Prescription assistance programs — reducing the medication bill

Your parent's pharmacy bag is thick with bottles. Medications for blood pressure, cholesterol, arthritis, diabetes, anxiety, sleep. Some cost twenty dollars a month. Others cost hundreds. Your parent's Medicare covers some of it, but with deductibles and copayments, they're still spending more on medications than they spend on food.

You've wondered whether there's help. Maybe your parent qualifies for something. Maybe there's a program that could reduce the cost. But you don't know where to start, and the idea of applying for programs sounds overwhelming.

Here's the thing: there are real programs that reduce medication costs, and they're specifically designed for people in your parent's situation. Not all of them require your parent to be poor or to jump through impossible hoops. Some are simple. Some require paperwork, but the paperwork is worth it. The money you save is real.

Understanding the Basics

Most people think medication assistance is only for people with no income. That's not true. There are programs for people on fixed incomes, people with Medicare, people with insurance that doesn't cover certain drugs. The qualification rules vary widely, but the point is that if your parent is struggling to pay for medications, something might exist to help.

The biggest program is Medicare Part D, which is prescription drug coverage. If your parent is on Medicare, they probably have Part D already. But many people don't understand how Part D works or whether they're getting the best plan for their situation. If your parent is on Part D but struggling with costs, the problem might be that they're on the wrong plan, not that no help exists.

Then there are state pharmaceutical assistance programs, sometimes called prescription assistance programs. These programs exist in most states and are specifically designed to help people with moderate incomes who struggle to pay for prescriptions. Eligibility varies by state, but many have income limits that include people who seem reasonably well-off. If your parent's income is below a certain threshold, they can apply. Some states are generous with eligibility. Some are strict. You need to find out what your parent's state offers.

Pharmaceutical manufacturers run their own assistance programs. If your parent takes brand-name medications, the company that makes them might have a program that provides the medication free or at a reduced cost. This isn't well-publicized because people don't know to ask. But if your parent is taking expensive brand-name drugs, the manufacturer almost certainly has a patient assistance program.

Generic medications are typically cheaper than brand-name drugs, but they're not free. Some assistance programs focus on generics because they're cheaper and more people can use them. Some focus on helping people afford brand-name drugs when there's no adequate generic.

Non-profit organizations sometimes have programs to help with prescription costs. These are often focused on specific diseases like diabetes or heart disease. If your parent has a chronic illness, there might be an organization focused on that illness that provides medication assistance.

Your Parent's Specific Situation

The first thing you need to know is what medications your parent actually takes. Write them down. Include the drug name, the dose, and approximately how much it costs. Ask your parent's pharmacy for a cost breakdown if you're not sure. The pharmacy knows what each drug costs and what insurance covers.

Next, understand your parent's insurance situation. Do they have Medicare Part D? If yes, which plan? Some Part D plans are better for people taking lots of medications. Some are better for people with limited prescriptions. The plan your parent is on might not be optimal for their actual medication use. During the Medicare Part D open enrollment period each fall, your parent can change plans. If they're in a plan that's costing them too much, switching plans might help.

Then ask your parent about income. This isn't fun, but you need to know it to determine which programs they might qualify for. Approximately how much does their Social Security, pension, and any investment income add up to annually? Does their state program have income limits? Call your state pharmacy assistance program and ask for the income limits. You'll quickly know whether your parent is in the range for that program.

For brand-name medications, you need to know the specific drugs. If your parent takes a drug called Lipitor, for example, you'd go to Pfizer's website and look for patient assistance programs. If they take Metformin, which is typically generic and cheap, there's no manufacturer program because the drug is so inexpensive already. You need to look at the specific drugs your parent actually takes.

Document what you find. For each drug, write down whether there's assistance available, what the program requires, and what it might reduce the cost to. This isn't something you do once and never again. As your parent's medications change, you'll need to revisit this. As income changes, eligibility might change. Insurance plan changes might open new options.

Taking Next Steps

Start with the low-hanging fruit. If your parent is on Medicare Part D, spend an hour looking at whether their current plan is optimal. Go to Medicare.gov and use their plan comparison tool. Enter your parent's prescriptions and see which plans cover those drugs at the lowest cost. If a different plan would save money, talk to your parent about switching during the open enrollment period.

Next, find out what your state's pharmaceutical assistance program is called and what its website is. Every state has something, though the names vary. You might search "your state name" plus "prescription assistance program" or "pharmaceutical assistance program." When you find it, read the eligibility requirements carefully. If your parent seems to qualify, apply. The application usually requires proof of income, which is straightforward. Your parent's Social Security statements or tax return usually works.

For brand-name medications, identify which drugs your parent takes. Go to the manufacturer's website. Look for "patient assistance" or "patient programs." Most manufacturers make these programs relatively easy to find because they want to enroll patients. You'll usually fill out an application and provide proof of income. The program determines whether your parent qualifies. If they do, the medication becomes free or very cheap.

If your parent takes a lot of medications, consider consulting with a pharmacist. Many insurance plans cover pharmacist consultations. A pharmacist can review all your parent's medications and identify whether there are generic alternatives to expensive drugs, whether there are assistance programs you've missed, whether there are interactions you should know about. This is a free or very low-cost service that people rarely use.

Keep track of everything you apply for. Make a list of programs you've applied to and what you're waiting to hear. Some programs process applications quickly. Some take weeks. If you've applied to five programs, you want to remember which ones and follow up when you haven't heard anything.

Be persistent. The first program might deny your parent. That doesn't mean no help exists. Apply to others. Some programs have stricter eligibility than others. Your parent might not qualify for one but might qualify for another.

Once your parent is enrolled in programs, their situation might change. They might get a raise in pension income, which could affect eligibility. Their medications might change. They might get married or divorced, which affects the household income calculation. You'll need to update programs as circumstances change.

The other piece is that pharmaceutical assistance is constantly evolving. New programs appear. Old ones change their rules. Programs that would help with a drug one year might not the next. This isn't something you figure out once and then ignore forever. You check occasionally to see if anything new exists or if circumstances have changed in a way that opens up new options.

Some people pay for medication consultation from a pharmacist specifically to review their parent's medication situation and identify all possible cost-saving programs. This costs money upfront but might save thousands annually. It's worth considering if your parent takes multiple expensive medications.

The Reality of Savings

How much money are we talking about? That depends entirely on what your parent takes. If they're taking multiple expensive brand-name medications, assistance programs might save hundreds of dollars a month. If they're taking medications that have cheap generics, the savings might be modest. Either way, it's money you're not giving to pharmaceutical companies, and money saved is money your parent has for other needs.

The process isn't instant. It takes time to apply, to get approved, to fill out paperwork. You can't usually do it overnight. But if your parent's medications are a chronic expense, spending a few hours now to set up programs that reduce that expense for years makes sense.

The process also isn't permanent. Programs change. Eligibility changes. Your parent's situation changes. Staying aware of what exists and whether your parent still qualifies is part of the ongoing financial management of aging.

What to Do Right Now

If you haven't looked into medication assistance yet, start this week. Spend an hour gathering information about your parent's prescriptions and their insurance situation. Find the names of the medications, the doses, and the approximate costs. This is the foundation for everything else.

Then spend another hour researching. Call your state's pharmaceutical assistance program. Look at Medicare.gov and understand your parent's Part D plan. Check the websites of manufacturers for your parent's brand-name drugs. You're not committing to anything yet. You're just gathering information.

After you've gathered information, decide what makes sense to pursue. If switching your parent's Part D plan would save money, put that on your to-do list for the open enrollment period. If applying to your state's pharmaceutical assistance program seems like it might help, get the application started. If your parent takes expensive brand-names, apply to the manufacturer programs.

The effort you put in now compounds over years. If you reduce your parent's medication costs by two hundred dollars a month, that's $2,400 a year. If your parent lives ten more years, that's $24,000. That's not a fortune, but it's real money that could go toward other needs instead of prescriptions.

Many families get stuck in the assumption that medication costs are what they are, that there's nothing to be done about them. This isn't true. There are always options, and most of them involve paperwork and time, not money. Your time now is an investment in your parent's financial wellbeing going forward.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you are concerned about a loved one's cognitive health or safety, consult with their healthcare provider or contact your local Area Agency on Aging for guidance and support.