Department of Human Services

Q:  As a Medicare Beneficiary, How Can I Lower the Costs of the Prescription Drugs that I Need to Stay Healthy?

A:  There are several ways to cut the cost of your medicines, without compromising your health.  For starters, talk to your doctor, and see if there are other, less-expensive medicines available.  These can be generic formulations, lower-priced brand name medications, or even over-the-counter drugs.  Switching may save you a lot of money.

Also, if your doctor can recommend a lower cost drug option, before switching make sure that your current prescription drug plan will help pay for it.

If you can't switch, consider using a mail-order pharmacy, particularly for medicines you will be taking for a long time, because most of the time you have to purchase mail-order in 3-month quantities.  Most of the time, you will pay less by ordering this way, and renewing your order is as simple as a phone call.  Be sure to check with your doctor about getting a prescription that can be renewed.

If you're not already part of a Medicare prescription drug plan, which is Medicare Part D, joining one can help, too, especially if you have multiple prescriptions, or must take expensive brand-name drugs. You can always join a Medicare Part D plan during your initial enrollment period for Medicare. In most cases, the only other time you can join a Part D plan is during the open enrollment period in the fall, which is October 15 through December 7 every year, but there are some exceptions.

One exception is for people who qualify for Medicare's Extra Help program in paying for prescriptions.  If you meet the limited income and resources qualifications for this program, the cost you pay for your prescriptions drops sharply, and in many cases, you won't have to pay a monthly premium for the plan at all.  And, if you qualify, you can enroll in a Medicare prescription drug plan immediately, without waiting for the open enrollment period, to start cutting costs as quickly as possible.  To apply for the Extra Help program contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or you can apply online at www.socialsecurity.gov.

Q:  Are There Other Prescription Drug Savings Options if I Don't Qualify for the Extra Help Program?

A:  Yes, there are.  In some locations, a State Pharmaceutical Assistance Program (SPAP) can help.  These programs are available in 23 states, and help people with Medicare pay for the premiums of their Medicare Part D drug plans, and/or help cover your out-of-pocket costs for medicine. To find out if your state has such a program, visit www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx.

There are also programs run by drug manufacturers that can reduce the cost of medications they manufacture.  Many, but not all, manufacturer programs can be used by Medicare beneficiaries.  To find out if there is a program offered by the manufacturers of the drugs you take, and whether you qualify, visit www.medicare.gov/pharmaceutical-assistance-program/index.aspx.

There are also national and community-based programs that may offer assistance, such as the National Patient Advocate Foundation, or the National Organization for Rare Disorders.  Information on these assistance programs can be found on the Benefits Check Up website, www.benefitscheckup.org.

Finally, to get help finding these resources, you can call your State Health Insurance Assistance Program (SHIP). They provide free, knowledgeable, unbiased, and personalized counseling.  The SHIP phone number for your state is on the back page of your Medicare & You handbook, or you can get their number by calling Medicare's toll-free helpline, below.

If you have a question about Medicare, call 1-800-MEDICARE, which is, 1-800-633-4227.  Medicare's national toll-free helpline is available 24 hours a day, seven days a week, or visit www.medicare.gov or log onto www.healthcare.gov to read more about the Affordable Care Act.