Key Takeaway

• Some options to help you afford your medications include private health insurance, Medicaid, Medicare, patient assistance programs, state pharmaceutical assistance programs, pharmacy drug savings programs, and nonprofit organizations. You can also request the generic form instead of the brand name to save up to 85% on your prescriptions. 

Spending on prescription medications in the United States is almost double that of other wealthy countries, averaging over $1,000 per American per year. If you are struggling to pay for your medications, there are programs that can help you afford your prescription drugs and avoid the consequences of not taking your medications as prescribed. Please continue reading to learn about some programs that can help with prescription drug costs.

How do you pay for expensive medication?

Here are some ways to pay for expensive medication:

Private health insurance

Most private health insurance plans in the U.S. include prescription drug coverage. If you are insured, your plan’s formulary will list the drugs that are covered. Health insurers are allowed to create and adjust their own formularies as long as they comply with state and federal rules. There are usually tiers within the formulary, with tier 1 drugs typically being the least expensive. Top-tier drugs typically require a copay. Learn about what American health insurance coverage concerns.

Medicaid

Medicaid is a joint federal and state-funded government program that helps people with limited incomes pay for health care costs, including prescription medicines. Although it is an optional benefit, all states currently provide outpatient prescription drug coverage to eligible individuals. Learn more about recent Medicaid eligibility changes.

Medicare prescription drug coverage

If you meet the eligibility requirements for Medicare Part A and/or Medicare Part B, getting Medicare drug coverage (Medicare Part D) can help you pay for the prescriptions you need. Medicare drug plans are optional and offered to everyone. They add coverage for prescription drugs to Original Medicare. The Extra Help program helps people with limited income cut their Part D costs and obtain discounted medicines. You could pay no more than $4.50 for each covered generic drug and $11.20 for each covered brand name drug as part of this program. 

Not sure whether you should choose Medicare or Medicaid? Check out our blog “Medicare vs Medicaid: What’s the Difference?”

Patient assistance programs

Some pharmaceutical companies have prescription assistance programs (PAPs) that offer low-cost or free medicines to people who are uninsured or underinsured and cannot afford their medications.

State pharmaceutical assistance programs

Many states in the US have financial assistance programs to help eligible people pay for their health insurance premiums or prescription drug costs. 

Pharmacy drug savings programs

You can save up to 80% on your prescriptions by presenting your free BuzzRx discount card at participating pharmacies. 

Nonprofit organizations

Some nonprofits provide free medications or offer families with limited income help with copays, premiums, and prescription drug coverage. For example, the National Kidney Foundation is a non-profit organization that can offer resources and support for chronic kidney disease patients and their loved ones.  

What if I need a prescription but can't afford it?

If you are taking brand-name drugs and finding it hard to afford them, talk to your doctor after switching to generic drugs. Generic medications contain the same active ingredients and are equally safe and effective but can be 80-85% less expensive than their brand-name equivalents.

How to find drug assistance programs?

• Contact your State Medicaid Office to check eligibility and for information about prescription assistance programs and whether you qualify for any drug discounts.

• If you’re not sure that Medicare Part D is right for you, check with the State Health Insurance Assistance Program (SHIP) which helps beneficiaries find the Medicare program that is right for them. 

• You can cut your Medicare Part D costs by signing up for Extra Help. 

• Some pharmaceutical companies have programs that help to pay for prescriptions. You can find prescription assistance for medications in Medicare Drug Plan (Part D).

• You can also find out if there are any state programs for pharmaceutical assistance in your state.

• If you need help in paying for an expensive prescription drug, check the drug manufacturer’s website to see if they have a patient assistance program. 

• Contact nonprofit organizations like Harbor Path, Accessia Health, Good Days, Healthwell Foundation, Patient Advocate Foundation, Patient Access Network, and Rx Outreach to see if you are eligible for financial assistance and other benefits.

• Look up resources like Mental Health America for information about local and state prescription assistance programs.

• Check if your meds are available at discounted prices on the BuzzRx website. The BuzzRx discount card is free, and everyone is eligible. This prescription discount card offers unlimited use and can help you afford your medicine. 

Why are prescription drugs so expensive in the US?

Pharmaceutical companies justify the high price of prescription drugs in the U.S. as a result of costly funding required by the process of research and development. 

Another reason brand-name medications can be so costly is the lengthy clinical trials required to prove their safety and efficacy before the U.S. Food and Drug Administration (FDA) can approve them. 

However, despite the costly process of developing and approving a medication, many pharmaceutical companies make billions of dollars in profit and sell the same drugs for far less in other markets, such as Europe and Asia. Some of the reasons prescription drugs are so expensive in the U.S. include:

• Fees and incentives of pharmacy benefit managers add to drug costs. These are companies that negotiate between health insurance companies and pharmacies to decide which drugs will be covered and how much they will cost.

• Drug manufacturers drive profits with marketing tactics such as introducing a drug at a lower price and later jacking up the price, merging two companies to weed out competition, and using legal maneuvers to hold on to patents longer.

• Drug companies in the US spend billions of dollars on advertising, and these marketing costs add to the price of drugs.

References:

1. https://www.health.harvard.edu/blog/why-do-your-prescription-drugs-cost-so-much-202401183007#:

2. https://www.medicare.gov/drug-coverage-part-d/how-to-get-prescription-drug-coverage

3. https://www.dshs.texas.gov/hivstd/meds/spap