Medicare and prescription drugs: how to lower your annual cost

Most people shopping for Medicare drug coverage focus on the monthly premium. But premium is usually the smallest piece of what you'll actually spend on prescriptions over a year. The bigger levers are the ones nobody points out at enrollment: which formulary tier your drugs land on, whether you qualify for financial assistance, and whether you're still on last year's plan out of habit rather than because it's still the cheapest one for you. Here's where the real savings are.

1. Find out if you qualify for Extra Help

Extra Help, officially the Low-Income Subsidy (LIS), is a federal program that reduces or eliminates your Part D premium, deductible, and copays based on income and resources. It's separate from Medicaid, though people with Medicaid, Supplemental Security Income, or a Medicare Savings Program are usually enrolled automatically. If you're not sure whether you qualify, it costs nothing to check — the application goes through the Social Security Administration, and the savings can be substantial for people on multiple ongoing medications.

2. Check your state's pharmaceutical assistance options

Several states run their own pharmaceutical assistance programs (SPAPs) that work alongside Part D to further reduce drug costs for qualifying residents, and some offer separate discount programs regardless of income. These vary a lot by state, so it's worth a quick check with your state's department of aging or insurance department, or asking us — we're licensed in Virginia, Maryland, Georgia, Texas, Michigan, North Carolina, South Carolina, Alabama, Louisiana, Indiana, and West Virginia and can point you to what's available where you live.

3. Ask about generics and therapeutic alternatives

• Generic equivalents. Where a generic version of your medication exists, it almost always sits in a lower formulary tier than the brand-name version, meaning a lower copay every time you fill it.
• Therapeutic alternatives. Sometimes there's no generic for your exact drug, but a different medication in the same class treats the same condition and costs much less under your plan. This is a conversation for your doctor or pharmacist — never switch medications without their guidance — but it's worth asking the question directly: "Is there a lower-cost option in the same drug class that would work for me?"

4. Use your plan's preferred pharmacy and mail-order options

Plans often set lower copays at "preferred" network pharmacies, and a pharmacy that technically accepts your plan isn't necessarily a preferred one — the difference in your copay can be noticeable. Many plans also offer 90-day mail-order fills for maintenance medications at a lower per-fill cost than three separate 30-day pickups. If you're on a stable, long-term prescription, ask your plan whether mail order is available and what it would save you.

5. Ask your plan for a formulary exception or tier reduction

If a medication you need is on a high-cost tier or isn't on your plan's formulary at all, you and your doctor can request a formulary exception, asking the plan to cover the drug at a lower tier or to cover it at all based on medical necessity. It's a formal request with your doctor's documentation attached, and it doesn't always succeed — but for an expensive, medically necessary drug, it's worth the effort before simply accepting the sticker price.

6. Re-shop your plan every Annual Enrollment Period — even if you're happy with it

This is the single most overlooked cost-saving move. Formularies, pharmacy networks, and premiums can all change from one plan year to the next, even for a plan you've been happy with for years. A plan that was the cheapest option for your medications last year is not guaranteed to be the cheapest this year. Every Annual Enrollment Period (October 15 – December 7), it's worth running your current drug list against what's newly available for the coming year, whether you have a standalone Part D plan or drug coverage bundled into a Medicare Advantage plan.

7. Compare standalone Part D against a bundled Medicare Advantage plan

If you have Original Medicare with a Medigap policy, you need a separate standalone Part D plan since Medigap doesn't cover prescriptions. If you're on Medicare Advantage, drug coverage is typically already built in. Occasionally, switching between these approaches — not just switching within one — changes your total annual drug cost meaningfully, especially if your medication needs have changed since you first enrolled. This is exactly the kind of comparison worth having a second set of eyes on.

How Honorbrook helps

Lowering your prescription costs on Medicare almost never comes down to one silver bullet — it's usually two or three of the moves above stacked together: checking for Extra Help, confirming your pharmacy is preferred, and re-shopping your formulary at Annual Enrollment. We run your exact medication list against the plans available in your area, flag assistance programs you may qualify for, and show you the real annual cost — not just the premium. It's free, and we're licensed in Virginia, Maryland, Georgia, Texas, Michigan, North Carolina, South Carolina, Alabama, Louisiana, Indiana, and West Virginia.

This article is general information, not advice. Program eligibility, formularies, and plan rules vary by plan, carrier, state, and year — a licensed agent will help you review your specific situation.