Why 60 million Americans may struggle to afford their medications
The current structure of the Medicare Part D program affects some of our most vulnerable neighbors—especially older adults living on a fixed income.
For them, the burden of high out-of-pocket costs for their medications can mean difficult choices between getting treated or paying for daily living expenses—things no one should have to worry about.
Use this Medicare Part D FAQ to equip yourself with answers to the most commonly asked questions about this critical issue.
Medicare Part D is an optional prescription drug program for people on Medicare. The structure of Medicare Part D plans can be complex, but there are resources to help you understand and enhance your prescription coverage.
- Medicare.gov is the official U.S. site for Medicare and offers information to help you understand your Medicare Part D costs and benefits.
- Medicare Interactive is a free online reference tool created by the Medicare Rights Center to help older adults and people with disabilities navigate the complex world of health insurance.
- My Medicare Matters is a free educational service from the National Council on Aging designed to make it easier for people with Medicare to make informed decisions about their coverage.
A drug formulary is a list of specific prescription drugs that are covered by a health insurance plan, which includes drugs that are preferred because of efficacy and cost.
Most Medicare Part D plans categorize the medications they cover into groups called “tiers.” Most formularies have three to five tiers, and more expensive drugs are placed in higher tiers.
To learn how formulary tiers affect your out-of-pocket costs, check out the helpful reference sheet we’ve put together.
We understand it can be difficult to discuss finances with your healthcare provider, but we want you to feel empowered to speak up and push back.
Don’t be afraid to ask your doctor, pharmacist, social worker, or healthcare provider for advice on where to find financial assistance.
We created a tip sheet with questions to help you get the conversation started.
When insurance is inadequate, certain charitable organizations like PAN can help reduce your out-of-pocket medication costs.
If we are unable to assist you with your out-of-pocket costs for prescription medications, one of the following organizations* may be able to help:
- The Assistance Fund »
- CancerCare »
- Good Days »
- HealthWell Foundation »
- Leukemia & Lymphoma Society »
- National Organization for Rare Disorders (NORD) »
- Patient Advocate Foundation »
- Patient Services, Inc. »
*Please note that this resource list is intended to serve as a reference guide only and does not indicate PAN’s support of any particular organization. PAN cannot determine or guarantee whether patients will be eligible for assistance from these organizations.
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