If you belong to a Medicare Part D plan but cannot afford your medications under this coverage—whether or not you have Extra Help (federal assistance that helps with the costs of the Medicare drug benefit) or get help from a state prescription assistance program—there are a few options that might help, especially during your Part D plan’s coverage gap (“doughnut hole”):
– If you have Extra Help, find out if your drug plan has a mail-order option. Because you have Extra Help, you may be able to receive a 90-day supply of mail-order medications and pay the same amount you would pay at the pharmacy counter for a 30-day supply.
– Request that your plan put your drug in a lower “cost tier” for you. To do so you will have to have your doctor submit a formal request to your plan to ask for an “exception” to the formulary.
– Some pharmacies and hospitals will waive copays for people with low incomes. Talk to your pharmacist or hospital about your financial situation and see if they will help.
– Some states, such as New York, offer pharmaceutical assistance programs called “SPAPs” that help their members pay the out-of-pocket costs of a Medicare Part D drug plan.