Lowering the cost of prescription medications is important.
Each year, prescription medications costs continue to rise. We continue to see fewer medications covered with deductibles, copayments and coinsurance amounts increasing. Knowing the resources available can have a significant impact on your monthly prescription costs.
Below you will find resources to help you explore cost saving options for medications. These options might not be available to everyone so understand how these programs would impact your prescription drug plan.
FOR MEDICARE BENEFICIARIES
There are several programs to investigate to help with the cost of medications. Most programs are income based and the limits can vary from state to state.
Extra Help: A Federal program also known as Low Income Subsidy (LIS). If eligible, this program provides financial assistance for Medicare beneficiaries with a limited income. To see if you are eligible, check on the ssa.gov website. They constantly update the website but at one point they had a calculator to see if you might qualify. You can also apply for extra help on this website. If approved, this could help with the cost of your prescription drugs or some deductibles and copays.
State Pharmaceutical Assistance Programs (SPAPs). Not all states offer these programs. When offered, they generally provide a subsidy towards your monthly premium and/or the cost of medications. Search for the SPAP in your state to see if one is available or if you qualify.
PROGRAMS FOR ANYONE TAKING MEDICATIONS
Prescription Assistance Programs (PAPs): Drug manufacturers offer these programs. They can be discounts, coupons or grants. Each program can have different eligibity criteria. Always look at the drug manufacturers website for different programs they offer, particularly if it is an expensive medication. As an agency, we stay on top of these programs, so reach out to us if you need assistance.
Discount Options
One of the newer options available for purchasing medications outside of your prescription drug plan are discount programs. There are several organizations that offer these and in some circumstances it is worth comparing them. Three areas where these programs can be valuable:
- Your provider prescribes a medication not covered on your prescription drug plan
- A medication is a Tier 3 or 4 and your plan has a coinsurance for these Tiers
- In a calendar year you won’t meet your catastrophic phase.
When using a discount program, the money you pay does not count towards your prescription drug plan. If there is a possibility you will reach the catastrophic phase in a calendar year, don’t use the discount programs.
Discount Coupon Program
Download the app for these programs. Enter your medications then check the price of your medication.
When using a discount coupon, let the pharmacist know in advance. Some check automatically but letting them know up front helps everyone.
Mail Order Discount Program
These plans are only available through mail order but are worth investigating. Enter your medication to check the price.
When using a discount program to purchase your medications, the cost does not apply toward your deductible or catastrophic phase. If it looks like you will reach that amount in a calendar year, using the discount coupons might not be the best choice. This is important.
CHANGES TO MEDICARE PART D
In 2022 Congress passed the Inflation Reduction Act which has provisions that will impact Prescription Drugs. Some of the immediate changes that you can take advantage of are:
- Cost sharing for adult vaccines has been eliminated for vaccines covered under Medicare Part D. This is big especially for those of you needing to get your shingles vaccine.
- For people on Medicare using Insulin, the monthly cap is $35.00. This only applies when your insulin is covered on your prescription drug plan.
In 2025 the maximum someone has to pay for their covered medications is $2,000. This will increase by $100 each year so in 2026 the maximum is $2,100. The premium is not included in this maximum and medications not on the formulary do not count towards the maximum. Medication costs using a discount program like GoodRx or Costplusdrugs.com do not count towards the catastrophic phase.
TIPS FOR MANAGING YOUR MEDICATION COSTS FOR PEOPLE ON MEDICARE
- Review your plan annually: Prescription drug plans tend to change from year to year. It is important to review your plan annually during the Medicare Open Enrollment period. (10/15 – 12/7). Confirm all of your medications are covered, your pharmacy is preferred and the plan is the best price for your medications.
- Consider generic drugs: Generic drugs can be significantly cheaper than brand-name drugs, but they can be just as effective. Ask your doctor if there is a generic option for your medication.
- Use a preferred pharmacy: By using a preferred pharmacy you usually get the best pricing for your medications. If your plan does not list a preferred pharmacy, make sure to use an in-network pharmacy. Check to see if your plan has a preferred pharmacy and use it whenever possible.
- Look for discounts: Ask your pharmacy if they offer any discounts. Those might be different than the resources listed in this article.
- Utilize mail-order services: Many prescription drug plans offer mail-order services for medications. This can be a convenient way to get your medications and sometimes at a lower cost. Check to see if your plan offers this service and the cost savings. Be sure to focus on the preferred mail order pharmacy for your plan
Understanding the resources available might help you reduce your medication costs with your current health plan.
If you have questions about your prescription drug plan, finding resources for lowering costs of your medications or how to find the best prescription drug plan for your medications, reach out to lynnmichel.com and our staff will be happy to assist.
WHO IS LYNN MICHEL INSURANCE, LLC?
Lynn Michel Insurance is an independent insurance brokerage, representing national and local insurance companies. We specialize in helping people who need individual health insurance and Medicare benefits. In 2025, we are licensed in MD, VA, DC, DE, NC, OH, NJ and FL. If you are looking for an agent in a state we don’t represent, let us know. We have a large network that we can connect you with. You can feel confident that someone in our network is reputable and has completed all of the proper certifications.
Debbie DeChambeau, the founder of Lynn Michel Insurance, started in the insurance industry as a junior in high school. She took a detour for a few years due to a family crisis. During that time, she continued to maintain her insurance license, certifications and continuing education requirements, then started Lynn Michel Insurance, LLc in 2019.
ADDITIONAL INFO ABOUT THE AUTHOR
Debbie believes in continuing education for her profession. She earned the designations of a Certified Insurance Counselor (CIC), Accredited Advisor of Insurance (AAI) and Certified Professional Insurance Agent (CPIA) and Certified Long Term Care (CLTC)
Over the years, Debbie has cared for several family members. She was instrumental in helping to raise her niece and nephew after the death of her sister and cared for her grandmother, uncle and parents in their senior years. She brings an experienced perspective when helping people choose their insurance protection.