Jeffrey Wade
Despite having insurance, many seniors in the United States struggle to afford their prescription medications. In fact, a federal report from 2019 found that 3.5 million Americans aged 65 and older had difficulty paying for their prescriptions. This issue is not limited to those over 65, as 1.8 million Medicare beneficiaries under 65 also faced problems affording their medications that year. This article will explore the reasons why so many people are unable to afford their prescriptions, even with insurance, and outline some potential solutions to this pressing issue.
| Characteristics | Values |
|---|---|
| Prescription medication is expensive | 20% of elderly individuals (65 years of age and older) say it is difficult to afford the cost of their prescription medicine |
| Rising prescription costs | Many Americans are finding that affording their prescribed medication is a financial strain on their budget |
| Solutions | Prescription discount cards, Medicaid, Medicare, pharmaceutical assistance programs, and nonprofits |
| Generic drugs | Generic drugs contain the same active ingredient and are approved by the U.S. Food and Drug Administration (FDA) to treat the same health conditions as their brand-name counterparts. They are equally effective, safe, and can be up to 85% cheaper than brand-name drugs |
| Drug assistance programs | Many pharmaceutical companies, state programs, and nonprofits have patient assistance programs (PAPs) that can lower the cost of medicines if you don’t have insurance or are underinsured and can’t afford your medicine |
| Medicare | If you're 65 or older, you can sign up for Medicare drug coverage (Part D) as a first step. Part D is an optional benefit from private insurance companies for an extra fee |
| Medicare Part D | The average out-of-pocket cost is $89 per month |
| Medicaid | The out-of-pocket costs range from $.99-$13 per month |
| Medicare Advantage | Some seniors face obstacles that prevent them from truly understanding how it works and who it benefits |
| Medicare Advantage | 65% of seniors’ prescription costs are out-of-pocket |
| Medicare Wraparound Programs | Provide financial assistance to cover the cost of prescriptions not paid for by Medicare Part D |
| Extra Help | A federal program that helps people on Medicare afford prescription drugs. Depending on how much you make, Extra Help covers some or most of the costs for your Medicare Part D coverage – things like plan premiums, deductibles, and copays |
| Online or mail-order pharmacies | These pharmacies are often less expensive |
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What You'll Learn
Seniors may be eligible for Medicare drug coverage (Part D)
Seniors who are entitled to Original Medicare Part A and/or enrolled in Medicare Part B may be eligible for Medicare Part D prescription drug coverage. Part D plans are part of the government's Medicare program but are offered and managed through approved private insurers. Seniors can either enroll in a separate, standalone Part D plan or choose to join a Medicare Advantage plan (Part C) that includes drug coverage.
Part D plans help protect against high-cost prescription drugs by offering various levels of cost coverage for different "tiers" of drugs. They offer flexibility and choices in cost and benefit levels depending on your needs and other coverage you may have. However, not all drugs are covered, and plans differ from insurer to insurer. Each plan has its own drug list, level of cost coverage, and monthly premium. Seniors should review the details of any plan before enrolling and select one that covers their prescription drug needs.
Seniors may also qualify for Extra Help with their Medicare Part D plan, which provides assistance with drug costs. They can apply for Extra Help and Medicare Savings Programs (MSPs) at the same time, as these state programs provide help with other Medicare costs. Additionally, some pharmaceutical companies offer patient assistance programs (PAPs) that can lower the cost of medicines for those with Medicare Part D coverage.
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Generic drugs are cheaper than name-brand drugs
The rising cost of prescription medication in the United States is making it difficult for many Americans to afford their prescribed drugs, even with insurance. In such cases, generic drugs are a cheaper alternative to name-brand drugs. Generic drugs are approved by the U.S. Food and Drug Administration (FDA) and contain the same active ingredients as their brand-name counterparts. They are equally effective and safe, with the same therapeutic effect, and can be up to 85% cheaper.
The FDA monitors and ensures the safety and quality of both brand-name and generic drugs, including testing for approval prior to marketing, ongoing inspections of manufacturing facilities, and the continued safety of drugs after approval. When a generic drug is found to have problems with safety or quality, the FDA issues a recall and removes the products from store shelves.
However, it is important to note that generic drugs may not always be a suitable alternative to name-brand drugs. In some cases, there may be a slight variation in the body's response to a different drug, which can create a significant problem. It is always recommended to consult with a healthcare provider or pharmacist before switching between generic and brand-name medications. Additionally, while generic drugs are usually cheaper, there have been instances where the prices of generic drugs have increased significantly, sometimes due to a decrease in the number of producers or supply issues.
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Nonprofits offer free medicines or financial assistance
In the United States, rising prescription costs are making both name-brand and generic drugs unaffordable for many, even for those with insurance. Nonprofits and patient assistance programs (PAPs) can help lower or eliminate the cost of medicines for those who are uninsured, underinsured, or unable to afford their medication.
Several nonprofits offer free medicines or financial assistance programs for prescription drugs, insurance premiums, or copays to individuals and families with limited income. For example, the HealthWell Foundation provides financial assistance to help with prescription copays, travel costs, behavioral health services, health insurance premiums, deductibles, and copays. The PAN Foundation offers similar support for out-of-pocket medicine costs, including copays, health insurance premiums, and transportation costs related to medical care. Good Days provides financial support for people who cannot afford the treatment they urgently need, including copay, travel, premium, and diagnostic testing assistance. Harbor Path delivers lifesaving medicine for free to people who are uninsured in 24 states.
Other Options for Financial Assistance
In addition to nonprofits, there are other options for financial assistance to help with the cost of medication. These include prescription discount cards, Medicaid, Medicare, and pharmaceutical assistance programs. For seniors specifically, the U.S. Department of Housing and Urban Development offers several programs for low-income seniors who need help supplementing their income, including a reverse mortgage program for homeowners aged 62 and up who have paid off their mortgage. The Low-Income Home Energy Assistance Program (LIHEAP) also provides federally-funded assistance for low-income seniors with home energy bills.
Patient Assistance Programs (PAPs)
Many pharmaceutical companies and state programs offer PAPs to lower the cost of medicines for those who are uninsured or underinsured. These programs vary, and eligibility is often based on insurance, income, and the specific medicine required. For example, AZ&Me is a patient assistance program for those with Medicare Part D coverage who cannot afford AIRSUPRA. Similarly, AstraZeneca US Patient Support offers copay savings cards and patient assistance programs depending on the type of insurance held.
Generic Drugs
If a prescription drug is not covered by an insurance plan, it may be more affordable to switch to a generic drug. Generic drugs contain the same active ingredient and are approved by the U.S. Food and Drug Administration (FDA) to treat the same health conditions as their brand-name counterparts. They are equally effective, safe, and can be up to 85% cheaper.
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Drug assistance programs from pharmaceutical companies
Many pharmaceutical companies, state programs, and nonprofits have patient assistance programs (PAPs) that can help lower the cost of medicines for people who cannot afford their prescription drugs, even with insurance. These programs are designed for those who do not have insurance or are underinsured. Eligibility for these programs depends on factors such as insurance coverage, income, and the type of medication required. Some programs may even provide free medicines to eligible individuals.
- Teva Cares Foundation Patient Assistance Programs: This program offers assistance to those who meet their eligibility requirements. For more information, visit their website or call 888-838-2872.
- Boehringer Ingelheim's Inhaler Price Cap: Boehringer Ingelheim has capped the cost of their inhalers at $35 for those with commercial or private insurance.
- Dupixent MyWay® Copay Card: This program helps lower the cost of copays for those with commercial insurance. For more information, visit their website or call 844-387-4936, option 1.
- AZ&Me Patient Assistance Program: AZ&Me offers assistance to individuals with Medicare Part D coverage who cannot afford AIRSUPRA. It is also available to those without insurance or whose insurance does not cover AIRSUPRA. For more information, call 866-480-0030.
- AstraZeneca US Patient Support: AstraZeneca offers savings and patient assistance programs for several of their medicines, depending on the type of insurance you have. They also provide copay savings cards.
- Mark Cuban CostPlus Drug Company: This company provides access to affordable medicines at the lowest possible price.
In addition to these company-specific programs, there are also other options to consider, such as prescription discount cards, Medicaid, Medicare, and nonprofits that offer financial assistance for prescription drugs. It is worth exploring these options to find the most suitable solution for your specific situation.
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State programs provide financial assistance for medications
Many seniors in the United States struggle to afford their medications, even with insurance. State programs, along with pharmaceutical companies and nonprofits, offer patient assistance programs (PAPs) to lower the cost of medicines for those who are uninsured or underinsured. These programs vary, and eligibility is often contingent on insurance coverage, income, and the medication required.
State Health Insurance Assistance Programs (SHIP) are available in many states to help seniors apply for Medicare Savings Programs (MSPs) and Extra Help with Medicare costs. Extra Help is a federal program that assists those with limited incomes and resources in paying for prescription drugs. It is available in the 50 states but not in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. If you do not automatically qualify for Extra Help, you can apply for it, and you may also qualify for a Medicare Savings Program at the same time.
Medicare Part D is a program that helps older adults with prescription drug costs. If you have limited income and resources, you may be able to get help through Medicare Part D's Low-Income Subsidy (LIS), also known as "Extra Help." The average out-of-pocket cost for those with Medicare Part D coverage is $89 per month. If you cannot afford your medication, you may be eligible for a patient assistance program like AZ&Me.
Some states offer lower copays or eliminate the copay altogether for those with Medicare Part D coverage. It is worth checking with your state to see if help with drug costs is available. Additionally, some pharmaceutical companies offer help with paying for their drugs, and mail-order prescriptions may also be a more affordable option.
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Frequently asked questions
If you are struggling to afford your medication even with insurance, some resources to help are prescription discount cards, Medicaid, Medicare, pharmaceutical assistance programs, and nonprofits. You can also talk to your doctor about taking a generic drug instead of a name-brand drug. Generic drugs are equally effective, safe, and can be up to 85% cheaper.
Many pharmaceutical companies, state programs, and nonprofits have patient assistance programs (PAPs) that can lower the cost of medicines. Some programs that specifically help seniors are Medicare wraparound programs and the federal Extra Help program.
Many pharmacy chains such as CVS, Walgreens, and RiteAid offer prescription drug savings. Some nonprofits offer free medicines or financial assistance programs for prescription drugs, insurance premiums, or copays to individuals and families with limited income.
You can try online or mail-order pharmacies, which are often less expensive and may offer a 90-day supply of your prescription, which means fewer copays for refills. You can also ask your doctor about lower-cost alternatives or look into prescription discount cards.
