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How to Lower Your Part D Drug Costs

May 25, 2023 | Shea Corti

Paying for prescription drugs can cause financial stress. There are some programs and strategies for lowering your prescription drugs. Let’s review some ways you can save on your drug costs.

First, the Extra Help program.

Extra Help is a federal program that helps pay for your out-of-pocket costs with Medicare prescription drug coverage. Your income and assets determine if you are eligible:

  • Monthly income
    • Individuals: Up to $1,843 per month
    • Couples: Up to $2,485 per month
  • Assets
    • Individuals: Up to $16,660
    • Couples: Up to $33,240

Even if you think your income or assets are above the eligibility limits, you could still qualify for Extra Help because certain types of income and assets may not be counted. You automatically qualify for Extra Help if you have Medicaid, Supplemental Security Income, or a Medicare Savings Program.

There are many benefits to the Extra Help program. Extra Help:

  • Pays for your Part D premium up to an amount determined by your state
  • Lowers the costs of your prescription drugs.
  • Gives you the flexibility to change your Part D plan more often, if needed, such as to lower costs
  • Eliminates your Part D late enrollment penalty if you have one

Remember that Extra Help is not a replacement for Part D. It is also not a plan. It is a cost assistance program. To be eligible, you must have a Part D plan to receive Medicare prescription drug coverage. If you do not choose a plan, you will in most cases be automatically enrolled in one.

Second, your state may have a State Pharmaceutical Assistance Program.

Many states offer State Pharmaceutical Assistance Programs, which are called SPAPs for short. SPAPs help state residents pay for prescription drugs, but each program works differently.

  • States may coordinate their drug assistance programs with Part D.
  • Some SPAPs require that you sign up for Part D in order to qualify for assistance.
  • Many SPAPs continue providing coverage during your Part D Plan’s coverage gap.
  • Your SPAP may also help pay for your Part D plan’s premium, deductible, or copayments.
  • Certain states have qualified SPAPs. Qualified SPAPs provide a Special Enrollment Period to allow you to enroll in or make changes to your Part D or Medicare Advantage coverage.

To learn if your state has an SPAP and to find out if you qualify, call your local State Health Insurance Assistance Program (SHIP). Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

Finally, let’s look at some other strategies and programs that could help you save on drug costs.

Whether or not you qualify for Extra Help or an SPAP, you may have other options to help save on high drug costs:

  • If you are struggling to pay for expensive brand-name medications, you may want to speak to your doctor about using a generic drug. Generic drugs are often less expensive than brand-name drugs.
  • You can also speak to your doctor about getting samples of your medication if you are temporarily having trouble accessing it.
  • You may try speaking to your pharmacist about waiving your copay. Although pharmacists cannot routinely waive copays for people without Extra Help, your pharmacist may waive your copay on a case-by-case basis.
  • If you are getting a drug from a hospital pharmacy, you may also be able to ask if the hospital has a charity care program that would allow you to access the drug at a lower cost.
  • You may be able to get medications at a reduced price for national or local discount programs, which you can find on www.NeedyMeds.org or www.GoodRx.com.
  • You might also be eligible for free or low-cost directly from the company that makes them. These programs are called Patient Assistance Programs, or PAPs. In most cases, your doctor applies for you.

Still have questions?   

Your SHIP is here for you! You can contact your SHIP for any other Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

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