How can you get help paying for your medications?
Even with insurance, out-of-pocket costs for prescription medications can be surprisingly high. GoodRx research found that more than half of Americans have trouble paying for prescription medications, and nearly a third aren’t filling their prescriptions due to high costs.
So how can you get help paying for your medications? Talking to your prescriber about more affordable options is a good first step. But there are many other ways to keep your prescription medication costs down.
Key takeaways:
- If you need help paying for your medications, first talk to your prescriber about more affordable options. You may be able to save by switching to a lower-cost generic or choosing a medication that’s covered by your insurance.
- Look into savings through manufacturer copay savings cards and patient assistance programs, or use online tools to compare medication prices and find discounts. If you qualify, programs like Medicaid or Medicare Extra Help can also reduce your expenses.
- Other practical ways to help you pay for your medications include getting a 90-day supply, using tax-advantaged funds, or asking your healthcare team if it’s safe to split higher-dose tablets.
These 10 tips from GoodRx, a platform for medication savings, may help you save on your prescription medications.
1. Ask for a lower-cost generic
Ask your prescriber for a medication that has a lower-cost generic available, if possible. Generic medications work just as well as brand-name versions, but typically cost much less — with or without prescription insurance.
For example, a 30-day supply of brand-name Zoloft 50 mg costs an average of $576.77 without insurance. But the same dose and quantity of generic sertraline costs about $30.75 on average.
2. Check your insurance plan’s formulary
An insurance plan’s formulary lists the medications the plan covers. Formularies are often divided into several tiers. Lower-tier medications generally have a lower cost. Higher-tier medications typically have a higher cost or require extra steps (such as prior authorization or step therapy) before the plan will cover them.
If you have prescription insurance, reviewing your plan's formulary can help you save money. You’ll be able to see if your medications are covered and at what cost. You can also see if any of your medications are in a high tier. You can then ask your prescriber about lower-tier alternatives.
This helps you to make informed decisions about your medications and find ways to save money.
3. Look for a manufacturer copay savings card
Many manufacturers offer copay savings cards or programs to help you save on the cost of your medications. These are often for brand-name medications that don’t have a lower-cost generic available.
Many copay savings cards require enrollees to have insurance coverage. But some programs offer savings to those without insurance, too. You typically aren’t eligible for these programs if you have government-funded insurance, such as Medicare or Medicaid.
Some common examples of copay savings cards and programs include:
You can find a copay savings card directly via the manufacturer website for your medication. You can also use medication pricing tools to find the different savings programs available.
4. Ask for a 90-day supply
Asking your prescriber for a 90-day supply of your medication (instead of a typical 30-day supply) can be a smart way to save money. This approach works best for any medications you take regularly for chronic health conditions.
If you have prescription insurance, your plan may charge you a lower copay overall when you fill a 90-day supply of your medication. Keep in mind that you may need to use a mail-order pharmacy in order to access this discount.
You may also pay less overall with a 90-day prescription if you’re paying for the medication out of pocket (without insurance). When you buy a larger quantity, you typically pay less per dose. So while the upfront cost might be higher, you'll likely save money in the long run. Plus, you'll make fewer trips to the pharmacy, saving you time and travel costs.
5. Talk to your healthcare team about splitting your pills
You may be able to save money by asking your prescriber for a higher dose of your medication and splitting the pills in half. For example, if you take sertraline 50 mg once daily, ask your prescriber to write you a prescription for sertraline 100 mg instead. You’ll get a 60-day supply out of just 30 tablets, which can help you save money.
But keep in mind that you can’t split all pills in half. Many medications are specially formulated and won’t work properly if you cut them. So be sure to talk to your pharmacist before trying this savings option.
6. Use a free prescription discount service
Prescription discount providers can help reduce your out-of-pocket costs. There are discounts available for both brand-name and generic medications. What’s more, you can compare prices at pharmacies near you to find the best deal.
Most discount cards can’t be combined with insurance. But in some cases, the coupon price may be lower than your insurance copay or coinsurance. So it’s often worth comparing the two prices.
Good to know: You can also use discount cards to save on the cost of over-the-counter (OTC) medications. You’ll just need a prescription for the OTC product from a healthcare professional.
7. Use your HSA, FSA, or HRA funds
If you have a health savings account (HSA), a flexible spending account (FSA), or a health reimbursement arrangement (HRA), you can use it to help cover your out-of-pocket medication costs. These tax-advantaged healthcare accounts let you pay for eligible expenses with tax-free dollars.
Pay for your medication directly with your HSA or FSA card, or cover the cost yourself and submit a request for reimbursement. The funds in HSAs and HRAs typically roll over annually, but you have to use your FSA dollars before the deadline or they’ll expire.
8. See if you’re eligible for Medicare Extra Help
If you have Medicare Part D, you may qualify for Medicare Extra Help. This program helps people with limited resources pay less for certain brand-name and generic medications.
Eligibility is based on income and resources. The income limits change yearly, so it's worth looking into even if you didn't qualify in the past.
9. Look into Medicaid coverage
Medicaid is a government-sponsored program that provides free or low-cost healthcare coverage (including for prescription medications) to people who meet certain income requirements and other qualifications.
Each state’s Medicaid program has its own eligibility requirements and list of covered medications. You can look into your eligibility and apply for Medicaid coverage online, or by visiting a state Medicaid office in your area.
10. Apply for patient assistance programs
If you’re uninsured or underinsured, patient assistance programs (PAPs) could help you access your medications for free or at a low cost. Similar to copay savings cards, these programs are often sponsored by pharmaceutical manufacturers.
To qualify for a PAP, you generally need to meet income requirements and provide proof of being uninsured or underinsured. Some common manufacturer-based patient assistance programs include:
Nonprofit PAPs
There are also nonprofit PAP organizations that could help you pay for your medications. Some examples include:
State PAPs
State Pharmaceutical Assistance Programs (SPAPs) offer eligible residents financial help with prescription medication costs. Some also offer specialized assistance, such as for HIV medications. The individual programs, benefits, and eligibility criteria vary from state to state.
The bottom line
Paying for prescription medications can be a challenge, even if you have insurance. Many people struggle with high costs, and some skip filling their prescriptions because of it. A good first step is to talk to your prescriber about more affordable options, such as switching to a lower-cost generic or choosing a medication that’s covered on your insurance plan’s formulary. You can also look into manufacturer copay savings cards and patient assistance programs, or use tools to compare prices and find discounts.
Other ways you may be able to save money on your medications include getting a 90-day supply, using tax-advantaged funds, and asking your healthcare team if it’s safe to split higher-dose tablets. If you qualify, programs like Medicaid or Medicare Extra Help can also reduce your expenses. Exploring these options and asking the right questions can make your medications more affordable.
This story was produced by GoodRx and reviewed and distributed by Stacker.
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