How to Afford Prescriptions When You Have High Copays

How to Afford Prescriptions When You Have High Copays

How to Afford Prescriptions When You Have High Copays

High copays can make essential medications unaffordable. But with the right strategies—manufacturer programs, state assistance, generics, formulary exceptions, and smart pharmacy choices—you can dramatically reduce your out‑of‑pocket costs.

Quick Take

Nearly 1 in 3 adults say they’ve skipped or rationed medications due to cost. High copays hit hardest when drugs fall on expensive tiers or require coinsurance instead of flat copays. The fastest ways to lower costs: ask about cheaper alternatives, use manufacturer assistance, check state programs, request exceptions, compare pharmacies, and use cash‑price platforms when cheaper than insurance.

Watch: How to Afford Prescriptions With High Copays

1. Ask your doctor about lower‑cost alternatives

Doctors can often switch you to a cheaper medication without sacrificing effectiveness. Many plans charge far more for brand‑name or specialty drugs than generics.

Options to ask about

  • Generic versions of your medication
  • Therapeutic alternatives in a lower formulary tier
  • 90‑day supplies (often cheaper per dose)
  • Free samples while you transition
Tip: Ask your doctor to submit a formulary exception if the cheaper alternative isn’t medically appropriate.

2. Use manufacturer copay cards or patient assistance programs

Drug manufacturers often offer coupons or full assistance for expensive brand‑name medications.

Types of programs

  • Copay cards: reduce your copay at the pharmacy
  • Patient Assistance Programs (PAPs): free or discounted medication for eligible patients
  • Bridge programs: temporary free supply while insurance issues are resolved
Note: Some insurers use “copay accumulator” programs that prevent coupons from counting toward your deductible.

3. Check if you qualify for Medicare Extra Help or state assistance

Low‑income patients may qualify for major cost reductions through federal or state programs.

Programs to explore

  • Medicare Extra Help: reduces premiums, deductibles, and copays to as low as $4.90–$12.15 per drug
  • State Pharmaceutical Assistance Programs (SPAPs): help pay Part D costs or cover drugs your plan doesn’t

4. Compare pharmacy prices—even when using insurance

Copays vary widely, and sometimes the cash price is cheaper than using insurance.

Ways to compare

  • Check prices at multiple pharmacies
  • Use cash‑price tools like GoodRx or pharmacy discount programs
  • Ask the pharmacist if the cash price beats your copay

5. Ask your insurer for a tiering exception or prior authorization review

If your drug is placed on a high‑cost tier, you can request a lower tier placement or coverage review.

What to request

  • A tiering exception (moves your drug to a cheaper tier)
  • Prior authorization reconsideration
  • Medical necessity documentation from your doctor

6. Use mail‑order or preferred pharmacies

Many insurance plans offer lower copays at preferred pharmacies or through mail‑order services.

Benefits

  • Lower copays for 90‑day supplies
  • Reduced dispensing fees
  • Automatic refill discounts

7. Split pills or adjust dosing—but only with doctor approval

Some medications can be safely split to reduce cost, but only if your doctor confirms it’s appropriate.

Examples

  • Higher‑dose tablets that cost the same as lower doses
  • Medications designed for splitting (scored tablets)
Never split extended‑release or coated medications.

Quick comparison: Ways to reduce high prescription copays

Strategy How It Helps Best For
Generics & alternatives Moves you to cheaper formulary tiers Most chronic medications
Manufacturer assistance Reduces or eliminates copays Brand‑name or specialty drugs
State & federal programs Major reductions for low‑income patients Medicare & limited‑income households
Cash‑price comparison Sometimes cheaper than insurance Common generics
Tiering exceptions Moves drug to lower copay tier Non‑generic brand drugs

FAQ: Affording prescriptions with high copays

Why are my copays so high?

Many plans place brand‑name or specialty drugs on higher tiers with higher copays or coinsurance.

Can I get help if my plan won’t cover my drug?

Yes—your doctor can request an exception, and manufacturers often offer assistance programs.

Is it legal for pharmacies to charge different prices?

Yes. Pharmacies negotiate their own prices, which is why comparison shopping matters.

Can I use coupons with Medicare?

Generally no, but Medicare Extra Help and SPAPs can dramatically reduce costs.

Final thoughts

High copays don’t have to force you to skip medications. With the right mix of assistance programs, formulary strategies, pharmacy comparisons, and doctor‑supported alternatives, you can significantly reduce your out‑of‑pocket costs and stay on track with your treatment.


Boss Block: Official Prescription Cost Assistance Resources

Trusted government and nonprofit sources for lowering prescription drug costs.