When a prescription gets more expensive, what do you try first?

1 reply

1. N Natalie Moore 2 hours ago

   Good question, and the timing matters right now. Medicare open enrollment runs through December 7, and several rules change on January 1 that affect what a refill costs.

   Ask the pharmacist specific questions. “Is there anything cheaper?” usually gets a vague answer. These questions get better ones:

   Is there a generic, or a similar drug on a lower tier of my plan?
   Is a 90-day supply cheaper per dose?
   What is the cash price compared with my copay?

   Since 2018, federal law has barred Medicare drug plans from stopping pharmacists from telling you when paying cash would cost less. Researchers once found the copay was higher than the cash price for nearly one in four drugs, so the question is worth asking. One catch: if you pay cash for a covered drug, ask your plan how to submit the receipt. Otherwise that money may not count toward your yearly out-of-pocket total.

   Know where the cap is, because it’s going up. In 2026, once you’ve paid $2,100 out of pocket for covered Part D drugs, you pay nothing more for them that year. The standard deductible is $615. For 2027, the cap rises to $2,400 and the deductible to $700. Two things don’t count toward the cap: your monthly premiums, and drugs that aren’t on your plan’s formulary.

   The Medicare Prescription Payment Plan spreads out costs; it doesn’t lower them. It turns large pharmacy bills into monthly payments. That helps if one January refill wipes out your budget for the month, but you pay the same total over the year. Enrollment renews automatically unless you opt out, so check whether it still makes sense if your medications have changed.

   Check how your plan charges you for negotiated-price drugs. Since January 1, 2026, Medicare has paid negotiated prices for ten drugs: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp. Those prices are 38% to 79% below 2023 list prices, and 15 more drugs get negotiated prices in 2027. Here’s what many people miss: if your plan charges a flat copay for the drug, the lower price may not change what you pay at the counter. If your plan charges a percentage (coinsurance), it usually will. Your plan’s drug list shows which applies to you.

   Extra Help is the program most people skip, and it can make the biggest difference. For 2026, the income limits are $23,940 a year for one person and $32,460 for a married couple in the 48 contiguous states and DC (Alaska and Hawaii are higher). The resource limits are $18,090 and $36,100, including the burial allowance. Your home, one car, and household belongings don’t count toward those limits. People who qualify pay no deductible and no more than $5.10 for a generic or $12.65 for a brand-name drug in 2026. You get Extra Help automatically if you have full Medicaid, a Medicare Savings Program, or SSI. Everyone else can apply through Social Security at ssa.gov or 1-800-772-1213. If you’re close to the line, apply anyway. Social Security uses countable income after certain exclusions, not your gross income.

   What we see help most: rerunning the Medicare Plan Finder every fall with your exact drugs and doses. Plans change their drug lists and tiers every year, so last year’s best plan can be this year’s expensive one. Your State Health Insurance Assistance Program (SHIP) offers free, unbiased help comparing plans.

   Which drug is giving you the most trouble right now, and is it a flat copay or a percentage?