Options for those who are having trouble affording drug costs.

If you are enrolled in a Part D plan but cannot afford your prescriptions—whether or not you have Extra Help or get help from a State Pharmaceutical Assistance Program (SPAP)—there are a few additional strategies that may help lower your drug costs.

Ask your doctor:

• About generics: Generic drugs are often less expensive than brand-name drugs, and might be more affordable for you. Check with your doctor to see if a generic drug will work for you.
• For samples of your medication: This is a temporary solution, as your doctor may not be able to provide samples for very long. If you are using samples, be sure to explore other options for getting your drugs covered.

Ask your plan:

• About mail-order prescriptions: If you have Extra Help and your drug plan has a mail-order option, you may be able to get a 90-day supply of your prescription at a lower cost. Keep in mind that with mail order, it may take longer to get your drugs than if you were to go to the pharmacy yourself. Plan ahead when filling your prescriptions by mail.
• For a tiering exception If your Part D plan is covering your drug and your copayment is expensive, it could be that the medication is on a high tier. A tiering exception request is a way to request lower cost-sharing.

Ask your pharmacy or hospital:

• To waive your copay: Pharmacies are not allowed to routinely waive their copays for people without Extra Help, but your pharmacist can waive copays on a case-by-case basis. Tell your pharmacist you cannot afford the copay, and request that it be waived. If you are looking for a pharmacy that may waive your copay, make sure it is in your plan’s network. (Also be sure to ask your plan if the amount the pharmacist waives counts toward your out-of-pocket limit.) Some pharmacies routinely waive copays for people with Extra Help. Ask your pharmacist if your pharmacy does this.
• About charity care: Hospitals may have a charity care policy that can reduce your drug copays if you cannot afford them. Under such a policy, your final copay is determined by your income (using a sliding scale). To qualify, your prescription must be written by a doctor in the hospital and filled out at the hospital’s pharmacy. Tell the hospital’s pharmacist that you cannot afford the copay and ask if you qualify for prescription assistance. (Make sure to confirm that the hospital’s pharmacy is in-network.)

There may be other options to lower costs at the pharmacy.

• For a promotional pharmacy price: Check if a pharmacy in your plan’s network has a special promotion (limited time offer) to sell a medication that is on your plan’s formulary at a lower price. You will need to tell the pharmacist to refill your medication without using your Medicare drug coverage. It is best to take advantage of such specials only during your deductible or coverage gap because it is only during these times that what you pay will count toward reaching your plan’s catastrophic coverage limit.
  • You will need to submit your receipts to your plan with any other required documentation in order for this amount to count toward reaching the catastrophic coverage limit. Contact your plan to find out more information.
• About pharmacy discount generic programs: Some retail pharmacies offer year-round discounts on generics. Check with in-network pharmacies to see if they sell any of your prescribed generics at a lower price. If you normally pay a coinsurance, you will pay it based on the lower store price.