Leah Kari, retired pharmaceutical representative and licensed insurance agent
Prescription drugs are lifelines that improve our health and quality of life. Often medication costs might prohibit filling a prescription. The Inflation Reduction Act (IRA) brought welcomed cost relief effective Jan. 1, 2025. The IRA placed a $2,000 limit on you and your prescription drug coverage’s share of cost for plan-covered Part D medications. When the $2,000 limit is reached, the plan pays the entire cost of your covered Part D prescription drugs: You pay zero out-of-pocket costs. To benefit, one must be enrolled in a stand-alone prescription drug plan or have prescription drug coverage through a Medicare Advantage plan. The drugs must be on the plan’s formulary or the $2,000 limit will not apply.
Further relief for those using expensive drugs lies in pharmaceutical assistance programs (PAPs). PAPs may help those struggling to afford their prescriptions.
What’s a PAP? PAPs are sponsored by pharmaceutical companies, certain non-profit organizations, and government agencies. to provide no cost or discounted medications to eligible individuals.
How Do I Qualify? Eligibility requirements vary. There may be income thresholds or a requirement to provide documentation of financial hardships. Age, medical condition, and residency status may apply.
Where Do I Start?
1. Ask your provider: Your provider is aware of the cost and if assistance programs are available. Some have staff who handle PAP matters or alert you if a grant is offered.
2. Gather Your Documentation: You’ll need identification, medical and insurance information, as well as proof of income or a tax return.
3. Complete and Submit the Application: You will apply online or via paper applications based on the organization. Providing complete and accurate information will avoid processing delays. Be mindful of deadlines for submission to qualify.
4. Follow Up: After submission, contact the organization for status updates. If more information is needed, provide it promptly to expedite the review process.
If you don’t qualify, don’t be discouraged by your medicine’s cost. Other resources may help manage prescription costs:
State and Federal Programs: Social Security’s Extra Help and the State Health Insurance Program (SHIP) offer help for prescription medications to eligible individuals.
Non-Profit Organizations: The Patient Advocate Foundation, Needy Meds, and Good Day, as some examples, offer resources for aid with medication costs.
Pharmacy Discount Cards: Available at participating pharmacies, these no-cost, no-obligation cards are found at the pharmacy counter and may reduce the cost of medications. Beware: If you do use a discount card for a drug, that drug will not be run through your prescription drug coverage and you’ll risk reaching the $2,000 limit. This is a key consideration. Call your plan or licensed insurance agent for guidance on this.
PAPs help meet the challenges in affording prescription medications and are simple to navigate. Relief in the cost of medications is a vital lifeline to ensure access to essential medications.
For more information, reach Leah Kari at 520-484-3807 or email leah@leahkarisolutions.com. (TTY users dial 711).