If a drug is not covered under a Medicare plan, what is one potential avenue the patient could explore?

A patient whose prescribed drug is not covered under a Medicare plan can potentially explore seeking assistance programs from drug manufacturers. Many pharmaceutical companies offer patient assistance programs to help individuals access their medications, particularly if they face financial barriers. These programs can provide free or low-cost medications to eligible patients who cannot afford their prescriptions, thereby ensuring that patients still receive the necessary treatment despite coverage limitations.

Alternative therapies, while an option, may not address the specific needs of the patient or may result in higher out-of-pocket costs. Joining a new insurer could be a lengthy and complicated process, as it may not align with the patient’s health needs and timelines. Waiting for plan reviews to change coverage is uncertain and may take an inordinate amount of time without guaranteeing that the specific drug will eventually be included. Thus, seeking assistance programs offers a proactive and often immediate solution to accessing needed medications.