Field Work

Drug Discounts, Other Help Available

Consumers are powerless to control spiraling medication prices, but low-income, uninsured and under-insured individuals can often get help paying for their drugs.

The help, in the form of subsidies or prescription price reductions, comes from four sources. The first is exclusively for seniors on Medicare, but the rest are available to everyone.

Federal aid

Medicare’s Extra Help program provides up to $4,900 to subsidize retirees’ drug copayments and Medicare Part D premiums. Individuals are eligible for this assistance if their income is less than $18,210 and the value of their investments, bank accounts and other assets is under $14,390. The limits for couples are $24,690 in income and $28,720 in assets.  Retirees who own their homes do not have to include the property’s value in this limit. Social Security’s website explains what does and does not count as assets.

Social Security takes the applications for this Medicare program. Applications can be submitted either online (SSA form 1020) or in person by making an appointment at a local Social Security office.  Social Security also notifies seniors about whether they qualify.

Price discounts in an app

If your drug is not covered by your health insurance, Consumer Reports suggests trying two cell phone apps (or go online) to search for the lowest-cost prescriptions at various pharmacies in your area. On the apps – GoodRx and BlinkHealth – search your drug name and dose and enter your zip code to find the discounted prices, which can vary dramatically. These companies act as middlemen between consumers and Pharmacy Benefit Managers, which buy generic and brand-name medications in bulk from manufacturers and pass the volume discounts on to consumers. GoodRx provides a coupon that can be saved on a phone or printed out for the pharmacist. BlinkRx requires consumers to pay for the drug on its website and provides a voucher for the pharmacist. These cash prices will not be run through insurance – and won’t count against your deductible – said Lisa Gill, Consumer Reports deputy editor and a specialist in medication pricing.

Walmart also offers discounts on generic drugs, and Costco has very low retail drug prices. Which option is best for you? “It’s going to depend on which medication you take and probably where you live,” Gill said. Not everyone will have success in reducing their costs but, she added, “if the drug’s not covered by insurance, it’s worth trying.”

Drug company discounts

For brand-name medications, consumers may have more luck checking for a manufacturer discount. RxAssist is a one-stop website for consumers of all ages applying for discounts or free medications directly from pharmaceutical companies. To check whether assistance is available, enter a specific drug’s name on RxAssist’s website – say, Lantus, the insulin. When the user is sent to the next page, they can click on the drug’s name to be forwarded to a page with the drug maker’s application form and program guidelines – in this case, Sanofi.  To qualify, most companies require that individuals have low incomes, lack medical insurance, or are underinsured, said Shirley Titus, RxAssist’s Program Coordinator. But Sanofi’s Lantus page says that it may help some Medicare beneficiaries, too, if they are “ineligible for [Sanofi’s] low income subsidy and have spent at least 5% of their annual household income (out of pocket) on medications.”

RxAssist’s database also provides information about copay assistance programs and about a drug discount program for the non-profit pharmacy RxOutreach. RxOutreach helps patients find lower-cost alternatives to expensive medications. For example, there are several generic options for Plaquenil, a common treatment for autoimmune conditions. Patients follow the same process: enter the brand-name drug – Plaquenil – and follow the links to a page detailing RxOutreach’s applications, requirements for prescription assistance, and other information. (As a last resort, Titus said patients can also call a drug company directly. RxAssist provides a directory with phone numbers for RxOutreach and the drug companies.)

Finally, anyone can print out and use RxAssist’s discount card. Titus said patients can call the number on the card – 877-537-5537 – to get information about drug prices and pharmacies in their area that participate in the program. The pharmacies include both neighborhood stores and major companies like CVS, according to RxAssist.

Pharmacies will negotiate prices

A recent blog post highlighted a strategy for reducing drug costs that not everyone is familiar with: negotiate with your pharmacist.

In the article, California pharmacist Mohamed A. Jalloh explains: “If you process a prescription through your insurance – whether under an employer’s health insurance or Medicare drug coverage – the price may be higher than paying straight cash for the medication.” So ask the pharmacist if he or she can help. “Anyone can do this,” Jollah said.

In the blog’s comment section, numerous readers weighed in with their own tips or described their successes and failures in cutting their medication costs.

Squared Away writer Kim Blanton invites you to follow us on Twitter @SquaredAwayBC. To stay current on our blog, please join our free email list. You’ll receive just one email each week – with links to the two new posts for that week – when you sign up here.  This blog is supported by the Center for Retirement Research at Boston College.

5 Responses to Drug Discounts, Other Help Available

  1. geoff says:

    I take many drugs daily due to a medical condition and during the initial phase after retiring (due to health reasons) I tried to apply to pharmaceutical companies for subsidies. However, after looking into it, the income threshold is so low one would have to be in poverty to get grants. This is just an MBA marketing driven ploy to make the companies look like they help citizens. It is a con job. I should know, I taught marketing courses at a graduate level in an ivy league school.

    • Dave G. says:

      Not sure your idea of poverty level. I’ve seen qualifying incomes from $35,000 to $65,000 and have helped multiple clients apply. Patient Assistance programs are specific to the drug, the manufacturer, your income, number of people in household and any other drug coverage you may have.

      If you have Part D, most require you first exhaust your Initial Coverage Limit ($3,820 in 2019) before they give you the drug. Others simply want to see you’ve spent a certain amount ($600-$900) out of pocket for all drugs to qualify. Assistance programs change and you must re-apply to remain in the program.

  2. Nancy says:

    BlinkRX seems to have become WellRX.

  3. Edward Hoffer MD says:

    Be sure to spend some time on the phone to do price shopping. The difference in price among pharmacies is astonishing. In the fall of 2018, Mass PIRG staff called pharmacies in 11 states and got prices varying by as much as 3,000% – and that is not a typo. 40mg esomeprazole from $10 to $338 for 30 days.

    Read my book Prescription for Bankruptcy.

  4. Gerald E. Marino says:

    Hi…you have suggested very good sites for price discounts (GoodRx and Blinkhealth). But I’ve been buying from Webhealthmart for several years. They provide overnight delivery and discounts on generic products.