Understood Care
Prescription costs vary based on your plan’s formulary, tier placement, whether a drug is a brand, generic, or biosimilar, and whether it is covered under Part D at the pharmacy or under Part B when given in a clinic or with equipment like an insulin pump. Starting in 2025, the Part D out of pocket cap makes spending more predictable across plans, and you can opt into a payment plan that smooths costs by month. Insulin has special protections that limit monthly costs when covered by Part D or by Part B for pump users.
Medicare redesigned Part D so you pay your plan cost sharing until you reach a two thousand dollar yearly maximum for covered drugs. After you reach that limit, you will not have new out of pocket drug costs for the rest of the year. Plans also offer a payment plan that lets you spread what you owe over the months of the year.
If your insulin is covered by Part D, the plan must limit your cost for a one month supply to thirty five dollars. If you use a pump covered by Part B, Part B limits the insulin coinsurance to thirty five dollars for a one month supply and the Part B deductible does not apply to the insulin itself.
You can bring these options up during a visit. See our conversation tips at https://understoodcare.com/healthcare-info/talking-with-your-healthcare-provider
Some drugs are covered under Part B when administered in a clinic or when used with covered durable medical equipment. Most retail prescriptions are covered under Part D. Knowing which benefit applies can prevent surprise costs and help you plan refills.
If a needed drug is not on your plan’s drug list, or it is on a high cost tier, your prescriber can request an exception with medical reasons. If the plan denies the request, you can appeal. For urgent health risks, your prescriber can request a fast decision.
You can get hands on application support from our team at https://understoodcare.com/care-types/application-help
Federal rules generally do not allow manufacturer copay coupons to be used for drugs paid by Medicare or other federal programs. Many manufacturers operate separate patient assistance programs that may provide free medicine if you qualify. Your advocate can help you apply and coordinate with your prescriber.
High costs can make it hard to stick with treatment. Your advocate reviews options, compares pharmacies, and guides you through savings programs so you can focus on your health without financial stress. Learn more at https://understoodcare.com/care-types/lower-costs-of-medication
Your advocate checks for generics, biosimilars, and plan preferred options, then helps you talk with your prescriber about fits that protect your health and your budget.
We connect you with manufacturer patient assistance, pharmacy savings at preferred network pharmacies, state programs, and Extra Help when eligible, and we handle the back and forth to keep things moving.
We explain your plan’s formulary and rules such as prior authorization and step therapy, help request exceptions, and support appeals when needed.
When medicines are expensive, people often delay or skip doses. We help ease the pressure by setting up refills, confirming coverage, using the monthly payment option when helpful, and troubleshooting denials so you can follow the plan your clinician recommends.
Whether you take one medicine or several, your advocate works with you, your prescriber, your plan, and in some cases the manufacturer to keep costs manageable and access reliable. Start at https://app.understoodcare.com/
Reach out urgently if you are considering skipping doses due to cost. Your prescriber may have safe alternatives, samples, or documentation to support an exception. An advocate can join calls with your prescriber, prepare forms, track prior authorizations, and follow up with your plan until you have a clear path forward.
If you want help right now, visit https://understoodcare.com/care-types/lower-costs-of-medication or start at https://app.understoodcare.com/
This content is for education and does not replace medical advice from your clinician. If you have urgent questions about your medicines or symptoms, contact your healthcare provider or call 911.
We know navigating Medicare and care needs can feel lonely, but you don’t have to do it alone.
Our caring team takes care of the paperwork, claims, and home care so you’re always supported.
