Financial Assistance for Prescription Drugs

Covered in this guide:

The Challenge of Rising Prescription Drug Costs
Medicare Coverage of Prescriptions
Prescription Drug Coverage for Veterans
Medicaid Coverage of Prescriptions
Prescription Assistance Programs from Pharmaceutical Companie
Other Options to Lower Medication Costs
Additional Prescription Medication Resources and Organizations
Financial Assistance for Prescriptions in Your State

Updated: August 11, 2023 | Reviewed by: Marc Levesque

Financial Assistance for Prescription Drugs

According to the National Council on Aging, older adults spend more than $600 a year on prescription medications, even with Medicare. If you’re one of the 20 million Americans who take blood pressure medications such as Lisinopril or rely on drugs like Levothyroxine to manage a thyroid condition, you know that prescription drug costs can add up, even for relatively affordable generics. If you or a loved one has a medical condition that requires an advanced or recently introduced medication, these drugs may cost more than $1,000 a day.

To help seniors and their families understand how to get help paying for prescription drugs, we developed this guide with information about Medicare and Medicaid, pharmaceutical company assistance programs, drug coverage for Veterans as well as a discussion of other ways to reduce medication costs, such as mail order and in-store savings.

The Challenge of Rising Prescription Drug Costs

Rising prescription drug costs and out-of-pocket expenses are hot-button topics and political issues. Although more than 4 billion prescriptions are filled in the United States every year, it doesn’t mean that patients always have an easy time accessing the medications they need. The statistics are surprising:

Americans spend more than $333 billion on prescription medications every year, and Medicare covers about 30% of payments.
The Merck Manual reports that almost 90% of seniors take at least one prescription drug, and 36% regularly take at least five medications.
According to Harvard researchers, up to 14% of low-income adults skip their medications to save money.
One in five older adults has received a prescription drug discount in the past year, according to the Kaiser Family Foundation (KFF).

Even if you can afford the medications you need, you may be looking for ways to lower your out-of-pocket expenses. The good news is that the industry has an impressive array of resources. This guide provides practical information to help you manage your prescription drug benefits and access financial assistance programs through Medicare, Medicaid, prescription drug manufacturers and other organizations. We’ve also included some helpful tips to help you get the best deal on your prescription medications and become a more informed consumer.

Medicare Coverage of Prescriptions

Nearly all Medicare Advantage Plans include this coverage, and most seniors who have Original Medicare choose to enroll in a Part D plan. Even though Part D is optional, it’s important to note that there could be late-enrollment penalties down the road if you don’t sign up for a plan when you first become eligible.

Drug Coverage with Original Medicare- Medicare Part D

If you have Original Medicare, a standalone Part D plan that you purchase separately will cover most of your prescription drug costs. Monthly premiums range from $10 to $100, although KFF puts the median at $43 for 2022. Certain items, including vaccinations, osteoporosis shots and medications administered in a medical facility, are still covered by Part B.

Understanding Part D

If you have a Part D prescription drug plan, you’ll pay a monthly premium as well as an annual deductible and a copay when you pick up your medications. Part D drug plans have a coverage gap that occurs after you spend approximately $4,430 on medications.

After that, you pay 25% of the plan’s negotiated medication price for name-brand and generic medications. The manufacturer and the insurance provider cover the remaining cost. Some or all of these expenses may count toward your cumulative spending to get you out of the coverage gap.

Once you spend $7,050 out of pocket on prescription medications, catastrophic coverage will reduce your copays for the rest of the year. You may also qualify for certain financial assistance programs while you’re in the doughnut hole.

Medicare Part D Extra Help

Even with Medicare, out-of-pocket costs can add up, but you may qualify for assistance. A federal program called Extra Help is available to help Medicare beneficiaries with their Part D premiums, deductibles and copays. The Social Security Administration estimates that this benefit is worth about $5,100 per year. Additionally, if you qualify for Extra Help, you won’t have to pay a late enrollment penalty if you didn’t have drug coverage previously.

Note that your premiums and share of costs may vary depending on which plan you choose, so you’ll need to compare plans to determine which option best suits your needs.

If you qualify for full Extra Help, you’ll pay no more than $3.95 for generics and $9.85 for name-brand medications. Individuals who receive partial Extra Help usually pay a reduced rate equal to 15% of their plan’s formulary price.

Here are a few of the program’s requirements:

Eligibility

Your income can’t exceed $20,385 for individuals or $27,465 for couples.
You must have no more than $15,510 or $30,950 in countable assets and resources.

How to Apply

The Social Security Administration (SSA) processes Extra Help applications. There are a few ways to apply.

You can apply online at SSA.gov.
To apply over the phone, call (800) 772-1213.
For local assistance, contact the nearest SSA field office.

Appealing a Decision

If you disagree with an application decision or prequalification letter, contact your local office or call the SSA at (800) 772-1213. Information about how to file an appeal will be included with the notice. You can also appeal by completing Form SSA-1021, Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs, and mailing it to:

Wilkes-Barre Data Operations Center
P.O. Box 1030
Wilkes-Barre, PA 18767-1030

Drug Coverage with Medicare Advantage Plans

Medicare Advantage Plans typically cover all the medications you need. If your plan doesn’t offer a prescription drug benefit, you may be allowed to sign up for a standalone Part D plan. This option varies by policy, so it’s important to check. Enrolling in Part D could cancel your Advantage Plan and return you to Original Medicare.

Medicare Supplement Insurance Coverage of Prescriptions

Many seniors purchase an optional Medigap insurance supplement to reduce or eliminate their out-of-pocket costs. There are approximately 10 types of standardized Medigap supplements available, depending on your state and local area. They may cover all or part of your deductibles and copays, excluding your Part B hospital deductible. However, Medigap supplements don’t cover prescription drugs unless your coverage began before January 2006. If your Medigap plan with prescription drug coverage was grandfathered in, you can’t sign up for a Part D plan at the same time. If you do, Medicare will permanently terminate the prescription drug portion of your Medigap policy, and you won’t be able to reinstate this benefit.

Prescription Drug Coverage for Veterans

VA Pharmacy Benefits

Pharmacy coverage is a standard part of the VA’s health care benefits package. However, your VA provider must write prescriptions for coverage. When insurance laws changed in 2006, VA pharmacy benefits became creditable coverage under Medicare. This means that you aren’t required to have Part D coverage if you’re on Original Medicare, but you can have both types of coverage if you want to. If you decide to enroll in Part D later, you won’t have to pay a penalty. There are some caveats. For example, you may be unable to resume your VA pharmacy benefits if you decide to disenroll.

If you decide to use your VA benefits instead of your Part D coverage, here’s how it works:

Most beneficiaries pay $5 to $8 for a 30-day supply of generics.
Name-brand medications typically cost $11 for a 30-day supply.
You may be eligible for a $700 annual copay cap if you’re in certain priority groups.
Some veterans qualify for free medications per their income, disability classification or military achievements.

TRICARE Pharmacy Benefits for Military Retirees

Certain military retirees may receive prescription drug coverage through their TRICARE plan. It covers military and in-network pharmacies as well as mail-order deliveries. Out-of-pocket costs depend on the medication. Preferred generics are the most affordable, while non-formulary drugs cost the most. Copays range from $0 to $38 in most cases. However, the plan may not cover certain medications.

Medicaid Coverage of Prescriptions

If you’re struggling to pay for prescription medications and other essentials, you may qualify for Medicaid. The state and federal governments manage this health insurance program, and it is available to individuals who have limited income and assets or are unable to afford their medical expenses. According to Medicaid.gov, prescription drug coverage is an optional benefit based on federal regulations. However, all states choose to provide pharmacy coverage.

When Medicaid pays for medications, it bases prescription drug prices and pharmacy reimbursements on complex formulas that consider ingredient costs and the required labor and materials to dispense the medication. As a consumer, you may be responsible for a nominal share of cost when filling your prescriptions. This varies by state. Here are a few things that you should know:

According to the KFF, 15 states, including Connecticut, Florida, Idaho, New Jersey and Texas, don’t require a share of cost for Medicaid-covered prescriptions.
Even in states that have a prescription drug copay, some eligibility groups may be exempt from this requirement.
If you’re a Medicaid beneficiary, pharmacies must dispense your medication regardless of your ability to pay.

If your state requires a copay, expect to pay about $3 on average. Federal law caps Medicaid prescription drug copays at $4 for preferred medications and $8 for non-preferred drugs for individuals who earn below 150% of the Federal Poverty Level. If you make more than this, you may still qualify for reduced copays. Medicaid eligibility is based on your income and assets and varies depending on your state and other factors, such as your age and health.

Prescription Assistance Programs from Pharmaceutical Companies

Patient assistance programs or prescription assistance programs, also called PAPs, are typically operated by prescription drug companies or affiliated charitable foundations. They help uninsured and underinsured Americans access medications that their insurance doesn't cover or are too expensive.

Each program has its own eligibility requirements. Some programs serve seniors and Medicare beneficiaries, while others focus on helping uninsured individuals. The application may consider your age, income and medical needs. Some applications are specific to the medication that you’re requesting. You may need to provide documentation from the prescribing physician or medical professional.

Depending on the program, you can receive your medications for free or at a low cost, even if your household income exceeds $50,000 or $100,000. If you’re on Medicare, PAPs can cover your Part D copays, but these payments won’t count toward your out-of-pocket spending. Here are a few of the nation’s largest PAPs:

Company	Prescription Assistance Program
Johnson & Johnson	The Johnson & Johnson Patient Assistance Foundation Inc. manages the PAP for the world’s largest pharmaceutical brand. Individuals who earn up to 400% of the Federal Poverty Level can receive help with the cost of certain medications, including cancer-fighting drugs.
Roche	Genentech Access Solutions and the Genentech Access to Care Foundation get insured and uninsured patients access to the brand’s medicine. Genentech can help you understand your insurance benefits, and you may be eligible for a copay assistance card that will cover your out-of-pocket costs.
Pfizer	Pfizer RxPathways helps consumers access the brand’s prescription drug assistance programs. In addition to assisting patients with understanding their insurance benefits, the program provides copay assistance and free medications. You may qualify even if you earn up to 400% of the Federal Poverty Level.
Eli Lilly	The Lilly Cares Foundation provides free medications to individuals in need. The program covers dozens of medications, including insulin. Income limits are 300%, 400% or 500% of the Federal Poverty Level, depending on the medication. Seniors with Part D drug coverage are one of the program’s target groups.
Novartis	The Novartis Patient Assistance Foundation offers free medications to individuals who are uninsured or have limited drug coverage with financial hardship. If you're married, you may qualify for assistance if your household income is less than $100,000. The brand also has a copay assistance program that caps your monthly copay at $30 for a 30-day refill.
Merck	Merck’s Patient Assistance Program provides vaccines and up to one year of free medication to adults who are uninsured, have limited insurance coverage or cannot afford their medications due to financial hardship. You may qualify if your household income is $73,240 or less for couples.
GSK	GSK for You offers free medications to individuals who are uninsured or are on Medicare and meet certain financial requirements. It has copay assistance for certain medicines. You may also qualify for coupons or free trial offers.
Sanofi	Sanofi Patient Connection provides medication assistance to seniors enrolled in Medicare Part D who earn below 400% of the Federal Poverty Level. It also offers support for insurance claims, prior authorizations and appeals. The program covers more than a dozen medications, including vaccines and injectables.
AbbVie	MyAbbVie Assist offers free medications without copays or shipping costs to individuals with limited health insurance coverage. A two-person household can earn more than $109,000 and still qualify for assistance. Eligibility may depend on the medication you’re requesting.

Other Options to Lower Medication Costs

Maximizing your insurance benefits and relying on industry resources are effective ways to access your medications, but there may be other ways to save. Here are a few strategies:

Coupons

If your doctor recently prescribed you a new medication, you may qualify for coupons, vouchers or trial offers to cover your initial refill. Brands such as McKesson and GlaxoSmithKline offer discount programs for new patients and uninsured consumers. Check with the manufacturer before you fill your prescription for the first time.

Drug Discount Cards

Today, consumers can sign up for numerous prescription discount cards, including many that are free. These benefits are available thanks to pharmacy benefit managers who contract with providers and negotiate discounted cash rates. Other companies then market the membership cards. Brands such as GoodRx and SingleCare claim to save you up to 80% on popular medications. You may also find discount cards specific to your state.

Tax Deductions

Out-of-pocket prescription drug costs and medical expenses may be tax deductible if these expenses exceed 7.5% of your adjusted gross income for the previous year. Don’t forget to keep track of your medical expenses or ask your pharmacy for a purchase summary at the end of the year. Your state may offer similar deductions when you itemize.

Generic vs. Brand Name

Generic versions of medications typically become available six to 20 years after the original medication. This is due to legal protections provided by the FDA. Regardless of whether or not your insurance covers a prescription, you can save a significant amount by purchasing generic equivalents. Every year, generic and biosimilar medications save Medicare $96 billion, or $1,053 per participant.

Retail vs. Mail Order/Online

You may save money by purchasing your medications from a mail-order pharmacy or online provider. Just make sure to choose a reputable company. According to the FDA, the provider must have a license from your state’s pharmacy board and a physical address in the United States. Some individuals choose to purchase their medications from foreign sources. In most cases, this is legal as long as the FDA approves the drug and you aren’t importing more than a 90-day supply.

Shop Around

If you have to pay for medication out of pocket, shop around. Prices can vary significantly, even in a small geographic area. For example, in Chicago, the cost of popular medications such as the cholesterol drug Lipitor ranges from $3 to $30 at local pharmacies with a discount card. Many big-box stores and national chains offer an extensive list of low-cost generics for as little as $4 for a 30-day supply.

In-Store Offers

Several grocery stores have free prescription medications, including Meijer, Reasor’s and Price Chopper. These programs often cover antibiotics, vitamins, diabetes and blood pressure medications and other frequently prescribed drugs. While Publix discontinued its free drug program in 2022, it still offers many low-cost medications. Kroger has an annual membership program valid for all of its brands. Many medications are free through this program. Your wholesale club membership could also earn you discounts on certain medications.

Additional Prescription Medication Resources and Organizations

Prescription drug prices have been a hot topic for many years, and several organizations dedicate themselves to affordable medications for consumers. Financial assistance may be available through churches and charitable organizations in your local area. There are also statewide and national resources that you can turn to.

Program	Services
RxAssist	RxAssist operates a patient resource center that provides information about drug-specific financial assistance programs. It also offers a prescription discount card and information for patients and health care professionals.
Medicine Assistance Tool	Sponsored by a group of pharmaceutical manufacturers, the Medicine Assistance Tool provides information about valid patient assistance programs for an individual's medicines.
Needy Meds	This nonprofit is a comprehensive resource for information about patient assistance programs, including how to apply. It also provides a discount card and information about where to find $4 generics.
Together Rx Access	Together Rx Access is a prescription discount program sponsored by a group of drug makers. It’s available to individuals who are uninsured, don’t qualify for Medicare and have a single household income of $45,000 or less.
Patient Advocate Foundation	The Patient Advocate Foundation offers copay relief and financial help with deductibles and other out-of-pocket expenses for insured individuals, including seniors on Medicare.
The Assistance Fund	The Assistance Fund (TAF) can help cover prescription drug copays and other treatments related to more than 80 chronic diseases. It also offers information to health care providers about available resources.
PAN Foundation	This charitable organization focuses on helping uninsured and underinsured patients afford their medications and pay for out-of-pocket expenses related to chronic disease management. Funds focus on specific conditions, such as asthma, colon cancer, Parkinson’s and osteoporosis.
Blink Health	Blink Health is a discount plan organization that offers lower drug prices to all Americans. It provides discounts on 15,000 medications. Prescriptions can be filled at 35,000 locations or through the company’s online pharmacy.

Financial Assistance for Prescriptions in Your State

Everyone should be able to afford the medications they need. Below, we’ve compiled comprehensive guides for every state explaining the available resources for prescription medication payment assistance.

If you’re still looking for help with managing your prescription medication costs, reach out to your local senior center, Area Agency on Aging or age-focused nonprofit to learn more about the resources available in your area. Your doctor, pharmacist or insurance company can also help you locate and apply for financial aid.

Alabama	Indiana	Nebraska	Rhode Island
Alaska	Iowa	Nevada	South Carolina
Arizona	Kansas	New Hampshire	South Dakota
Arkansas	Kentucky	New Jersey	Tennessee
California	Louisiana	New Mexico	Texas
Colorado	Maine	New York	Utah
Connecticut	Maryland	North Carolina	Vermont
Delaware	Massachusetts	North Dakota	Virginia
Florida	Michigan	Ohio	Washington
Georgia	Minnesota	Oklahoma	West Virginia
Hawaii	Mississippi	Oregon	Wisconsin
Idaho	Missouri	Pennsylvania	Wyoming
Illinois	Montana

Covered in this guide:

The Challenge of Rising Prescription Drug Costs

Medicare Coverage of Prescriptions

Drug Coverage with Original Medicare- Medicare Part D

Understanding Part D

Medicare Part D Extra Help

Drug Coverage with Medicare Advantage Plans

Medicare Supplement Insurance Coverage of Prescriptions

Prescription Drug Coverage for Veterans

VA Pharmacy Benefits

TRICARE Pharmacy Benefits for Military Retirees

Medicaid Coverage of Prescriptions

Prescription Assistance Programs from Pharmaceutical Companies

Other Options to Lower Medication Costs

Coupons

Drug Discount Cards

Tax Deductions

Generic vs. Brand Name

Retail vs. Mail Order/Online

Shop Around

In-Store Offers

Additional Prescription Medication Resources and Organizations

Financial Assistance for Prescriptions in Your State

State Resources for Seniors in Alaska

State Resources for Seniors in Alabama

State Resources for Seniors in Arkansas

State Resources for Seniors in Arizona

State Resources for Seniors in California

State Resources for Seniors in Colorado

State Resources for Seniors in Connecticut

State Resources for Seniors in Delaware

State Resources for Seniors in Florida

State Resources for Seniors in Georgia

State Resources for Seniors in Hawaii

State Resources for Seniors in Iowa

State Resources for Seniors in Idaho

State Resources for Seniors in Illinois

State Resources for Seniors in Indiana

State Resources for Seniors in Kansas

State Resources for Seniors in Kentucky

State Resources for Seniors in Louisiana

State Resources for Seniors in Massachusetts

State Resources for Seniors in Maryland

State Resources for Seniors in Maine

State Resources for Seniors in Michigan

State Resources for Seniors in Minnesota

State Resources for Seniors in Missouri

State Resources for Seniors in Mississippi

State Resources for Seniors in Montana

State Resources for Seniors in North Carolina

State Resources for Seniors in North Dakota

State Resources for Seniors in Nebraska

State Resources for Seniors in New Hampshire

State Resources for Seniors in New Jersey

State Resources for Seniors in New Mexico

State Resources for Seniors in Nevada

State Resources for Seniors in New York

State Resources for Seniors in Ohio

State Resources for Seniors in Oklahoma

State Resources for Seniors in Oregon

State Resources for Seniors in Pennsylvania

State Resources for Seniors in Rhode Island

State Resources for Seniors in South Carolina

State Resources for Seniors in South Dakota

State Resources for Seniors in Tennessee

State Resources for Seniors in Texas

State Resources for Seniors in Utah

State Resources for Seniors in Virginia

State Resources for Seniors in Vermont

State Resources for Seniors in Washington

State Resources for Seniors in Wisconsin

State Resources for Seniors in West Virginia

State Resources for Seniors in Wyoming

Expert Reviewer

Marc Levesque