Can't afford your medication? Free and low-cost prescription help

Prescription prices vary enormously depending on how you pay. The same drug can cost a few dollars as a generic, a moderate amount with insurance, or a very large amount at full list price. The first and simplest move is always to ask your prescriber and pharmacist whether a generic, a biosimilar, an older drug in the same class, or a different dose form would work as well and cost less.

Patient assistance programmes (PAPs) are run by pharmaceutical manufacturers and give brand-name medicines free or at very low cost to people who meet income criteria and lack adequate coverage. Applications usually need a form completed with your prescriber and proof of income. The medicine is often shipped to your doctor's office or home. Income limits are frequently generous, sometimes several times the poverty line.

Community health centres and some hospitals participate in the federal 340B programme, which lets them buy medicines at steep discounts. Many pass savings to low-income and uninsured patients through their pharmacies. If you use a health centre, ask whether its pharmacy can fill your prescriptions at a lower price.

For people on Medicare, Extra Help reduces Part D premiums and copays substantially, and the Medicare drug benefit now has an annual out-of-pocket cap for covered drugs, with the option to spread costs into monthly payments. Insulin costs for Medicare enrollees are capped per month for covered insulins. Some states run their own pharmaceutical assistance programmes for older adults or people with specific conditions.

Discount cards and cash-price comparison sites can lower costs for uninsured people or for drugs not covered by insurance - sometimes below an insurance copay. Use them carefully: they do not count toward your insurance deductible, and you should share all your medications with one pharmacist to check interactions.

Manufacturer programmes often exclude people with Medicare Part D or Medicaid, though some make exceptions. Check each programme's rules.

1. Ask your prescriber about cheaper options

   Generics, older drugs or different doses can cost far less. Ask directly: 'Is there a less expensive option that would work for me?'

2. Check the manufacturer's patient assistance programme

   Search the drug name with 'patient assistance programme', or use the manufacturer's website. Ask your doctor's office - many help with forms.

3. Use a community health centre pharmacy

   Ask whether you can fill prescriptions there at 340B discounted prices.

4. Apply for coverage

   Medicaid if eligible; on Medicare, apply for Extra Help through Social Security.

5. Check your state's programme

   Search your state name with 'pharmaceutical assistance programme'.

6. Compare cash prices

   For uncovered drugs, compare pharmacy prices and discount options.

7. Talk to your pharmacist

   They can suggest savings and check interactions.

Generic drug

A copy of a brand-name drug with the same active ingredient, usually far cheaper.

Patient assistance programme (PAP)

A drug manufacturer programme giving medicines free or at low cost to eligible people.

340B programme

A federal programme letting certain clinics buy medicines at discounted prices.

Formulary

The list of drugs an insurance plan covers, often in tiers with different copays.

Prior authorisation

Insurer approval required before covering certain drugs.

Out-of-pocket cap

The annual limit on what Medicare Part D enrollees pay for covered drugs.

• Medicare.gov - help with costswww.medicare.gov
• HRSA - find a health centrefindahealthcenter.hrsa.gov