Understood Care
If the cost of medicine is getting in the way of your health, you are not alone. Older adults often skip refills or split pills because of price concerns. An advocate can step in to lower costs, prevent mistakes, and coordinate with your doctor and pharmacist so you can stay on your treatment plan. [NCHS reports cost related medication challenges among older adults, which underscores why this support matters]. CDC
Advocates with Understood Care help you compare safe options, request insurance exceptions, and find financial assistance programs. You can also learn more about our direct support at https://understoodcare.com/care-types/lower-costs-of-medication and how we coordinate with your care team at https://understoodcare.com/care-types/care-coordination
We start with the details that drive the price. During your first call, we ask for the exact medication name, dose in milligrams, how often you take it, the pharmacy you use, and your plan information. With that, we can:
From the video, here is how that looks in practice. Debbie from Understood Care explains that many people have seen savings program commercials. If a verified discount price is lower than your copay, you can ask the pharmacist to process the prescription as a cash transaction using that discount. Large chains sometimes promote price comparisons in ads, but they may not volunteer the lowest price at the counter. Your advocate will check multiple programs for you, confirm your plan is charging correctly, and make sure you are not overcharged. There are many options, and you do not have to sort them alone.
FDA approved generics must have the same active ingredient, strength, dosage form, route of administration, and clinical effect as the brand name medicine. Generics typically cost less and work the same for most people. We can prepare a one page note for your prescriber with equivalent options to consider and send it to your pharmacy once approved.
Medicare drug plans use rules like prior authorization, step therapy, and quantity limits. When a rule blocks access or raises your cost, your advocate can request a coverage determination and, when appropriate, a formulary or tiering exception with supporting medical notes. If the plan denies the request, we help you file an appeal and track the deadlines.
Extra Help is a federal program that lowers premiums and reduces copays for people with limited income and resources. Many people who qualify are not enrolled. We screen you, complete the application, and follow through with Social Security and your plan. Medicare
For step by step application support, visit https://understoodcare.com/care-types/application-help
Starting in 2025, you can choose to spread your out of pocket prescription costs for covered Part D drugs into monthly bills from your plan. This option can make expenses more manageable during the year, although it does not reduce the total you owe. Your advocate can explain whether it fits your situation and help you enroll with your plan.
Depending on your medications and your state, added help may be available
Discount cards and pharmacy cash prices are not insurance. You generally cannot combine them with your Medicare drug plan for the same fill. If a cash price is lower than your copay, using the cash price can make sense for that fill, but it usually will not count toward your Medicare out of pocket spending total for the year. We will compare both options and explain the tradeoffs before you decide.
Pharmacists are allowed to tell you when a lower cash price is available. Federal rules prohibit gag clauses that used to stop pharmacies from sharing lower price options with Medicare beneficiaries. Still, many systems do not automatically show the lowest price, so asking is important. Your advocate will ask for you and document the answer.
Important note about manufacturer copay coupons. Federal guidance warns that copay coupons from drug manufacturers cannot be used for medicines paid by Medicare Part D. If a manufacturer coupon seems attractive, we will help you review compliant alternatives such as independent charity programs or formulary exceptions.
One medication list, shared safely. We create a current list that includes each medicine, dose, timing, prescriber, and pharmacy. With your permission, we share cost saving options and prior authorization details with your care team and send updates when anything changes.
Clear next steps after every call. You get a written summary that includes which price option we recommend, whether we are filing a coverage determination or appeal, what your doctor needs to sign, and when you should expect the next update.
Medication Therapy Management. If you qualify for your plan’s Medication Therapy Management program, we encourage you to complete a comprehensive medication review with the plan pharmacist and we can join the call if you want an extra set of ears.
Understood Care is ready to help. You can start here https://understoodcare.com/care-types/lower-costs-of-medication
This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.
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