Helping Medicare Patients Manage Medication Costs

One of the most frustrating aspects of medicine is knowing there are medications available, but patients cannot access them due to cost. High medication costs can force many older adults with chronic conditions to delay or skip needed treatment. For Medicare patients, the challenge is often tied to copays, deductibles, and out-of-pocket cost spikes that can occur during the year under Part D prescription drug coverage.

Two helpful forms of support include copay assistance programs through nonprofit organizations and Medicare’s cost-smoothing features. While participation varies by plan, the Medicare smoothing concept is intended to make out-of-pocket spending more predictable.

Foundations That Help With Prescription Copays

Nonprofit foundations can provide financial assistance for prescription copays based on eligibility rules. Some programs target specific diagnoses or medications.

HealthWell Foundation

The HealthWell Foundation provides assistance for eligible patients managing chronic conditions who meet program criteria, including many Medicare Part D beneficiaries.

Patient Advocacy Resources

Navigating Medicare drug coverage and assistance programs can be confusing. Eligibility depends on factors such as income, medication and your Part D plan.

Patient Advocacy Network

The Patient Advocacy Network connects patients and caregivers with guidance and resources to identify available assistance.

Medicare Help That Can Lower Costs: Extra Help (LIS)

Many Medicare patients should first determine whether they qualify for Extra Help, AKA Low-Income Subsidy (LIS). It can significantly reduce Part D premiums, deductibles and copays.

The Medicare Smoothing Program

Some Medicare beneficiaries experience large changes in out-of-pocket spending as Part D coverage phases shift during the year. The Medicare smoothing approach is designed to reduce those spikes.

What Patients Should Do

• Ask how out-of-pocket costs are calculated.
• Ask if the plan offers smoothing or cost-predictability options.
• Request an explanation of how copays change during the year.

Medicare plan features vary, so patients should confirm details directly with their Part D plan.

Medication-Specific Assistance Programs

Some medication manufacturers also offer programs that reduce out-of-pocket costs for eligible patients.

Medicare assistance programs: medicare.gov/pharmaceutical-assistance-program.

Patients can also check for state pharmaceutical assistance programs through the same Medicare resource.

Quick Checklist: What to Gather Before Applying

• Medicare card
• Medication names and dosages
• Pharmacy name and location
• Prescriber information
• Part D insurance information
• Income and household information (if required)
• Recent copay or out-of-pocket statements (if requested)

Medication costs shouldn’t force difficult choices. With support from foundations, advocates and Medicare resources, many patients can reduce copays and avoid treatment interruptions.