If you take one or more prescription medications but are struggling to afford them, you’re not alone. A recent study found that over a quarter of people who take prescription medications have trouble paying for some or all of the drugs.
If you’re having trouble affording your medications, you have options.
How Prescription Drug Insurance Coverage Works
Each insurance company has a formulary, or, essentially, a list of drugs that they will pay for. The formulary contains categories of drugs, ranging from cheapest to most expensive.
The cheapest drugs are usually generic drugs, while name brands tend to have a higher price tag. Generics are usually older and have been available to the public for a number of years, while name brands are generally newer to market.
Do Your Homework
When your doctor writes a new prescription for you, check with your insurance company to see if it is covered and how much the co-pay will be. If the co-pay is more than you can afford, ask your doctor to prescribe something else. In most cases, your doctor can offer you other options. This is an important part of being your own health care advocate.
Some insurance companies make their formulary accessible online, allowing you to look up the co-pay in advance — even while you’re sitting in your doctor’s office. If you can’t get access to the formulary, call your insurance company or pharmacy after your appointment to check on the price before you fill the prescription.
How to Find the Right Prescription Drug Coverage
If you can afford it, you should consider getting prescription drug coverage — especially if you’re currently having trouble paying for your medications.
When searching for prescription drug coverage, make sure it’s affordable. If the monthly payments are low, but the deductible (the amount you pay before your co-pay starts) is too high, you should consider a different plan. The point of insurance is to make your medications easier to afford — not harder!
Check when open enrollment for insurance is available on healthcare.gov. Not sure where to start? Visit 211maryland.org or call 2-1-1 to connect with experts who can guide you through the complex insurance process.
Additional Options to Help Cover Costs
If you have commercial insurance, co-pay assistance cards could be an option for you. Almost all brands of prescription medication offer these “discount” cards which make the first or first few co-pays less expensive; sometimes they make the co-pay $0. To find a co-pay assistance card, search the drug name and “copay cards” in Google or another search engine. Unfortunately, if you have Medicare/Medicaid, co-pay assistance cards will not work.
You can also sign up for a drug discount program through a pharmacy. However, before doing this, make sure you know what medications are covered and how much they will cost. Programs like GoodRX may not offer discounts low enough for the drug to be affordable, but it often will help.
What to Do If You Have Medicare
Medicare is health insurance through the government for people who are 65 and older or under 65 with certain disabilities or conditions. Everyone who has Medicare is offered prescription drug coverage. There are several options to choose from. However, you can choose not to use it, but prescription drug coverage is highly recommended.
If you have Medicare, you may find that there are gaps in your coverage. This can occur if your deductible has been met and the coverage phase has ended. This is the best time to use a “drug company assistance program” to help cover the costs.
To take advantage of this, contact the drug company. They will ask you to submit paperwork so you can be approved for assistance. Unfortunately, patients with Medicare will not qualify for copay cards.
If you get Medicare, have been a Maryland resident for at least six months, and have an income at or below 300% of the Federal Poverty Level, you may be able to sign up for a “premium subsidy” called the Maryland Senior Prescription Drug Assistance Program. It pays a certain amount toward a member’s Medicare prescription drug plan premium, so the amount you pay toward your prescription plan is less saving you money each month. You would use this “premium support” to switch out of a high deductible part D plan.
Medically reviewed by Paul Solinsky, PharmD.
