How to Pay for Expensive Prescription Drugs in the United States
The out-of-pocket cost of prescription drugs can be a serious drain on your retirement income. Fortunately, Medicare Part D may be able to help you with the costs of prescription drugs.
Many people have prescription drug coverage under Medicare Part D. You can enroll in a stand-alone Medicare Part D prescription drug plan, or a Medicare Advantage prescription drug plan. Both of these types of coverage:
- May help pay for your prescription drugs
- Are optional
- Are available through private insurance companies contracted with Medicare
Managing the cost of prescription drugs: is a Medicare prescription drug plan really worth it?
If you take several different prescription drugs, or if you take any expensive medications, it might be a good idea for you to sign up for a Medicare prescription drug plan. These plans may cover your prescription drugs.
Medicare prescription drug plans may have certain out-of-pocket costs. Your plan might charge a monthly premium and may have an annual deductible you have to pay before the plan covers your medications. And you might have to pay a coinsurance or copayment for your prescription drugs.
- Not every Medicare prescription drug plan charges a monthly premium. Some Medicare Advantage prescription drug plans, for example, have premiums as low as $0.
- Not every plan has a deductible for you to pay.
- No matter what out-of-pocket costs you might pay with a Medicare prescription drug plan, it’s generally worth it if the cost of your medications is higher than the plan’s cost-sharing amounts.
- You might need more prescription drugs in the future, and it could help to have coverage under Medicare Part D.
Are you curious about Medicare prescription drug plans in your area? You can start comparing plans right away by entering your zip code where indicated on this page. You can enter your prescription drugs to see which plans cover them, and at what cost.
Managing the cost of prescription drugs: understanding your plan benefits
It’s important to understand that just because you have a prescription drug plan, it doesn’t guarantee that your medications are covered. Every Medicare prescription drug plan has its own formulary. That’s a list of covered prescription drugs. Not every plan might cover all your prescription drugs.
On the other hand, every Medicare prescription drug plan must cover medications in certain drug categories. The plans sort the drugs into cost-based tiers. Usually you pay the lowest coinsurance amount for generic medications. You typically pay more for brand name medications.
Also, Medicare protects you from high prescription drug costs in another way. If you spend a certain amount of money on covered prescription drugs in one year ($5,100 in 2019), you enter the “catastrophic phase” under Medicare Part D. From then until the end of that year, you’ll only pay a small coinsurance or copayment for each covered prescription.
What if you have a plan, but still need help paying for expensive prescription drugs?
Perhaps you take a specialty medication for treatment of a chronic condition or serious illness such as cancer, Parkinson’s disease, multiple sclerosis, or rheumatoid arthritis. If you can’t afford your share of the cost of the medication on the plan’s specialty tier (usually the highest tier of covered medications), ask your doctor to request the plan make an exception to cover the prescription drug at a lower tier level for you. That means you’d pay less for the prescription. The plan doesn’t have to grant the request, but it will consider it in relation to your health-care needs, and whether or not a less expensive medication could treat you.
A variety of federal, state and corporate assistance programs may help pay for your prescription drugs if you qualify.
- Medicare Extra Help is a program for those with low incomes that may help pay for prescription drug costs. Learn more about Extra Help.
- State Medicaid agencies may help pay prescription drug costs.
- Some major pharmaceutical companies may give you certain medications at a reduced cost or no additional cost. Contact the company that makes your prescriptions to learn if they can assist you with costs. Click here for help.
- Some non-profit organizations such as the PAN foundation may help people with certain diseases pay for expensive medications in their treatment. Find out more at panfoundation.org.
- If you have a specific health condition, sometimes there’s a non-profit organization centered around that illness that might list resources about getting help paying for cancer drugs. For example, the American Cancer Society has resources on its website, cancer.org,
Managing the cost of prescription drugs: discount coupons
Even if you don’t qualify for help paying for prescription drugs, you might be able to use discount coupons. Some pharmaceutical companies have discount coupons online for certain brand-name drugs. Ask your pharmacist for information about these coupons.
Remember, with the click of a button you can instantly start comparing Medicare prescription drug plans. Just type in your zip code on this page and you’re on your way to valuable plan information. You can even enroll online in minutes.