The strategies and programs below can help you choose a Part D plan and save on prescription drug costs. If you have a Medicare Part D plan, decreasing costs may keep you out of the coverage gap, also called the donut hole. This is the period during which you are responsible for paying a large percentage of your drug costs. (Note previously, the coverage gap or “donut hole” was so called because you had to pay 100% of your drug costs. Now, due to health care reform, you must pay only 45% of your brand name drug costs and 58% of your generic drug costs. This percentage will decrease over the next several years until the donut hole is eliminated in 2020 and you pay just 25% of your drug costs throughout the year.) See Prescription Drug Coverage (Medicare Part D): An Overview.
If you enter the donut hole but are unlikely to spend a total of $4,850 out-of-pocket before the end of the year to receive catastrophic coverage, the cost-saving strategies below may help. In general, what you pay using these programs does not count toward your true-out-of-pocket (TrOOP) expenses. Learn more about what does and does not count toward your TrOOP.
Free One-on-One Counseling
Free, confidential, unbiased Medicare counseling is available from your county Health Insurance Counseling & Advocacy Program (HICAP) office. Call 1-800-434-0222 or find your local office online.
Topics on this page:
- Decision Support Tools
- Cost-Saving Strategies
- Government Programs
- Patient Assistance Programs (PAPs)
- Additional Information
1. Decision Support Tools
For information about Medicare prescription drug coverage, call 1-800-MEDICARE (1-800-633-4227); TTY users should call 1-877-486-2048. Be sure to have your Medicare card, a list of the drugs you take and the name of your pharmacy ready when you call.
Medicare.gov – The Official U.S. Government Site for People with Medicare has many publications and useful tools, as well as fact sheets, Frequently Asked Questions and other resources.
- Medicare Plan Finder — Searches for health and prescription drug plans offered in your area that meet the criteria you enter.
- Publications — Dozens of downloadable fact sheets and tip sheets available in English, Spanish, Chinese, Korean, Russian, Vietnamese and Tagalog. You can also download the annual “Medicare & You” handbook, which includes phone numbers of many plans offered in your area. In addition, you can call individual drug plans for formulary information, although it may be difficult to get the exact information you want. Beware of heavy-handed marketing and drug-plan sales, and keep written records of promises made by drug-plan representatives (including date, time, promises made and who you spoke with by phone or in person). See Marketing Rules for Your Protection.
- Review your Medicare Part D plan annually to make sure it provides the most comprehensive coverage for your drugs at the lowest cost. Call your local Health Insurance Counseling & Advocacy Program (HICAP) office at 1-800-434-0222 or Medicare at 1-800-MEDICARE (1-800-633-4227) to ask for assistance finding a plan. Alternatively, you can use the Medicare Plan Finder.
- Talk to your doctor about switching to generic drugs or less-expensive brand-name drugs. The Consumer Reports Best Buy Drugs (CRBBDs) website provides reports on various drug categories. Each report reviews both the prices and scientific evidence of the drugs’ effectiveness. It then analyzes and compares drugs within that category to create CRBBD recommendations.
- Ask your doctor for free samples of your prescriptions.
- Find out if using your plan’s mail-order pharmacy would cost less. Call your plan for details.
- Apply for government or private programs that might reduce your drug costs.
- Contact Patient Assistance Programs (PAPs) that cover your drugs.
- Check the prices for your prescriptions at multiple pharmacies. Pharmacies such as Costco sell drugs for less than others (you do not need to be a Costco member to use its pharmacy).
- Check out the $4 generic drug programs at Wal-Mart and Target pharmacies.
- Investigate internet pharmacies that sell drugs online. Some online pharmacies sell discounted prescription drugs from outside the United States. The discounts can be up to 50% less than the price charged within the United States. Note: Importing prescription drugs that are not approved by the Food and Drug Administration (FDA) is illegal, but the FDA does permit importing small quantities of prescription drugs for personal use.
If you are considering ordering prescription drugs from outside the United States through an online pharmacy, please note the following:
- Payment to an online pharmacy does not apply toward your Medicare Part D cost sharing, if you have a Medicare Part D plan.
- Some websites may be fraudulent and may not be a pharmacy.
- Some disreputable online pharmacies supply counterfeit drugs.
Medicare Low-Income Subsidy (LIS) Program (also known as “Extra Help”)
The LIS program helps Medicare beneficiaries with limited income pay for their Medicare Part D plan premiums and deductibles. Those who qualify for the LIS program have lower drug copayments. See Extra Help with Part D Costs.
People who have both Medicare and Medi-Cal pay no more than $7.40 per prescription for Medicare-covered drugs (see Extra Help with Part D Costs). Medi-Cal covers certain drugs not covered by Part D. To apply for Medi-Cal, call your local County Department of Health Care Services to start the application process.
California Prescription Drug Discount Program
At Medi-Cal participating pharmacies, you can get prescription drugs at the Medi-Cal rate plus a $0.15 processing fee. This rate may be lower than the Part D rate. Payments may not apply toward your Part D cost-sharing. This program should not be used as a substitute for Medicare Part D. To receive benefits, show your Medicare card at Medi-Cal participating pharmacies. Learn more.
Department of Veterans Affairs (VA)
Eligibility in the VA’s Medical Benefits Package is based on military service. The benefits include creditable coverage for prescription drugs for a 30-day supply of medication at VA pharmacies. The copayment amount depends on what “priority group” the veteran is in. To claim the VA benefit, you must get a prescription from a VA physician. Veterans who have the VA Medical Benefits Package may also enroll in a Medicare Part D plan. They may save money by filling certain drugs through the VA program and others through the Part D plan. Veterans may also choose to have only VA coverage and enroll in a Medicare Part D plan later. Since the VA prescription drug coverage is creditable, the late enrollment penalty will not apply. For more information, call 1-877-222-8387 or visit the VA website.
TRICARE Senior Pharmacy Program
Active and retired military service members and their spouses may be eligible for TRICARE, which is part of the Military Health System. TRICARE for Life (TFL) members who turned 65 after April 1, 2001, must enroll in Medicare Part B. For people who have TFL and Medicare, TFL pays after Medicare has paid. TFL offers creditable prescription drug coverage; if you have TRICARE for Life, you may decide not to enroll in a Medicare Part D plan. For more information, call TFL at 1-866-773-0404, or visit the TRICARE for Life website.
Many pharmaceutical companies offer PAPs that provide free or low-cost drugs to qualified individuals. Each program has its own eligibility criteria and application process. Some provide drugs only if they are excluded from your Medicare Part D plan’s formulary, you are in the coverage gap or you are not enrolled in a Medicare Part D plan.
Medicare can tell you which PAP covers your drugs, if you qualify and how to apply. Call 1-800-MEDICARE (1-800-633-4227) or visit the PAP page on Medicare’s website. Call the company that makes your drug for PAP details. Note: If a PAP pays for your drugs, that payment will not count toward cost-sharing (your TrOOP) in your Medicare Part D plan.
The websites below contain searchable databases with information on prescription drug resources and financial assistance with prescription drug costs. Many specifically help you find patient assistance programs (PAPs) that offer your drugs.
- Partnership for Prescription Assistance (PPARx) offers a single point of access to more than 475 public and private PAPs, including over 200 programs offered by pharmaceutical companies. You can also access the PPARx by phone at 1-888-4PPA-NOW (1-888-477-2669). Sponsored by PhRMA (the Pharmaceutical Researchers and Manufacturers of America).
- RxAssist offers a comprehensive database of PAPs, as well as practical tools, news, articles and up-to-date information on how to access assistance from nearly 150 companies in receiving hundreds of medications. Searches can be performed on a multitude of variables: company name, brand-name drug, generic drug name and drug-therapy class.
- RxHope allows patients and their providers to apply for PAPs offered by hundreds of manufacturers, and to find information on programs offered by the state and federal government, as well as pharmaceutical companies. The Patient Assistance Information section of the site provides data about particular products and companies.
- NeedyMeds allows you to enter your medication name to find PAPs that pay for your specific medication. This site has an alphabetical list of over 4,400 prescription medications.
- GoodDaysfromcdf.org – Good Days is a non-profit organization that assists patients with chronic disease, cancer and other life-altering conditions obtain certain expensive, life-saving medications they need. Patients must meet certain income qualifications and have private insurance or a Medicare Part D plan. You can also reach them by phone at 1-877-968-7233.
- BenefitsCheckUp is a service of the National Council on Aging. It has an online screening tool that searches over 2,000 public and private benefits programs. Many of these programs can help certain qualified people ages 55 and older pay for some costs of prescription drugs, health care, utilities, and other essential items or services.