Alyssa Lane
If you are struggling to afford your medication, there are a number of options available to help you obtain lower-cost drugs. These include prescription discount cards, Medicaid, Medicare, pharmaceutical assistance programs, and nonprofits. Many drug companies have patient assistance programs that cover some or all of the costs of their medicines, and some offer medications to patients for free or at a very minimal cost. Additionally, many pharmacy chains such as CVS, Walgreens, and RiteAid offer prescription drug savings, and mail-order prescriptions may also be more affordable. If you are a student, you can look for your school's health center or peer support group, and if you are employed, you can ask your company's human resources department about their Employee Assistance Program (EAP).
| Characteristics | Values |
|---|---|
| Prescription discount cards | BuzzRx, GoodRx, SingleCare, Scriptsave WellRx, County prescription drug discount cards |
| Government programs | Medicaid, Medicare, Extra Help, LI NET, State Health Insurance Assistance Program (SHIP), Medicare Savings Programs (MSPs), Qualified Medicare Beneficiary (QMB) |
| Drug companies' programs | Patient Assistance Programs (PAPs), AZ & Me AstraZeneca Prescription Savings Program, Janssen CarePath, Patient Assistance Program |
| Pharmacy programs | CVS, Walgreens, RiteAid, Walmart, Albertsons, 340B pharmacy |
| Other | Employee Assistance Program (EAP), VA mental health and substance use services, Indian Health Service (IHS) |
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What You'll Learn
Government subsidies for low- and middle-income groups
The federal government subsidizes health insurance for most Americans through various programs and tax provisions. The Congressional Budget Office and the Joint Committee on Taxation regularly prepare projections of the federal costs associated with each kind of subsidy. The federal government subsidizes health insurance differently for different groups of people. For example, the average subsidy per Medicare enrollee in 2023 is $13,150 for people aged 65 or older and $18,320 for people younger than 65 with certain medical conditions or disabilities.
The federal poverty guidelines, commonly known as the federal poverty level, in 2023 begin at $14,580 of income for a single person and increase by $5,140 for each additional person in a household. The federal subsidies for health insurance per subsidized enrollee vary among sources of health insurance and within subgroups of enrollees. For instance, the Inflation Reduction Act (IRA) and American Rescue Plan Act (ARPA) enhanced health insurance subsidies increase the amount of financial help available to eligible individuals under the Affordable Care Act (ACA) and expand subsidies to middle-income people. Before the ARPA and IRA, individuals making above 400% of poverty were ineligible for ACA Marketplace premium subsidies. Now, individuals with incomes over four times the poverty level ($103,280 for a family of three in 2024) can access subsidies that were previously unavailable to them.
Additionally, the Low-Income Subsidy (LIS) helps people with Medicare afford prescription drugs and lowers the costs of Medicare prescription drug coverage. The LIS is available to people who qualify for the full (100%) premium subsidy but are in a plan that increases their premium amount. The federal government also offers Medicaid, a government program for people with low incomes that provides health coverage and prescription drug coverage for eligible patients. Furthermore, the Extra Help program is a federal program that helps people on Medicare afford prescription drugs by covering some or most of the costs for things like plan premiums, deductibles, and copays.
There are also other options for individuals who cannot afford insurance and drugs. Many drug companies have patient assistance programs that cover some or all of the costs of their medicines. Some pharmaceutical companies offer prescription discount cards that can help save money on prescriptions at retail and mail-order pharmacies. Many pharmacy chains, such as CVS, Walgreens, and RiteAid, offer prescription drug savings. Nonprofits also offer free medicines or financial assistance programs for prescription drugs, insurance premiums, or copays to individuals and families with limited incomes. County prescription drug discount cards are available to residents of U.S. counties that are members of the National Association of Counties (NACo) and have joined the association's Live Healthy program.
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Medicaid and Medicare
If you are struggling to afford your medication, there are a few options you can consider. Firstly, you can look into prescription discount cards, pharmaceutical assistance programs, or nonprofits that offer free medicines or financial assistance. Additionally, government programs like Medicaid and Medicare can provide access to affordable healthcare and medication.
Medicaid is a government program that offers health coverage to people with very low incomes. It is a joint federal and state program, which means that while the federal government sets general rules, each state runs its own program with varying eligibility requirements and benefits. Medicaid typically covers expenses such as nursing facility services, home health services, and assistance with paying for Medicare premiums. All states offer prescription drug coverage for eligible patients under Medicaid, and those with Medicaid often don't pay anything for covered medical expenses.
Medicare, on the other hand, is a federal health insurance program for individuals aged 65 and above and those with certain disabilities or conditions. To obtain prescription drug coverage under Medicare, you can join a separate Medicare drug plan (Part D) offered by private insurance companies. Medicare Part D may also qualify you for drug assistance programs that can further lower your medication costs. Additionally, the Extra Help program is a federal initiative that assists individuals on Medicare in affording prescription drugs by covering costs such as plan premiums, deductibles, and copays.
It is important to note that eligibility for Medicare and Medicaid may overlap, and it is possible to have coverage under both programs simultaneously. To determine your eligibility and understand the specific benefits offered in your state, be sure to research your state's Medicaid and Medicare programs.
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State Children's Health Insurance Program (CHIP)
The State Children's Health Insurance Program (CHIP) is a program administered by the United States Department of Health and Human Services. CHIP provides matching funds to states for health insurance for families with children. The program was designed to cover uninsured children in families with modest incomes that are too high to qualify for Medicaid but too low to afford private coverage. CHIP is a partnership between federal and state governments, with programs run by individual states according to federal requirements.
CHIP was formulated in the aftermath of the failure of President Bill Clinton's comprehensive health care reform proposal. First Lady Hillary Clinton's brainchild, the legislation to create CHIP was co-sponsored by Democratic Senator Ted Kennedy and Republican Senator Orrin Hatch. It was included in the Balanced Budget Act of 1997, which President Clinton signed into law in August 1997. The Children's Health Insurance Reauthorization Act of 2009 extended CHIP and expanded the program to cover an additional 4 million children and pregnant women, and the Bipartisan Budget Act of 2018 extended CHIP's authorization through 2027.
By February 1999, 47 states had set up CHIP programs, and by April of that year, 1 million children had been enrolled. States with separate child health programs can impose cost-sharing, tailor their benefit packages, and employ flexibility in eligibility and enrollment matters. Routine "well child" doctor and dental visits are free under CHIP, but some states may charge a monthly premium for coverage.
To apply for CHIP, you can fill out an application on the Health Insurance Marketplace. If it looks like anyone in your household qualifies for CHIP, your information will be sent to your state agency, and they will contact you about enrollment.
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Online companies for prescription drug savings
Prescription drugs can be expensive, but there are a number of online companies and resources that can help you obtain lower-cost drugs. Firstly, you can look into prescription discount cards. Cards such as BuzzRx, GoodRx, SingleCare, Scriptsave WellRx, and America's Pharmacy are accepted at most pharmacies across the US and can help you save up to 80% on prescription drugs. GoodRx also allows you to compare current prices and discounts at different pharmacies.
Secondly, you can look into patient assistance programs (PAPs) that are offered by many drug companies. These programs cover some or all of the costs of their medicines and are often aimed at low-income individuals or people with disabilities. RxHope and PatientAssistance.com are websites that offer applications and coupons for such programs.
Thirdly, you can explore online companies that offer prescription drugs at cheaper prices. For example, Mark Cuban Cost Plus Drugs is an online company founded by Mark Cuban and Dr. Alexander Oshmyansky, which offers generic drugs at the lowest possible price. They work with a trusted fulfillment partner, HealthDyne, to fill your prescriptions from their accredited pharmacies and ship them to your doorstep.
Additionally, if you are 65 or older, you can sign up for Medicare drug coverage (Part D), which may also qualify you for drug assistance programs. If you are a member of a federally recognized American Indian or Alaska Native Tribe, you can also look for services provided by the Indian Health Service (IHS).
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Patient support and advocacy organizations
- Patient Advocate Foundation (PAF): PAF is a national non-profit organization that provides case management services and financial aid to Americans living with chronic, life-threatening, or debilitating illnesses. They offer the Co-Pay Relief (CPR) program, which provides direct financial assistance to individuals with co-payments, co-insurance, or cost-sharing responsibilities for prescription drugs.
- Pharmaceutical Companies' Patient Assistance Programs (PAPs): Many pharmaceutical companies have PAPs that help cover the costs of their medications for those who cannot afford them. These programs can be found through drugmakers' websites, nonprofit sites, or by asking your doctor or pharmacist.
- State Pharmaceutical Assistance Programs: Several states offer programs to help uninsured or underinsured residents pay for medications. These programs are often aimed at individuals who do not qualify for Medicaid.
- County Prescription Drug Discount Cards: Some U.S. counties, through the National Association of Counties (NACo) Live Healthy program, offer their residents free prescription drug discount cards. These cards provide discounts at pharmacies nationwide.
- Nonprofit Organizations: Various nonprofits offer free medicines or financial assistance programs for prescription drugs, insurance premiums, or copays. These nonprofits often support individuals and families with limited incomes.
- Employee Assistance Programs (EAPs): If you are employed, your company may offer an EAP, which is a free and confidential service to support employees with mental health, substance use, or other personal issues.
- Indian Health Service (IHS): If you are a member of a federally recognized American Indian or Alaska Native Tribe or their descendants, you can look for services provided by the IHS.
- AAFA (Asthma and Allergy) : AAFA is a patient support and advocacy organization that provides education and support to patients and families living with asthma and allergies. They also offer connections to resources and information about asthma and allergic diseases.
- PAN Foundation: The PAN Foundation is dedicated to accelerating access to affordable and equitable healthcare through financial assistance, advocacy, and education. They cover a wide range of diseases and chronic illnesses.
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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. Many drug companies have patient assistance programs that cover some or all of the costs of their medicines.
If you are unable to afford your medication without insurance, you can try prescription discount cards such as GoodRx, SingleCare, and Scriptsave WellRx. These cards can help you save money on your prescriptions at retail pharmacies and mail-order pharmacies. You can also try asking your doctor about generics and alternative medications, which may be more affordable. Additionally, you can look for health centers that provide free or low-cost care, or contact your local state insurance commissioner's office to inquire about state drug assistance programs.
If you don't have insurance and can't afford your medication, you can try contacting the manufacturer of the medication to inquire about potential assistance programs. Many drug manufacturers offer medications at a free or minimal cost to patients who are unable to afford them. You can also try finding a health center that provides free or low-cost care, or look into nonprofit organizations that offer financial assistance programs for prescription drugs. Additionally, if you served in the military, you can look into VA mental health and substance use services.
