In the United States, approximately 66% of adults take at least one prescription medication, according to the Georgetown University Health Policy Institute. Paying for prescriptions is a concern for millions of people, especially older adults who live on fixed incomes and may need multiple prescriptions to manage conditions such as diabetes, heart disease and high blood pressure. AARP has been compiling data on drug prices for more than a decade, and its most recent report shows that consumers are right to be concerned. In 2015, prices increased for 97% of the brand-name medications tracked by AARP. Furthermore, 90% of brand-name medications doubled in price between 2006 and 2015.
This guide provides an overview of the programs available to help seniors save money on their prescriptions, along with tips for reducing out-of-pocket costs.
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1Medicare Prescription Programs
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Medicare Part D
For adults who've reached the age of 65, enrolling in Medicare can help defray the costs of prescription medications. Medicare Part A and Part B, also known as Original Medicare, don't cover most prescriptions. Therefore, seniors enrolled in Original Medicare should purchase Medicare Part D, a supplemental plan that offers drug coverage. Part D plans are offered by private insurance companies, giving seniors a wide range of options when it comes to coverage details and out-of-pocket costs.
Medicare sets a minimum coverage level that all insurance companies must follow when developing their Part D prescription plans. As long as insurers meet these minimum standards, they're free to determine which drugs are covered and how drugs are assigned to coverage tiers. These tiers help insurance companies reduce costs by charging higher copayments for the most expensive medications. The lowest tier is typically reserved for low-cost generic drugs, while the highest tier is for brand-name, nonpreferred drugs. Many plans also have a specialty tier for the most expensive drugs, which have no generic equivalents and can't be substituted with something less costly.
Medicare Advantage
Another option is to purchase a Medicare Advantage plan that includes coverage for prescription drugs. While Original Medicare is administered by the federal government, Medicare Advantage plans are offered by private insurance companies. These "all-in-one" plans include hospital insurance, health insurance and prescription insurance. Some insurers even include vision and dental coverage in their Medicare Advantage plans.
Prescription coverage is included with most Medicare Advantage HMO and PPO plans, but prescriptions may not be covered by private fee-for-service plans. Therefore, it's important to compare plans carefully and read the fine print before enrolling.
Enrollment Options
Seniors interested in Medicare Part D or Medicare Advantage can enroll in any of the following ways:
- Call 1-800-MEDICARE.
- Contact a private insurance company directly.
- Fill out a paper enrollment form
- Use the Medicare Plan Finder to compare plans and enroll.
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2Medicaid Prescription Programs
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Medicaid is a government program designed to cover medical expenses for Americans who meet eligibility requirements related to income or disability status. The program is jointly funded by the federal government and state governments, which means recipients in different states may not receive the same level of coverage.
Under federal Medicaid rules, states aren't required to cover prescriptions; however, all 50 states offer some type of drug coverage.
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For states that do require prescription drug co-pays, the co-payment amounts are typically just a few dollars per prescription. For example, Arkansas Medicaid recipients pay just $0.50 per $3.00 per prescription depending on the original cost of the drug.
Each state also has its own rules regarding the use of generics or preferred drugs. Utah uses a preferred drug list, while New Jersey requires prior authorization for some medications. A few states also have limits on the number of prescriptions covered each month; Oklahoma has a limit of six per month, while Texas has a limit of three prescriptions per month in most drug classes.
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3Saving Money With Generics
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The Association for Accessible Medicines reports that generic drugs generated savings of $253 billion in 2016.
Generic medications undergo rigorous testing to ensure they have the same effects as brand-name drugs; the U.S. Food & Drug Administration also inspects manufacturing facilities to ensure that pharmaceutical companies follow all relevant laws and regulations when manufacturing generic medications.
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Generic drugs cost less than their brand-name counterparts for three main reasons.
- First, pharmaceutical companies spend millions, sometimes billions, of dollars to develop new drugs. When new brand-name drugs enter the market, manufacturers set prices high to recoup their research and development costs.
- Second, companies that manufacture generic drugs don't have to conduct clinical trials to demonstrate that their products are safe and effective, reducing the cost of bringing these drugs to market.
- Finally, when a pharmaceutical company releases a new brand-name drug, there's no competition in the marketplace, which drives up prices. Several manufacturers produce the same generic medications, increasing competition and lowering costs for consumers.
As a result, older adults can save a significant amount of money each month by purchasing generic drugs instead of brand-name ones.
Quantity Discounts
Another way to save money on prescriptions is to request a 90-day supply of each medication instead of a 30-day supply.
Switching to a 90-day supply of a long-term medication reduces the number of prescriptions filled to just four per year, reducing processing costs for insurance companies. As a result, many insurers now offer financial incentives for consumers to order 90-day supplies of their medications.
For example, Providence Health Plan only charges twice the normal monthly co-pay for a 90-day supply of some drugs. If the typical monthly co-pay is $15, a 90-day supply would cost $30 instead of the $45 it would cost if the consumer filled the prescription every month for three months.
Mail-Order Services
Using mail-order prescription services is another way to save money on medications. Major insurers reduce their costs by purchasing large quantities of medications and having third-party mail-order services fill prescriptions for those medications. As a result, seniors may pay less for larger quantities of their prescription drugs.
Cash Payments
In some cases, it costs less to pay cash for a prescription than it would to pay the required co-pay. For example, Walmart offers a low-cost prescription program that makes dozens of common medications available for just $4. If a consumer's insurance plan typically charges a $10 co-pay for drugs on the lowest tier, it's cheaper to pay the $4 out of pocket than it would be to pay the co-pay.
- First, pharmaceutical companies spend millions, sometimes billions, of dollars to develop new drugs. When new brand-name drugs enter the market, manufacturers set prices high to recoup their research and development costs.
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4Prescription Assistance and Discount Programs
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Consumers should always ask their insurers if there's any way to save money on monthly prescriptions. Even if the insurer says no, several programs are available to help defray the costs of prescription medications and ensure older adults stay as healthy as possible. Some of these programs are designed to help consumers save money on specific brand-name drugs, while others offer general discounts on a variety of medications.
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Drug-Specific Discount Programs
Bristol-Myers Squibb Patient Assistance Foundation
The Bristol-Myers Squibb Patient Assistance Foundation provides temporary help to pay for Eliquis, Empliciti, Sprycel, Opdivo, Nulojix, Yervoy and Orencia. Assistance is available to uninsured consumers with yearly incomes at or below 300% of the federal poverty level. To be eligible for this program, consumers must live in the United States, the U.S. Virgin Islands or Puerto Rico and be under the care of a licensed prescriber.
GSK for YouGSK for You is managed by GlaxoSmithKline and offers coupons, free trial offers and assistance paying for certain GSK medications. Prescription assistance is available to residents of the United States and Puerto Rico. To be eligible, an applicant must have no prescription drug coverage through any insurance company or prescription program and meet certain income requirements.
Help at Hand Patient Assistance ProgramTakeda Pharmaceuticals administers the Help at Hand Patient Assistance Program to help defray the costs of more than a dozen drugs. The plan covers medications such as Dexilant, Lialda and Prevacid Solutab. To be eligible, a consumer must live in the United States, have a household income of no more than five times the federal poverty level and not have access to any alternate sources of funding. The Help at Hand Patient Assistance Program is available to uninsured consumers and individuals who have inadequate health coverage.
Johnson & Johnson Patient Assistance FoundationThe Johnson & Johnson Patient Assistance Foundation provides free prescriptions to consumers who meet certain eligibility requirements. To be eligible, the consumer must be taking a medication that has been donated to the program by Johnson & Johnson. Applicants must live in the United States or a U.S. territory, lack health insurance or have insurance that doesn't cover the medication and be under the care of a licensed prescriber in the United States. The program covers more than two dozen medications, including Concerta, Elmiron, Haldol and Remicade.
Patient Assistance NowPatient Assistance Now is an online tool managed by Novartis. Consumers can use the tool to search for medications and answer questions about their income and insurance status. Based on the information provided, the tool recommends resources to help reduce the cost of prescription medications.
General Savings Opportunities
DrugCouponSaveDrugCouponSave offers coupons and discount cards provided by drug manufacturers. Coupons are available for drugs like Abilify, Suboxone and Buprenorphine.
GoodRxGoodRx allows consumers to compare prescription prices at local pharmacies to determine where medications are the least expensive. The site also offers coupons for some medications, drastically reducing the cost of paying for prescriptions.
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5Resources By State
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