How to Get Help with Medication Costs and Affording Other Healthcare

Prescription prices challenge many consumer budgets, but you may qualify for help with medication costs as well as other healthcare expenses.

Here are some strategies for affording prescriptions and other healthcare costs.

What if I can't afford my prescriptions?

About one-third of people in the U.S. don't fill their prescriptions because of high costs. Not taking prescribed medication as directed risks your health and may increase your medical expenses in the long run. You can work with healthcare professionals at your doctor's office and pharmacy to make prescriptions more affordable with and without insurance.

There are many ways to save on prescription medications. Your options include:

• Using GoodRx coupons

• Switching to generic medications or biosimilars

• Using manufacturer copay savings offers

• Applying for patient assistance programs

• Comparing prices at different pharmacies

• Using your funds from a health savings account (HSA), flexible spending account (FSA), or health reimbursement arrangement (HRA)

• Splitting pills, if safe for you (check with your prescriber and/or pharmacist)

• Getting a 90-day or 3-month supply instead of filling every month

• Using a mail-order pharmacy

• Using Medicare's Extra Help program, if you qualify for the low-income subsidy

• Using Medicaid, if you're eligible

• Using a State Pharmaceutical Assistance Program, which is also available in Washington, D.C., and some territories

• Seeing if you qualify for a Pharmaceutical Assistance Program, as long as your prescriptions are covered by Medicare Part D

• If you have insurance, using an in-network pharmacy

• If you have insurance, using a medication that's covered by your formulary

How to get help with medication costs

Sometimes, you need a prescription and can't get a lower price. Here are some ways to get help accessing your medication affordably:

• File an appeal with your insurance plan: You can ask your prescription plan to cover a certain medication that you need. If your appeal is denied, you can request an independent review by your state or territory insurance regulator.

• Contact patient advocacy organizations: Some charitable groups, such as the Patient Advocate Foundation, focus on supporting people with costly medical care. Patient advocacy groups - particularly ones associated with your condition - can guide you to resources that can help with medication costs.

• Check with patient assistance programs: Drugmakers, their foundations, and other nonprofit organizations may help you get your medication for free. You can use Fund Finder to locate a program that can assist you, based on your condition and other specifics.

Patient assistance programs

As mentioned, patient assistance programs help people with no insurance or those who are underinsured afford their medications. These programs may be offered by pharmaceutical companies, nonprofit organizations, and government agencies. Some of these include:

• HealthWell Foundation, which helps people with insurance cover premiums, deductibles, copays, and other out-of-pocket costs for specific conditions

• PAN Foundation, which assists people who have specific conditions that are rare, chronic, and/or life-threatening

Your healthcare professional can use RxHope to apply for free or discounted brand-name medications directly from manufacturer patient assistance programs on your behalf.

State pharmaceutical assistance programs

State Pharmaceutical Assistance Programs, also known as SPAPs, are run by some states and territories to help pay prescription-related costs for certain people with limited financial resources. SPAPs mainly assist older adults. Eligibility requirements vary by program.

Free prescription programs

Pharmaceutical companies often have special programs that can help you afford your medications. These include partnerships with related company foundations or relationships with other nonprofit organizations that connect people in need with deeply discounted or free medication. Some free prescription programs also can be considered patient assistance programs. You can also find these services by searching GoodRx for your medication and looking for information about ways to save.

Here are some examples of free prescription programs:

• AstraZeneca: The AZ&Me AstraZeneca Prescription Savings Program can help you get free medication. You are eligible if you don't have health insurance or if you have Medicare but still can't afford your prescriptions. There are also income requirements. AstraZeneca makes many medications, including Farxiga, which is used for Type 2 diabetes and other conditions, and Tagrisso, which treats lung cancer.

• Janssen CarePath: The savings program known as Janssen CarePath is transitioning to become J&J with Me. For a while, you'll see both names used. This savings program includes more than 40 medications, including Remicade, Simponi, and Stelara, all of which treat autoimmune conditions. There are no income requirements to participate in the savings program. The Janssen CarePath Patient Assistance Program is for people who have insurance, but face affordability challenges. There are income requirements for that program.

• Lilly Cares: The Lilly Cares Foundation Patient Assistance Program helps people in financial need access more than two dozen medications at no cost. Eligible medications include several insulins in different formulations - such as Humalog and Humulin R - as well as Cymbalta, which treats conditions including depression, anxiety, and long-term pain.

• Merck: MerckHelps assists people in affording their medications through several programs, such as the Merck Patient Assistance Program and the Merck Vaccine Patient Assistance Program. MerckHelps also has a program to replace certain medications you received in the hospital. You may be able to get medications at no cost, including Keytruda, which treats many types of cancer, and Januvia, for Type 2 diabetes.

Generic medications

For starters, generic medications are typically less costly than brand-name versions. Talk to your healthcare professional about generics and other lower-cost alternatives that could be prescribed.

Your pharmacy may offer generics for less than $10 per fill. The Walmart Prescription Program provides certain generic medications for $4 for a 30-day supply at typical doses and $10 for a 90-day supply. You can also find savings at many pharmacies nationwide by using a GoodRx coupon for a generic version of your medication.

While biosimilar medications are made and regulated differently than generics, choosing them instead of their reference biologic can save you money.

Crowdsourced fundraising

Before the internet, crowdsourced medical fundraising meant barbecues, fish dinners, charitable concerts, donation jars, and passing the hat in your local area. But over the last decade, online medical fundraising increasingly means digital crowdsourcing worldwide to pay for healthcare expenses. GoFundMe - founded to raise money for social causes and now the largest global crowdfunding platform - reports that about one-third of donations go to medical costs. By 2023, the site was raising about $750 million a year for medical expenses.

You can start an individual crowdfunding campaign to help with your healthcare costs, but be aware that most efforts on GoFundMe reach less than half of their fundraising goals. It's also important to recognize that GoFundMe and other platforms charge transaction fees. In addition, the amount you raise could have personal tax implications or change your eligibility for Medicaid and other government benefits.

Medicare Part D changes coming in 2025 and 2026

If you have a Medicare prescription plan, there are changes coming in 2025 and 2026 that can save you money and help you manage costs. These updates apply to you whether you have a standalone Part D plan or your prescription coverage is included in your Medicare Advantage plan. The changes include:

• $2,000 out-of-pocket limit: In 2025, you won't spend more than $2,000 out of pocket for prescriptions covered by your plan. After that, your prescription plan picks up 100% of the costs of your covered medications.

• Medicare Prescription Payment Plan: This option allows you to be billed for your portion of covered medication costs instead of paying your pharmacy directly. Starting on January 1, 2025, the Medicare Prescription Payment Plan can help you manage your out-of-pocket costs, but it doesn't save you money or reduce your medication prices. People likely to find the greatest relief from the payment plan have costly medications that require them to meet their annual deductible early in the year. The payment plan can spread those costs over the entire year.

• Donut hole eliminated: Starting on January 1, 2025, the donut hole - also known as the Medicare Part D coverage gap - will be eliminated. Part D cost-sharing will collapse to three phases: deductible, initial coverage, and catastrophic coverage. After meeting your deductible, which is $590 maximum in 2025, you enter the initial coverage phase of cost-sharing with your insurance plan until you reach $2,000 in out-of-pocket spending. Then, you qualify for catastrophic coverage, which means your covered medications are paid in full by your prescription plan for the rest of the year.

• Medicare Drug Price Negotiation: Medicare can now negotiate the prices of high-cost prescription medications with drugmakers because of provisions in the Inflation Reduction Act of 2022. The program aims to reduce prices for medications covered under Part B outpatient insurance and Part D prescription coverage. The 10 medications selected for the first round of Medicare Drug Price Negotiation are all covered by Part D and treat conditions including diabetes, heart failure, and psoriasis. The lower prices will be effective January 1, 2026.

How to get help affording other healthcare costs

Besides prescriptions, you may have trouble paying for your healthcare, such as doctor visits and hospital stays. Here are ways to find free and low-cost healthcare and health insurance:

• Check out hospital programs: You may qualify for financial assistance programs from hospitals that are required to offer free and discounted care to people with low and moderate incomes. This can help you avoid medical debt.

• Find free and low-cost healthcare: You may find many types of healthcare at low or no cost in your community, including access to diapers, condoms, Narcan, and durable medical equipment at no cost.

• Access medical transportation: Nonemergency medical transportation is covered by some Medicare Advantage plans. If your health plan doesn't provide that benefit, the National Aging and Disability Transportation Center - which advocates for available and accessible transportation for seniors, people with disabilities, and caregivers - can help you find free and low-cost transportation in your area.

• Get help paying medical bills: Here are 10 solutions for tackling unpaid medical expenses you can't afford.

• Enroll in a low-cost insurance plan: Most people find an ACA plan for $10 or less per month if they qualify for a premium subsidy.

• Stay on your parent's plan: If your parent has a job-based or ACA marketplace plan, you can become or remain a dependent on that insurance up to age 26 - and until you're older, under certain circumstances, in several states.

• Use a student health plan: If you're enrolled in a college or university at any age, you may be eligible for a campus health plan.

• Join a loved one's plan: If you are married or have a domestic partner, you may be able to join their health plan.