The list had the problem. She'd typed in the incorrect drugs.
The entries were close to what she actually takes, but not quite. And one of the mix-ups was as small as capsule versus tablet. Same medication, different form. That was enough to blow the number into the stratosphere.
I would never in a million years think that distinction mattered.
Most people wouldn't. But drug plans have a list of covered medications, called a formulary, and they sort drugs into tiers. Lower tier, lower cost, higher tier, higher cost. And the same drug in a different form can sit on a completely different tier.
So you could be pricing a drug you don't actually take.
Exactly. The comparison tool is doing math on the wrong input. It's like putting the wrong address into your GPS and being surprised you ended up somewhere weird.
And David and Jason had to sit down the day before her appointment and spend two hours sorting out what she actually takes.
That's what it took. And once they had the right list, the number came back down to earth and she was happy to keep her plan exactly as it was.
So her plan was fine the whole time. She just almost panicked over something that had nothing to do with reality.
And the flip side of that is also true, which Ian makes a point of flagging. A wrong list doesn't just make a good plan look terrible. It can make a bad plan look fine. So you could switch into a plan that's actually going to cost you more, because your comparison was using the wrong drugs.
Oh, that's the sneakier problem, right? Because if the number looks terrifying you at least know something is off. But if it looks fine and it's wrong, you just go with it.
And you don't find out until you're at the pharmacy in January.
Which is the worst possible time to find out. Okay so Ian's piece gives a really practical list of what to actually write down. Walk us through the spirit of it.
The big idea is: grab your bottles. Or call your pharmacy and ask for a printout of everything you filled this year. And then note not just the name, but the strength, the form, how often you take it.
The form being the tablet-versus-capsule thing.
That goes for extended release compared to regular, too. If you see letters after a drug name, like ER or XR or XL, those mean extended release and a plan can treat them as a different version from the regular one.
So the label on the bottle is the thing. Not what you think it says. What it actually says.
Spelled the way it spells it. Which sounds fussy, but this is why.
No, it makes sense now. You're giving the tool the actual ingredient, not your memory of the ingredient.
Right. And Ian also includes two things on the list that I thought were smart additions: who prescribed it, especially if you have more than one doctor writing prescriptions, and where you fill it.
Why does that matter?
Because some plans have preferred pharmacies that charge you less than other pharmacies even within the same network. And mail order can be cheaper too. So if the comparison is running the numbers on a different pharmacy than you actually use, the cost estimate is off.
Wait, so two pharmacies could both be in-network and still charge you two totally separate amounts for the same drug under the same plan?
With some plans, yes. One is preferred, one is not. The specifics of how that works plan by plan are honestly a question for one of our advisors, because those details vary, but the principle is in the article and it is real.
I had no idea. I thought in-network meant the price was the price.
A lot of people think that. It's one of those things that seems like it should be simple and is not.
Okay, there is one more thing on Ian's list that Jason mentioned on the show that I want you to flag because it is so easy to miss.
The cream.
It only gets filled twice a year because one fill lasts about six months. So it doesn't show up every month. It could very easily fall off your mental list of what you take.
But it absolutely belongs on the drug list. Because if you switch plans and that drug is on a higher tier, or not covered, you find out when you go to fill it in the spring.
So the rule is: if you take it, it goes on the list, even if you only fill it twice a year.
Even once a year. The frequency of the fill doesn't change whether it needs to be in the comparison.
That is such a good point. Because I would have left that off. I would have thought, oh I barely fill that, it's fine.
Most people do.
So let's go back to the big number for a second, because I keep thinking about someone sitting at their computer, running their list through a comparison tool, and seeing nearly a million dollars staring back at them.
And the instinct is to panic and make a fast decision.
Which is the wrong move.
Ian is pretty clear on this. If the number looks wildly off, a drug showing as not covered, a yearly cost with too many zeros, check the list first. The spelling, the strength, the form. Before you do anything else.
Don't panic, and don't make a decision based on a bad number.
Right. Because the problem might be the input, not the plan.
And if the number looks totally reasonable, don't assume the list is fine either, because that's exactly the trap we were just describing. A wrong drug list doesn't just inflate a good plan's cost. It can disguise a bad one, make it look like a perfectly fine choice when it really isn't.
This is why the advisors prepare before the appointment. David and Jason didn't wait until the client sat down to realize her list was off. They caught it the day before so that when she came in, they were already working with real numbers.
So they sorted through two hours of drug list confusion so she didn't have to.
That's kind of the whole job.
I love that. Okay, so for someone listening right now, what is the actual next step? Like, this week.
And that deadline we mentioned is what makes this week the week to act. You're not sitting on a lot of runway here. So the next step is to do exactly what we talked about a few minutes ago -- pull that list together the way Ian describes it. Whatever method gets you there, the goal is the same: name, strength, form, frequency, prescriber, pharmacy. Get it on paper.
And if you want a second set of eyes on it before you make any decisions?
Ian gives the number right in the piece: 602-281-3898. Bring the bottles. They'll do the sorting.
And if there are any specific questions about how tiers work for your particular drugs, or what preferred pharmacy really means in your situation, those are great questions to ask when you call.
Way better to ask than to guess, and way better to find out now than in January.
The whole point of this piece, really, is that a small detail, a capsule instead of a tablet, can completely change what you think your costs are going to be. And the fix isn't complicated. It's just getting the list right.
The list is the foundation. Everything else is math on top of it. Bad foundation, bad math.
And get it right, and maybe you realize your plan is already a good fit and you don't need to change a thing.
Which is exactly what happened to that client. She came in worried about a nearly million-dollar drug bill and left with the same plan she already had.
Because the plan was never the problem.
Capsule versus tablet.
That's going to stick with me for a long time.
File it next to reading the GPS address before you hit go.
Alright. If you want to read Ian Schaeffer's full piece, it has the complete kitchen-table checklist, all six items, and it's worth going through the whole thing. But more importantly, if you are in the middle of Annual Enrollment or just want someone to check your work before December 7th, call 602-281-3898 and bring your bottles. That is the move. Thanks for spending some time with us today.