Prescription medications are essential for managing health, but they can often be a significant financial burden. For those covered under Medicare, Medicaid, or ACA (Affordable Care Act) health plans, there are multiple strategies available to help reduce prescription costs. Whether through government assistance programs, choosing cost-effective medication options, or finding discounts, you can take steps to keep medication costs manageable.
Look into Medicare Extra Help
For those on Medicare, the Extra Help program is a valuable resource designed to assist with prescription drug costs under Medicare Part D. This program, sometimes called the Low-Income Subsidy (LIS), covers partial or full drug costs depending on income and resource limits. Extra Help can drastically reduce your monthly premiums, annual deductibles, and co-pays.
To qualify for Extra Help, you must meet specific income and resource thresholds. In 2024, for instance, individuals must earn less than about $21,870 per year to qualify, and limits are higher for married couples. The application process can be completed through the Social Security Administration’s website, and eligible beneficiaries typically save over $5,000 annually on drug costs.
Opt for Generic or Lower-Cost Alternatives
One of the most effective ways to save on prescription medications is to choose generic or lower-cost alternatives when possible. Generic drugs contain the same active ingredients and meet the same standards as brand-name drugs but typically cost much less. When your doctor prescribes medication, ask if a generic version is available.
Under ACA and Medicaid coverage, many plans will cover the full cost of generics or charge lower copays. Medicare Part D also covers many generic drugs at significantly lower prices. Always check with your pharmacist, as they may be able to recommend similar, lower-cost medications that are equally effective.
Consider Medicaid Prescription Coverage
Medicaid, a program specifically designed to provide healthcare for low-income individuals and families, often includes prescription drug coverage at low or no cost. Each state has its own Medicaid program, and coverage levels for medications vary, but many states include comprehensive prescription drug benefits.
If you’re eligible for both Medicaid and Medicare, you may qualify for “dual-eligible” coverage. This often provides additional savings on prescription drugs by covering costs not paid by Medicare, including some copays, deductibles, and premiums. Check with your state’s Medicaid office to understand your options and make sure you’re taking advantage of any available drug coverage.
Use Medicare and ACA Marketplace Comparison Tools
Both Medicare and ACA marketplaces offer online tools to compare drug costs, which can help you select a plan that covers your specific medications at the lowest possible cost. With Medicare, the Plan Finder tool allows you to search for plans that include your medications at the best rates. Similarly, the ACA marketplace includes features that help users evaluate plan options based on their prescription needs.
These tools enable you to view the cost-sharing structures of various plans, helping you make an informed decision that saves you money on drug costs throughout the year. This is especially useful during open enrollment periods, as you can switch plans to better align with your medication needs.
Look into Patient Assistance Programs
Patient Assistance Programs (PAPs) are initiatives offered by pharmaceutical companies to provide medications at low or no cost to eligible individuals. These programs are typically available to individuals who meet specific income guidelines and lack adequate prescription coverage. To apply, visit the drug manufacturer’s website or speak with your healthcare provider about available PAP options.
Some well-known assistance programs include NeedyMeds and RxAssist, both of which offer directories of available resources for prescription drugs. PAPs can be a significant resource for individuals on ACA or Medicare plans who need help covering high-cost medications not fully covered by their insurance.
Try Prescription Discount Cards
Prescription discount cards can provide substantial savings at pharmacies, and they’re widely available to individuals regardless of their insurance coverage. Cards from providers like GoodRx, SingleCare, and RxSaver allow users to search for discounted prices on medications at nearby pharmacies.
Medicare beneficiaries can still use these cards, though it’s essential to check with the pharmacy to understand if the discount price is lower than the Medicare Part D copay. For those on ACA plans, the discount cards can help cover costs for non-covered drugs, making these cards a convenient backup resource.
Leverage Mail-Order Pharmacies
Many Medicare, Medicaid, and ACA plans offer mail-order pharmacy options, which can provide a 90-day supply of medication at a lower cost than purchasing a 30-day supply at a retail pharmacy. These pharmacies often have reduced overhead costs and can pass the savings on to consumers.
Mail-order services may be particularly beneficial for individuals taking maintenance medications for chronic conditions like hypertension or diabetes. Medicare Part D and many ACA marketplace plans include mail-order options. Be sure to check with your plan provider about mail-order availability and potential discounts for 90-day supplies.
Take Advantage of State Pharmaceutical Assistance Programs (SPAPs)
Several states offer their own pharmaceutical assistance programs (SPAPs) to help residents with drug costs. These programs vary by state, and eligibility requirements are generally based on age, income, or disability status. SPAPs work alongside Medicare Part D to reduce out-of-pocket expenses, such as deductibles and copayments.
SPAPs may also help you during the Medicare “donut hole” coverage gap by covering a portion of the costs that Medicare does not. Contact your state’s Department of Health or similar agency to find out if an SPAP is available to you.
Ask About 90-Day Refills and Bulk Options
Some pharmacies, especially those in larger retail chains, offer 90-day refills for certain medications, which can provide a slight cost reduction. Buying in larger quantities can sometimes allow for greater discounts, which is especially useful for those on long-term medications.
Both Medicare and ACA plans may cover 90-day refills for certain generic medications, while Medicaid’s approach to this option varies by state. Be sure to ask your doctor and pharmacy if switching to a 90-day supply is available and cost-effective for your particular prescriptions.
Explore Manufacturer Coupons and Rebates
Many drug manufacturers offer coupons or rebates directly to consumers. These can be found on the manufacturer’s website or through sites that aggregate discount offers. Although these programs may not be compatible with Medicare Part D, they can often be applied for individuals with ACA or Medicaid coverage or for those without drug coverage entirely.
These discounts can make a significant difference in the cost of expensive medications, especially for specialty drugs that are not easily replaced by generics. Talk to your pharmacist or visit the drug’s official website to see if any manufacturer discounts or rebate programs are available.
Review Your Formulary Regularly
Both Medicare Part D and ACA plans provide a formulary, or list of covered medications, which can change from year to year. To ensure you’re getting the most out of your drug plan, review the formulary each year and compare it with your current prescriptions. If a drug you need is dropped from your formulary or becomes more expensive, consult your doctor about possible alternatives.
Medicare and ACA beneficiaries have the opportunity to switch plans during annual enrollment periods, and Medicaid beneficiaries can usually update coverage options throughout the year. Keeping an eye on your formulary helps you stay proactive about finding the best plan that meets your medication needs.
Consider Telehealth for Lower-Cost Prescriptions
Telehealth services have expanded under Medicare and ACA plans and may be able to offer reduced rates on specific prescriptions, especially for common medications like antibiotics and mental health drugs. Some telehealth providers partner with pharmacies to offer savings on both the visit and the prescription itself.
For Medicaid beneficiaries, telehealth is often available at low or no cost and can streamline the process of getting affordable prescriptions for routine needs. Discussing your prescription needs through a telehealth visit can often lead to more affordable options, particularly if the provider can prescribe a lower-cost generic or therapeutic alternative.
For more information, visit SSA.gov, Medicare.gov, and Healthcare.gov.
