Information on Medicare Prescription Drug Payment Assistance

Medicare prescription drug coverage comes under the Medicare Part D Drug Benefit, commonly called the prescription drug plans. Once a Medicare recipient’s drug costs reach a specific level, the patient enters the coverage gap, formerly known as the donut hole. This gap in Medicare’s prescription drug coverage requires Medicare recipients to pay 100% of their prescription drug costs out of pocket until their total prescription drug expenditures reach a set dollar amount that changes each year. The Social Security Administration, states and pharmaceutical companies all have programs for prescription drug payment assistance to Medicare recipients who enter the coverage gap.

Social Security’s Extra Help Program

Seniors can apply for the Medicare Rx Extra Help Program through the Social Security Administration to get an average of $3,900 in assistance with drug plan premiums, prescription co-pays and the Part D deductible. People receiving Supplemental Security Income (SSI) or dual Medicare-Medicaid benefits automatically get the Extra Help assistance. Other seniors need to meet certain income and asset restrictions for the Extra Help Program.

To qualify for the Extra Help Program, income from work, annuities, investments, pensions and other benefits must be below a level set each year by the Social Security Administration. Total assets, including bank account balances, investments, stocks, bonds, cash and real estate other than your residence are also subject to limits.

Medicare recipients can apply for the Extra Help program online through www.socialsecurity.gov, by phone or in person at any Social Security Administration office. For in-person applications to the Medicare Rx Extra Help Program, the Social Security Administration recommends arriving at least an hour before the office closes.

State Pharmaceutical Assistance Programs

At the state level, 23 states have programs to help low-income residents defray the costs of their prescription drugs or drug plan premiums. Eligibility and benefits vary by state, but all require some proof of residency in the state. Most state assistance programs have income limits for qualification and require applicants to be enrolled in a Medicare Part D Prescription Drug Plan. Medicaid recipients are generally not eligible for these programs. Some state programs subsidize prescription drug plan premiums for low-income Medicare recipients, while other reduce the costs of selected prescription drugs.

Pharmaceutical Companies’ Prescription Drug Payment Assistance

Most of the major pharmaceutical companies have patient assistance programs to help Medicare recipients pay for their prescription drugs. Some programs provide the prescription medications at a reduced price or even free to qualified Medicare recipients. The companies ship medication directly to the patient, or to the doctors for the patients to pick up.

To receive Medicare prescription drug payment assistance through the pharmaceutical companies, a person must be enrolled in a Part D plan and meet financial criteria that differs for each manufacturer and program. The programs only cover drugs made by that manufacturer, so people taking multiple drugs from different makers may have to apply to several programs, and not all drugs are covered under these programs. Prescription drug assistance program application forms are available at the pharmaceutical companies’ patient information websites.

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