On a recent episode of The Pitt, a patient arrives critically ill with diabetic ketoacidosis, a dangerous condition that happens when the body doesn’t have enough insulin and starts breaking down fat too fast, causing acids to build up in the blood.1 The reason wasn’t because of forgetfulness or denial. It was because of cost. The medication was too expensive, so the patient stretched doses until their body could no longer cope.
That storyline isn’t rare. It’s real life for millions of people managing chronic conditions in the United States. When medications become unaffordable, people don’t usually stop cold turkey. Instead they ration, they delay refills, and they take less than prescribed and hope for the best. Over time, that hope turns into complications, hospitalizations, and emergencies that could have been prevented.2
Pharmacy assistance programs exist because cost should never be the reason someone ends up in crisis. Knowing how to use them can mean the difference between managing a condition day by day and watching it spiral out of control.
Why Affordability Matters For Chronic Conditions
Staying healthy shouldn’t be a financial struggle, yet for many, the price of care is a constant weight. Here is a look at how medical and prescription costs are affecting families today:
- Almost half of all adults in the U.S. find it hard to pay for healthcare.2
- In the last year alone, about 30% of households struggled to pay their medical bills.2
- This burden is even heavier for Hispanic families, young adults, and those without health insurance. 2
When costs go up, people are often forced to make a dangerous choice: their health or their budget.
- 1 in 3 adults skipped or delayed the medical help they needed this past year because they couldn’t afford it.2
- For people under 65 without insurance, that number jumps to 75%.2
The Cost of Prescriptions
Medicine only works if you can actually get it. Because of high prices, many people are taking risks with their prescriptions:
- 21% of adults have left a prescription unfilled at the pharmacy.2
- 23% chose an over-the-counter option instead of the medicine their doctor ordered.2
- 1 in 7 people have skipped doses or cut their pills in half to make them last longer.2
In total, one-third of all adults have used at least one of these “cost-saving” measures, with women and low-income families feeling the most pressure.
What Pharmacy Assistance Programs Are
Pharmacy assistance programs is a broad term for legitimate programs that help lower what you pay for medications.3 They may be run by:
- Pharmaceutical manufacturers (often called patient assistance programs or PAPs)
- Nonprofits that provide copay help or grants
- State programs that help with prescription costs
- Federal programs that lower costs for people on Medicare
- Safety-net clinics and hospitals that can offer discounted drugs through specific programs
Some programs reduce your copay. Some provide the medication at a very low cost or no cost. Some help with premiums or deductibles.3
The Centers for Medicare & Medicaid Services (CMS) describes manufacturer-sponsored patient assistance programs as programs that may provide financial help or free product for low-income individuals to support prescription access.3
Step-By-Step Guide to Lower Your Monthly Medication Costs
This guide is designed for real life. You can do it in one afternoon or spread it across a week. Let’s get started!
Step 1: Get clear on what you’re paying and why
Before you can reduce costs, you need a clean picture of the problem.
Call your pharmacy and ask:
- “What is my copay for this medication with insurance, and what is the cash price without insurance?”
- “Is this medication on my insurance formulary, or is it non-preferred?”
- “Is a prior authorization required?”
Self-advocacy language: “I’m trying to stay adherent. I need to understand the exact reason this prescription is expensive so we can find a solution.”
Step 2: Ask about a lower-cost version that works the same
Many medications have a generic option or a therapeutically similar alternative (same purpose, different brand).4 Ask your clinician or pharmacist:
- “Is there a generic version?”
- “If not, is there a similar medication that my insurance covers at a lower cost?”
- “Can you prescribe a 90-day supply if it reduces my monthly cost?”
Self-advocacy language: “I’m not asking to stop treatment. I’m asking for an affordable option I can actually take every day.”
Step 3: Use manufacturer assistance when the drug is brand-name
If you’re on a brand-name medication, especially specialty drugs, ask about manufacturer programs.4
Many manufacturers offer:
- Copay cards (often for people with commercial insurance)
- Patient assistance programs that may provide the medication free or low-cost (often based on income and insurance status)
The Centers for Medicare & Medicaid Services (CMS) explains that manufacturers may sponsor Patient assistance programs (PAPs) that provide financial assistance or free product to low-income individuals.4
Self-advocacy language to your doctor’s office: “Can your team help me apply for the manufacturer assistance program for this medication? If you have a prior authorization team, I’d like them looped in.”
Practical tip: Many applications require proof of income and a prescriber signature. Ask the office who completes forms and what turnaround time looks like.
Step 4: Check nonprofit databases that list assistance options
If you don’t know where to start, use trusted “find help” databases. NeedyMeds is a national nonprofit that provides free information about programs that help people who can’t afford medications and healthcare costs.
Self-advocacy language: “I’m applying to multiple assistance options. I may need a letter confirming my diagnosis and medication list. Can your office provide that?”
Step 5: If you’re on Medicare, check “Extra Help” for Part D
If you have Medicare and limited income/resources, you may qualify for Extra Help (also called the Part D Low-Income Subsidy).
Medicare explains Extra Help helps pay Part D premiums, deductibles, coinsurance, and other costs, and some people qualify automatically while others apply.
Self-advocacy language: “I want to see if I qualify for Extra Help to lower my Part D costs. Can someone help me apply or confirm eligibility steps?”
Step 6: Look for state programs that help with prescriptions
Some states offer State Pharmaceutical Assistance Programs (SPAPs), which help certain populations pay for prescriptions and may provide wraparound support for Medicare Part D.
Self-advocacy language: “Does my state offer a prescription assistance program? If so, what are the eligibility requirements and how do I enroll?”
Step 7: Ask if your clinic or hospital is a 340B site
The federal 340B program allows certain “covered entities” (often safety-net hospitals and clinics) to access outpatient drugs at reduced prices to stretch limited resources and serve eligible patients.
The Health Resources and Services Administration (HRSA) describes 340B as enabling covered entities to stretch scarce federal resources and reach more eligible patients.
Self-advocacy language at your clinic: “Is this clinic a 340B site or connected to a 340B pharmacy? If yes, can my prescriptions be filled through that program to lower my out-of-pocket costs?”
Step 8: Ask for an insurance exception or appeal when needed
If your insurance denies coverage or requires step therapy, ask your clinician’s office to request an exception or appeal.
Self-advocacy language: “My current medication is clinically necessary and affordable access is a barrier. I’m requesting a formulary exception or appeal, and I want a copy of the decision in writing.”
Practical tip: Ask your insurer for the exact reason for denial, in plain language, and ask what documentation would change the decision.
Step 9: Set up a system so this doesn’t become a monthly crisis
Once you find a solution, make it repeatable. Ask:
- “Can this be filled automatically?”
- “Can I get a 90-day supply?”
- “When will this authorization or assistance expire, and what should I do before then?”
Self-advocacy language: “I want to prevent gaps. Please tell me what needs to happen to keep this affordable long-term.”
What To Do If You’re Already Rationing Medication
If you’re skipping or stretching doses right now, tell your clinician. This is medical information, not something to hide. Say this plainly:
“I’ve been taking less than prescribed because of cost. I need a safer plan so I don’t get sick.”
That one sentence helps your care team choose safer alternatives, monitor for complications, and connect you to assistance faster.
A Call to Action
Medication should not be the part of your health plan that breaks first. Inside the NOWINCLUDED app, bring your real numbers and real questions. Share what you’re paying, what you were prescribed, and what barrier you’re hitting.
You’ll find tools to prepare for pharmacy and doctor conversations, plus a community that trades practical solutions without judgment.
Open the NOWINCLUDED app and take one step today: pick one medication you’re worried about and start with Step 1. Staying on treatment is not just self-care. It’s protection.
References
- ADA. (2025). Diabetes & DKA (Ketoacidosis). Retrieved from American Diabetes Association: https://diabetes.org/about-diabetes/complications/ketoacidosis-dka/dka-ketoacidosis-ketones
- Sparks, G., Lunna, L., Montero, A., Presiado, M., & Hamel, L. (2026, January 29). Americans’ Challenges with Health Care Costs. Retrieved from KFF: https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/
- Center for Medicare Advocacy. (2015, November 30). Assistance with Paying for Prescription Drugs. Retrieved from Center for Medicare Advocacy: https://medicareadvocacy.org/finding-help-to-get-prescription-drugs/
- Cigna. (2025). Reducing Medication Costs. Retrieved from Cigna Healthcare: https://www.cigna.com/knowledge-center/hw/reducing-medication-costs-te7832
