Help paying for prescriptions

There are several routes, and they are not equal. This page puts them in the order of how much each one actually saves you — which is not the order you usually see them in.

1. Extra Help — start here

If your income is limited, this is the one that matters. Extra Help lowers your Part D premium, deductible and what you pay at the counter. It is free to apply and you apply through Social Security.

If you have full Apple Health, a Medicare Savings Program that pays your Part B premium, or SSI, you should already have it automatically — and if your pharmacy prices have not changed, something has gone wrong that is worth a phone call.

Read the full Extra Help guide

2. Manufacturer assistance programs

Drug companies run their own assistance programs, and for an expensive medication one of them can matter more than anything else here.

We do not keep a list. There are hundreds, they change constantly, and a stale list is worse than none — it sends people to programs that closed. Medicare maintains a current search tool, which is the right starting point.

Search Medicare's assistance program finder

Take the exact name and strength of your medication with you. Programs are listed by drug, not by condition.

3. Generics and lower-cost alternatives

This is underused and it belongs high on the list. There may be a generic version, or a different medication in the same class that costs considerably less and would work just as well for you.

This is a conversation for your prescriber. Not for your pharmacist alone, and certainly not for an insurance agent. Ask directly: is there anything clinically appropriate for me that costs less? Many people have never asked.

4. Where you fill it changes what you pay

Drug plans have pharmacy networks, and within those networks some pharmacies are preferred. The same prescription can cost different amounts at two pharmacies a mile apart on the same plan.

Mail order is worth comparing rather than assuming. Sometimes it is cheaper, sometimes it is not, and it depends on your plan and your medication. The trade-off is convenience against flexibility if a prescription changes mid-supply.

5. If your plan will not cover it

“Not covered” at the counter is not the end of the road, and far too many people treat it as one.

Coverage determination. You can ask your plan for a formal decision about a medication.
Exception request. Your prescriber can support a request when a covered alternative is not appropriate for you.
Appeal. If it is denied, there is a formal appeals process with deadlines.

Your plan must tell you how to start each of these. Ask them, and ask your prescriber's office to help — they do this regularly.

6. LI NET, if you are stuck in a gap

LI NET is a Medicare program that can provide temporary drug coverage for people who have Extra Help or Medicaid but are not yet enrolled in a drug plan. It exists for the gap where somebody is approved on paper but has nothing to show at the counter.

Ask your pharmacist about it, or call 1-800-MEDICARE. Coverage periods and time limits are set by Medicare, so confirm the current rules with them.

7. The Medicare Prescription Payment Plan

This does not lower your costs

It spreads what you owe across the remaining months of the year instead of you paying a large amount at once. You pay the same total. People sign up expecting a discount, and there is not one.

That is not a reason to dismiss it. If a large pharmacy bill in January is the problem, smoothing it across the year is a real help. Just go in understanding what it is: a cash-flow tool, not a savings program.

It is free, and you join through your drug plan rather than through Medicare directly.

What caps your Part D costs

2026 Part D out-of-pocket limit:: $2,100

2026 figures, last reviewed 2026-07-21. Confirm at Medicare.gov.

Once your covered out-of-pocket drug spending reaches the annual limit, your covered drugs are $0 for the rest of that year under the applicable rules. That cap applies whether or not you use the payment plan.

Have your coverage reviewed

Everything above works within whatever drug coverage you already have. The other lever is the coverage itself — drug lists, tiers and pharmacy networks differ, and the plan that was cheapest for your prescriptions last year may not be this year.

That is worth checking annually with your actual medication list in hand.

Questions people actually ask

What is the single biggest thing I can do?

Apply for Extra Help, if your income is limited. It is the only item on this page that reduces what your medication actually costs rather than changing how or when you pay for it. It is free to apply and you apply through Social Security.

My pharmacy says my drug is not covered. Is that final?

No. You can ask your plan for a coverage determination, and if it is denied you can appeal. Your prescriber can support a request for an exception when a covered alternative is not appropriate for you. Plans have to tell you how to do this, and there are deadlines, so start rather than waiting.

Does the Medicare Prescription Payment Plan save me money?

No, and this is the most misunderstood thing in Medicare drug coverage. It spreads your covered out-of-pocket costs across the remaining months of the year instead of you paying a large amount at once. You pay the same total. It helps cash flow, not cost.

Should I use mail order?

Sometimes it costs less and sometimes it does not, and it depends on your plan and the medication. It is worth comparing rather than assuming either way. The trade-off is convenience against flexibility if a prescription changes.

Can my doctor help lower the cost?

Often, yes, and this is underused. There may be a generic, or a different medication in the same class that costs less and is clinically appropriate. That is a conversation for your prescriber, not for a pharmacist, an insurance agent or a website.

Official sources

Bring your prescription list

Tim can review the drug coverage he represents against your actual medications, strengths and pharmacy — which is the only way to know what a plan would really cost you rather than what it costs on average.

Talk With Tim About Medicare: (360) 472-4261

This line is recorded, as Medicare requires for plan conversations.

Last reviewed September 2026. American Senior Choices does not determine eligibility for government assistance programs. Program rules, limits and benefits can change. Talk to your prescriber before changing any medication.

Disclaimer: American Senior Choices is not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Currently we represent 5 organizations which offer 33 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.