What we do
Prescription drug cost review
The single highest-value twenty minutes in Medicare. Bring your bottles; we will tell you what next year costs on each plan and whether you qualify for help paying for it.
What you get
Concrete things, not a conversation about a conversation.
Every one of these is included, and none of it is billed to you. Our compensation comes from the carrier you eventually choose — or from nowhere at all, if the right answer is to leave your coverage exactly as it is.
- Projected annual drug cost on your current plan for the coming year
- The same projection for every realistic alternative in your county
- Tier, quantity limit, prior authorisation and step therapy flags for each drug
- Preferred versus standard pharmacy pricing, at the pharmacies you would actually use
- A screening for Extra Help / Low Income Subsidy eligibility
- Generic and therapeutic alternatives worth raising with your prescriber
How it runs
Step by step.
- 01
Read us the labels
Drug name, strength, and how many you take. Photographs of the bottles work perfectly. Approximations do not — a 20mg and a 40mg of the same drug can sit on different tiers.
- 02
We run every plan
Each drug against each formulary, at the correct tier, with the plan’s deductible structure and the pharmacy network applied. Preferred pharmacies are priced separately from standard ones.
- 03
We check for help
Extra Help, state pharmaceutical assistance programs and manufacturer patient assistance where relevant. A great many people who qualify never apply because nobody mentioned it.
- 04
You get a total, not a premium
Annual cost including premium, deductible and copays for each plan, ranked. That is the number that actually matters, and it frequently reorders the list completely.
Extra Help, and why so many people miss it
Extra Help, formally the Low Income Subsidy, reduces or eliminates Part D premiums, deductibles and copays for people within certain income and asset limits. The limits are more generous than most people assume, and qualifying changes the economics of drug coverage entirely.
People miss it for the ordinary reason that nobody tells them. It is not automatic unless you have Medicaid, Supplemental Security Income or a Medicare Savings Program. We screen for it in every review, and if you look close to the line we will point you at the application rather than guess.
Ways to bring a specific drug cost down
When a medication lands on an expensive tier, switching plans is only one of the available moves, and outside an enrollment period it is often not available at all. These are the others.
- A generic equivalent, where one exists and your prescriber agrees it is appropriate
- A therapeutic alternative on a lower tier — a different drug in the same class
- A 90-day supply, which many plans price better than three 30-day fills
- Mail-order pharmacy, where the plan gives it preferred pricing
- A different pharmacy — preferred and standard pricing can differ sharply
- A formulary exception request, supported by your prescriber’s medical justification
- Manufacturer patient assistance programmes for specific brand-name drugs
- Extra Help or a state pharmaceutical assistance programme, if you qualify
Help paying for prescriptions
| Programme | What it does | Where to apply |
|---|---|---|
| Extra Help (Low Income Subsidy) | Reduces or eliminates Part D premiums, deductible and copays | Social Security |
| Medicare Savings Programs | Can pay your Part B premium; confers automatic Extra Help | Your state Medicaid office |
| State pharmaceutical assistance | Varies by state; supplements Part D coverage | Your state programme |
| Manufacturer assistance | Brand-specific support for eligible patients | The manufacturer |
Frequently asked questions
What do you need from me?
The exact name, strength and quantity of every prescription you take, and the pharmacy you use. Photographs of the labels are ideal. Strength matters — the same drug at different doses can sit on different tiers with different prices.
Can you help lower what I pay for a specific drug?
Sometimes. There may be a generic, an equivalent on a lower tier, a mail-order option, a preferred pharmacy that prices it better, a manufacturer assistance program, or a plan whose formulary treats it far more favorably. We will find what is available and tell you what to discuss with your prescriber.
My drug just moved to a higher tier. Can I do anything now?
Possibly. There is a formal exception request process, and your prescriber can support it with medical justification. If we are outside an enrollment period, that route is often the only one available, and it works more often than people expect.
Coverage involved
The products this service touches.
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Part D prescription drug plans
Medicare Part D is prescription drug coverage sold by private carriers, either as a standalone plan alongside Original Medicare and a Medigap policy or bundled inside a Medicare Advantage plan. Each plan has its own formulary, tiers and pharmacy network, and an annual cap on what you pay out of pocket for covered drugs.
About this coverage -
Medicare Advantage (Part C)
Medicare Advantage (Part C) is a private plan that replaces how you receive your Part A and Part B benefits. Plans usually bundle prescription drug coverage and extras like dental and vision, often carry a $0 monthly premium, and cap your annual out-of-pocket costs — but you use a provider network and pay copays at the point of care.
About this coverage
Related services
Often needed at the same time.
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Annual coverage review
Your plan changes every January. We re-check it every October, before it costs you.
How it works -
Insurance plan comparison
Every realistic option in your county, compared against your own doctors and drugs.
How it works -
Claims support & appeals
A denial is the start of a process, not the end of one. We stay on it with you.
How it works