Manufacturer copay programs can sharply cut brand-name drug costs, but the rules differ for Medicare. Here is what to know.
How manufacturer copay cards work
Drug manufacturers offer copay cards (also called copay savings programs) to lower the out-of-pocket cost of specific brand-name medications, sometimes to a small fixed amount or even $0 per fill. You enroll through the manufacturer's website or your specialty pharmacy, and the savings apply at the pharmacy counter. These programs target patients with commercial insurance and usually exclude generics. They can be valuable when no generic exists and the brand is expensive. Each program sets its own income rules, enrollment caps, and annual maximums, so read the terms before relying on one.
Why Medicare seniors usually can't use copay cards, and what to use instead
Federal anti-kickback rules generally prohibit people with Medicare Part D or Medicaid from using manufacturer copay cards. Instead, Medicare seniors can turn to independent nonprofit foundations such as the PAN Foundation, HealthWell Foundation, and the Assistance Fund, which give disease-specific grants that can cover Part D copays for brand-name drugs. Manufacturer patient assistance programs (separate from copay cards) may also provide the drug free to low-income Medicare patients. Sorting out which program applies to your drug and coverage is confusing, so call 1-800-MEDIGAP (1-800-633-4427) and an agent will find the right one for you.