How to Afford COPD Medications on a Fixed Income

“The progression of COPD can be influenced by many things, including overall health, lifestyle habits, use of pulmonary rehabilitation, and smoking cessation,” says Gautam Sikka, MD, a pulmonologist at UTHealth Houston. “Taking medication as directed is definitely part of that list — it’s a crucial aspect of managing COPD effectively.”

But for seniors on a fixed income who may be using multiple medications for several conditions, it can be tempting to cut back on meds to save money when their COPD symptoms are better and they are breathing easier. Unfortunately, this can lead to COPD worsening faster than anticipated, says Dr. Sikka. A better strategy is to look into ways to afford these medications so there's no interruption in your COPD treatment.

Affordability Challenges With COPD Medication

Affordability is often a huge concern for many people with lung disease, including COPD, and it’s not uncommon to see patients reduce their medication amount or try to go without meds as a way to save money, says Mark Courtney, RRT, a respiratory therapist at the American Lung Association. But that can lead to poor long-term outcomes and may even increase the amount of medication needed, he says.

Even some maintenance inhalers can strain a budget, Courtney says. That’s because they may include the use of multiple inhalers, which leads to a higher copay or direct cost.

Evaluating Insurance Coverage

The first step in making COPD medications more affordable is to talk with your healthcare provider, says Sikka. Healthcare teams, including pharmacists, can be familiar with cost issues and may be able to help you navigate health insurance policy rules regarding medication coverage. For instance, they can provide documentation to help you get insurance approval for a medication, or they can provide options of alternative medications that may be more affordable, says Courtney.

“Many physicians know which medications tend to be covered better, so they may recommend a brand that has a lower overall cost,” he says. “They also know which treatment options have been selected for the Medicare Drug Price Negotiation Program.”

Keep in mind that you may have choices of different Medicare Part D plans. During open enrollment, you can evaluate which plan might be the most affordable, comparing drug copays and deductibles to find the plan that keeps your specific costs the lowest. The Medicare Plan Finder Tool allows you to enter your exact medications and compare coverage for them under different Part D plans.

Also note that Medicare has a maximum out-of-pocket cap of $2,100 for Part D plans.

Exploring Financial Assistance Programs

Another option for making COPD medications more affordable includes financial assistance and discount programs, which can vary from nonprofit organizations to manufacturer savings programs. Some states and local senior centers offer an ombudsman or other aide to find programs like these and complete an application.

Government Support

Charitable Copay Grants

Even if no patient assistance grants are available based on your specific situation and needs, the finder lets you enter your information and be notified as soon as a new opportunity becomes available, says Courtney.

Manufacturer Savings Programs

Many pharmaceutical companies have programs for when your health insurance policy doesn’t cover the cost of your medication. Eligible individuals typically include those with a commercial insurance policy, Medicare, Medicaid, or no insurance at all.

Known as savings programs, copay cards, patient assistance programs, or coupons, manufacturer programs generally have eligibility requirements based on insurance status, income, and the specific medication. Those who qualify get a coupon or other paperwork to take to their pharmacy. After your health insurance pays its portion of the medication’s cost (if any), the program pays part or all of the remaining copay or coinsurance. Pharmaceutical companies typically place a monthly or annual cap on how much they will cover each year. Once you reach that cost, you’ll be responsible for the remaining amount.

Pharmacy Savings Programs

• SingleCare This discount card can be used by anyone, regardless of financial need or insurance coverage. This organization partners with pharmacies nationwide to negotiate discounts on certain prescriptions.
• Medicine Assistance Tool This search engine, launched by the Pharmaceutical Research and Manufacturers of America, focuses on patient assistance resources.
• NeedyMeds A national nonprofit, NeedyMeds maintains a website listing prescription assistance programs and has a telephone help line.
• RxAssist Run by pharmaceutical companies, this online resource center has a comprehensive directory of patient assistance programs.

Doing this type of research can sometimes feel overwhelming, says Courtney. But talking with your healthcare provider’s office may help you select an option that fits your needs, since many healthcare providers offer financial navigator services.

Importance of Making the Effort

In general, it’s worth the time and effort to research options that make COPD medications more affordable, according to Courtney.

“Although there's no cure for COPD, proper management that includes medication adherence can reduce symptoms and improve quality of life,” he says. “Another advantage is that many of these medications have been shown to reduce the risk for exacerbations, keeping patients out of the emergency room or hospital.”