Here’s how to pay the lowest prices for your prescription drugs on Medicare

One of the most maddening parts of being on Medicare—and there are plenty—is figuring out how to get the best prices for your prescription drugs. If you think all you need to do is buy a Part D prescription drug plan, think again.

“You can go to pharmacies that are right down the street from each other and get different prices on your prescription drugs,” said Leigh Purvis, AARP’s senior director for health care costs and access.

Cindy George, senior personal finance editor at GoodRx, a prescription discount card company, said: “People are paying all kinds of prices for the same drug, with the same strength and dose every day.”

Yet it’s vitally important for Medicare beneficiaries to keep their prescription costs down.

At a time when U.S. drug prices are roughly twice as high as in comparable countries, and 42% of people 65 and older take five or more prescriptions, a quarter of people that age report having difficulty affording prescriptions. A 2023 survey by the KFF health research firm found that 11% of Medicare beneficiaries delayed or went without their prescription drugs in the previous year due to cost.

“You really have to do a lot of competitive shopping around,” says Dr. Richard Sagall, president of Needy Meds, a nonprofit offering free information on prescription drug savings. “But if you’re persistent, you can save thousands of dollars.”

You need to compare prescription prices regularly, though, to ensure you’ll get the lowest price every time you order—especially for expensive brand-name medications which can cost thousands of dollars; prices of generics may be 90% lower.

Where to find prescription savings on Medicare

Start by finding the best Medicare Part D plan for the prescriptions you take

That’s smart whether you have Traditional Medicare or a private insurer’s Medicare Advantage plan that includes a Part D component. (If you have a Medicare Advantage plan, you can switch to a different one or switch to Traditional Medicare during the Medicare Advantage Open Enrollment Period ending March 31.)

The Medicare site’s Plan Finder tool lets you compare how much you’d pay for your prescriptions on Part D plans available where you live.

Bear in mind that a Part D plan might have a great price for one of your medications, but not another one. It might not even cover one or more of your prescriptions in its list of medications, known as a formulary. “Every Part D insurer charges different co-pays for different drugs and has different drugs on its formulary,” said Diane Archer, president of Just Care USA, a digital hub for older Americans’ health and money.

When paying for your prescriptions, “you can just use your Part D coverage, it’s just that it might cost you a lot more than you should be paying,” Archer noted.

Get assistance with an expensive, brand-name prescription drug

See if its manufacturer offers a Patient Assistance Program (PAP) that could provide the medication for free, or at a dramatically reduced price, for a period of time. These pharmaceutical programs are offered for certain medications for people who qualify for financial assistance.

“The pharma companies give away billions of dollars’ worth of drugs every year” through PAPs, said Sagall. “We encourage everyone to look there because some of the eligibility guidelines are pretty generous. I’ve seen some for people whose income is 600 or 800 times the federal poverty level.” (That translates to roughly $100,000.)

Patient Assistance Program guidelines can vary for different medications at the same company, so you’ll want to check for a PAP for every pricey brand-name prescription you take.  “It’s really a complicated system for people to navigate,” said Purvis.

The NeedyMeds site tracks Patient Assistance Programs and has a free email alert service to get PAP updates.

Apply to your State Pharmaceutical Assistance Program (SPAP) for older adults if there is one and you qualify

Thirteen states, mostly in the Northeast, have SPAPs that help pay prescription-drug related costs for people with limited financial resources through cost-sharing assistance and reductions in Part D premiums. Some pay for prescriptions that Medicare or your Part D plan won’t cover.

The SPAP states are Delaware, Indiana, Maine, Maryland, Massachusetts, Missouri, Montana, New Jersey, New York, Pennsylvania, Rhode Island, Vermont and Wisconsin.

Most of them limit enrollment to lower-income people 65 and older, but the ceiling is much higher in Massachusetts, New Jersey, New York and Rhode Island. Wisconsin’s SPAP is open to older state residents with any income, according to James McSpadden, a senior policy advisor at AARP.

Nearly all the programs require beneficiaries to enroll in Medicare Part D plans; six are available only to residents in Medicare’s low-income subsidy program.

If you live in a SPAP state, your State Health Insurance Assistance Program (also known as a SHIP) or state Department of Health can tell you whether you qualify and how to enroll. “We found that there are a lot more people who are probably eligible than are actually enrolled,” said McSpadden.

Sign up for Medicare’s low-income subsidy program known as Extra Help, if you qualify

With Extra Help, your Part D premium and deductible are both $0 and you’ll pay no more than $4.50 for each generic drug and a maximum of $11.20 for each brand-name drug. Once the total drug costs paid by you and your plan combined hit $8,000, you pay $0 for each covered medication.

The Extra Help eligibility limits have been raised for 2024. This year, the program is available to individual on Medicare with income under $22,590 and assets of less than $17,220 (not including your home, one car and furniture).

Look into discount programs from pharmaceutical chains and disruptor from Mark Cuban

Major pharmacy chains such as CVS, RiteAid, Walgreens and Costco Pharmacy offer free or inexpensive loyalty or rewards programs for members. Some of these companies also have premium versions that cost more but provide bigger savings.

You can’t use your Part D prescription plan at Cuban’s Cost Plus Drug Company, but the savings can be huge if your medication is offered.

Cost Plus sells and delivers prescriptions—about 1,000 generics and 10 brand-name drugs—at its cost plus 15% and the pharmacy fee, if there is one. For instance, Cost Plus charges $5.60 for a metformin tablet (a generic diabetes pill), vs. about $20 at other pharmacies. The generic for the cholesterol drug Zetia costs $6.80 per tablet, compared with roughly $113 at other pharmacies.

“You might look at what Costco charges online for its drugs you take and what Mark Cuban’s Cost Plus pharmacy charges as a quick comparison against what your Part D drug plan charges,” advised Archer.

Get a pharmacy discount card (or more than one)

You’ve likely seen TV commercials for free or inexpensive cards like SingleCare or Good Rx and possibly wondered whether they’re worth the trouble.

Actually, these cards, also available as downloadable apps, can save you as much as 80% on some prescriptions, especially generics. Sometimes, they also have special money-saving deals on particular prescriptions and medical aids. For instance, GoodRx’s partnership with continuous glucose monitor maker Dexcom means its card can save $200 a month on Dexcom’s G6 system.

“Discount card programs can really help you cover those medications that aren’t covered through Medicare,” said Ramzi Yacoub, chief pharmacy officer at RxSense and SingleCare.

But there are nearly a dozen pharmacy discount cards and, based on review sites like Payingforseniorcare.com and Seniorliving.org, none always offer the biggest savings for users for all their prescriptions.

“The discount you get depends on the pharmacy,” said Sagall. “I’ve seen a $100+ difference between local pharmacies.”

When you use a discount card, you’re buying medications with cash and not using your Part D plan’s insurance. That means whatever you pay with one of the cards won’t reduce your Part D deductible and may not count towards your out-of-pocket limit, said Purvis.

The cards are typically accepted at major chain drugstore outlets and many local pharmacies; their costlier premium versions typically offer bigger discounts but at fewer drugstores than their free cards.

However, each discount card has its own list of medications than qualify, participating drugstores and assorted benefits, such as price alerts when a prescription’s price has dropped significantly. Some cards have home delivery; others don’t.

Their discounts can be volatile, too. So, the savings you get with a card one month at a particular pharmacy may be lower, or nonexistent, when it’s time for a refill. “The best deal today may not be the best deal next month,” said Sagall.

That’s why it’s best to always compare the card’s current price with your Part D plan’s price before buying a prescription.

Consider buying medications from a licensed online pharmacy in another country

You’re allowed to do this for personal use but you’ll want to take care that the pharmacy is reputable.

One way to avoid risks is by using the Pharmacychecker site, which verifies and monitors credentials of international online pharmacies and compares their prices. The 24-year-old site claims patients who compare prices globally before buying prescriptions often save 70% to 90% or thousands of dollars a year.

Nervous about buying prescriptions from outside the U.S.?

Archer’s take: “Many of the drugs we take are manufactured in India and China, so when you’re importing drugs from abroad, you’re often importing them from the same factories that are manufacturing drugs here. If you buy from verified pharmacies abroad listed on Pharmacychecker.com, you should not encounter any risks.”

Where to get help on prescription-savings questions

If all of this sounds overwhelming, you might want assistance from a human.

Your state’s SHIP plan has Medicare experts who dispense objective, free advice over the phone. You won’t be told which Part D plan or discount card to get, but you could learn how to make that decision yourself.

Your pharmacist can also lead you to the biggest savings on your medications.

Until 2018, pharmacists were prohibited from voluntarily telling customers they could save on prescriptions by buying with cash rather than insurance. Today, pharmacists can often tell you whether you’ll save more using your Part D plan or not and their computers may reveal which discount card would give you the largest price break on the prescription you need.

“Ask whether there’s a coupon available for that drug at a lower price than your Part D co-pay,” said Archer.

Medicare beneficiaries taking eight or more Part D medications for chronic diseases such as osteoarthritis, diabetes, depression, heart failure and depression may also qualify for the program’s free Medication Therapy Management, offered by all Part D plans. It lets you have one-on-one consultations with pharmacists to go over all your medications and see if there are lower-cost alternatives.

“Medication Therapy Management lets a pharmacist look holistically at all the prescriptions someone takes,” said McSpadden.

You can get help applying for a Patient Assistance Program through the NeedyMeds site’s directory of free advisors, typically offered by your local Area Agency on Aging or your state or county health department.

Needy Meds also has a toll-free number you can call weekdays to speak with one of its helpline representatives: 800-503-6897.

A few final money-saving tips

Sometimes, you can also save on prescriptions depending on the dosage and quantity you buy. “A five-milligram pill may be cheaper than splitting a 10-milligram pill and sometimes the 10-milligram is cheaper,” said Sagall.

You may get a price break by buying a three-month or six-month supply of a medication rather than one month. Walmart’s prescription program provides a 90-day supply of certain generics for $10 a month, for instance.

You could also save by getting prescriptions through your Part D insurer’s mail-order plan, though mail-order isn’t necessarily less expensive than in-person (plus there’ll be a delay in receiving what you need).

Prescription-drug savings will get easier in 2025 and subsequent years.

That’s because next year, a provision of the Inflation Reduction Act of 2022 will kick in, capping out-of-pocket Part D charges at $2,000. Starting in 2026, Medicare will begin implementing negotiated prices for a select number of expensive medications, unless lawsuits prevent that part of the Inflation Reduction Act from taking effect.

“It’s safe to say that there is help coming and people on Medicare should see their out-of-pocket prescription costs dropping soon,” said Purvis.

This story was originally featured on Fortune.com