How can I get help if I can’t afford my prescription?
Prescriptions can be very expensive, especially if you are taking a specialty medication. There are a few things that you can do if you cannot afford your prescription.
- See if a generic is available. Ask your healthcare provider or pharmacist if there is a generic version of the drug you have been prescribed. Generics can cost up to 85 percent less than their brand name counterparts and have lower copayments as well.
- Contact the manufacturer to see if they have a drug assistance program. If you have been prescribed a brand name drug that does not yet have a generic equivalent and you are having trouble affording it, contact the company that manufactures the drug to see if they have a drug assistance program. While these types of programs are not widely advertised, many companies do offer assistance to those who cannot afford their drugs. If a generic for the medication you need is not available, visit the Partnership for Prescription Assistance. The site allows you to search for the appropriate patient assistance programs, free of charge. See our prescription assistance resource guide for additional assistance programs that are available to lower the cost of your prescription drugs.
- Ask your healthcare provider for help. Often these drug assistance programs work with the cooperation of the patient, the healthcare provider, and the drug company. Your healthcare provider may need to call the pharmaceutical company and fill out one or more forms. Again, don’t be afraid to ask for this assistance. Your healthcare team is there to help you get the care you need, and they would rather fill out some forms than have you go without the drugs necessary to manage your condition.
- Apply for Medicaid. Medicaid helps millions of Americans get the healthcare they need, and this often provides assistance with drug costs. Medicaid programs vary by state and criteria for acceptance is not based on your income alone. To find out if you are eligible and if your prescriptions would be covered, you should contact the Medicaid agency in your state.
- See if your state has an assistance program. Many states have State Pharmaceutical Assistance Programs. Check if your state has a program that may be able to help you cover the costs of your prescription medications.
- Ask your pharmacist. In some cases, a pharmacist may be able to give you a few doses of a prescription to hold you over until you can get a written prescription from a healthcare provider. This is not something to rely on, but it doesn’t hurt to ask your pharmacist if this is something they can do for you if you get in a pinch. This may not be possible for certain high-cost or controlled medications, but may be possible for common, low-cost drugs.
- Ask for samples. Ask your healthcare provider if they have any samples they can give you.
- Appeal plan decisions. If your health plan does not cover the cost of your medication, you have the right to appeal and make a claim for why the drug should be covered.
- Contact the drug manufacturer directly. You may qualify for the manufacturer’s patient assistance program (if they have one), which could offset your copay.
- Work with your healthcare provider. Make sure they have properly documented your health history and see if they have any creative solutions so that your insurance plan will cover your prescription.
- Ask your employer for guidance. Many employers assume the financial risk of enrollees’ medical claims, and going to your employer can speed up the process.
- Appeal plan decisions. If your health plan does not cover your medication, you have the right to appeal and make a claim for why the drug should be covered.
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