Medicare Drug Price Negotiation Program Guide

Medicare Drug Price Negotiation Program Guide


The Medicare Drug Price Negotiation Program marks a major change in the way that prices are determined for certain medications commonly prescribed for Medicare enrollees. It was established by the passage of the Inflation Reduction Act, signed into law by President Biden on August 16, 2022. The program represents one of the most substantial changes to Medicare since its inception. 

Background of Medicare Price Negotiation 

Many think of Medicare only as the federal health insurance program for people who are 65 or older. But it also provides coverage for younger individuals with End Stage Renal Disease (ESRD) and other qualifying disabilities. In 2024, approximately 65 million people enrolled in Medicare, roughly half of them in traditional Medicare and the other half in Medicare Advantage programs.

The Center for Medicare & Medicaid Services (CMS) historically was not allowed to leverage the full buying power of its vast enrollee population to negotiate lower drug prices. Only private insurance companies administering Medicare Advantage or Medicare Part D (prescription coverage) plans were allowed to negotiate prices. 

The push for Medicare to negotiate drug prices directly with pharmaceutical companies gained momentum as part of broader healthcare reform and cost-reduction efforts. 

Objectives of Medicare

The Medicare Drug Price Negotiation Program tackles three key goals head-on:

  1. Making prescription drugs more affordable for Medicare enrollees—Although Medicare has no income ceiling, many enrollees have low or fixed incomes. And even those living well above the poverty line can find it difficult to meet high out-of-pocket prescription costs. 
  2. Curbing Medicare’s ever-increasing spending on prescription medications—High prescription costs account for a large chunk of Medicare’s spending, contributing to concerns about the long-term sustainability of this essential insurance program. In 2021, Medicare accounted for 32% of all prescription spending in the United States. 
  3. Encouraging pharmaceutical companies to price their medications to reflect the value to patients—Pharmaceutical companies might face increased pressure to lower their prices across the board, not just for Medicare but also for other payers.

The Negotiation Process Between Drug Companies and Medicare

The Medicare Drug Price Negotiation Program was carefully designed to achieve the desired outcomes. Here are the steps in the process:

Step 1 Drug Selection: 

Each year, a specific number of high-cost, single-supplier drugs are targeted for negotiation based on such factors as:

  • the total cost to Medicare—both Part B (for drugs administered in a doctor’s office) and Medicare Part D (which covers prescription drugs taken by enrollees on their own)
  • a lack of price competition, because the drug treats a rare disease or one with few, if any, alternative treatments or when, after at least 11 years on the market, there are no available generics or biosimilars
  • the drug’s clinical effectiveness and safety, individually and in comparison to other drugs prescribed to treat the same condition
  • the drug’s patent status, taking into account whether it is still under patent protection and has been on the market long enough without competition for negotiation to be appropriate
  • the potential impact on Medicare enrollees in terms of decreased out-of-pocket costs and improved access to the prescription medications they need
  • the potential impact on public health of greater accessibility to drugs prescribed for the treatment of very common or life-threatening conditions  

Certain orphan drugs, plasma-derived products, and drugs that are a low-spend for Medicare are excluded from consideration. 

The first stage of selection results in an initial list of 50 negotiation-eligible drugs, ranked according to total Part D gross covered prescription drug costs. Two additional considerations may eliminate some of the drugs on that list:

  • The Small Biotech Exception—For the years 2026 through 2028, there is an exception for certain “small biotech” drugs for which the drug company has submitted an application for exception that has been approved by CMS. 
  • The Biosimilar Delay—The selection of a particular biological product can be delayed if there is a high likelihood that a biosimilar will enter the market within the next two years.

From the initial list of negotiation-eligible drugs, CMS will then select the drugs for price negotiation. 

Selecting the drugs to consider for negotiation is a complex and painstaking process. And for the manufacturers of the selected drugs, it’s not exactly optional, at least not without penalty. 

Step 2 Negotiation: 

Pharmaceutical companies that refuse to negotiate or fail to reach an agreement with Medicare may have to pay a sizeable financial penalty. Most choose to participate, particularly when they can see some reasonable basis for engaging in fruitful price negotiation discussions.

The negotiation process engages both drug companies and the public through:

  • The submission of data from drug companies
  • Meetings between CMS and each drug company to discuss the data submitted
  • A public patient-focused listening session for each drug selected for price negotiation
  • An initial offer from CMS to each drug company, presenting CMS’s proposed price and its justification
  • A drug company can accept CMS’s proposed price or submit a counteroffer

During the first round of price negotiations, CMS may invite each drug company to participate in up to three negotiation meetings before August 1, 2024. 

Negotiation is considered successful when Medicare and a particular pharmaceutical company arrive at agreement on a drug’s price—one that is a fair reflection of value and meets Medicare’s cost reduction objective.

Step 3 Implementation of Negotiated Prices: 

The new price arrived at through negotiation becomes the price that Medicare pays the pharmaceutical company for the drug moving forward, including reimbursements under Medicare Part D plans.

Initial Drugs Selected for Price Negotiation

The first round of negotiation, which took place between June 1, 2022 and May 31, 2023, resulted in new pricing for the following 10 medications, effective beginning in 2026:

  • Eliquis (for the prevention and treatment of blood clots)
  • Jardiance (for diabetes and heart failure)
  • Xarelto (for the prevention and treatment of blood clots and risk reduction for people with coronary or peripheral artery disease)
  • Januvia (for diabetes)
  • Farxiga (for diabetes, heart failure, and chronic kidney disease)
  • Entresto (for heart failure)
  • Enbrel (for rheumatoid arthritis, psoriasis, and psoriatic arthritis)
  • Imbruvica (for blood cancers)
  • Stelara (for psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis)
  • Fiasp, Fiasco FlexTouch, Fiasp PenFill, Novolog, Novolog FlexPen and Novolog PenFill (for diabetes)

According to CMS, these 10 drugs account for $50.5 billion (about 20%) of total Part D gross covered prescription drug costs during the time period June 1, 2022 through May 31, 2023.

Moving Forward

The first round of drug price negotiation was for price applicability year 2026. The milestones and schedule will be announced in advance of the drug selection and price negotiation for price applicability year 2027 and each subsequent year. And future negotiations may target more than 10 prescription medications. 

The Congressional Budget Office has estimated that the Medicare drug price negotiation program will lower what Medicare pays for prescription drugs and reduce the budget deficit by $25 billion by 2031. 

Hundreds of Medications No Longer Covered by Insurance

Hundreds of Medications No Longer Covered by Insurance


Simplefill connects Americans who are finding it difficult, even impossible, to pay for the prescription medications they depend on to manage chronic diseases with the programs and organizations offering such help. To learn more about prescription assistance programs and how Simplefill can help you get enrolled, read below and become a Simplefill member today. 

200 Medications Dropped by Insurance for 2021

Millions of Americans got an unwelcome surprise this year when they learned that the prescription medications they rely on to manage chronic medical conditions are no longer covered by their health insurance because they were dropped from their plan’s formulary. 

What is a Formulary?

Every insurance plan has its own formulary—a list of covered medications, both brand name and generic. A formulary typically is divided into three to five tiers that determine how much of the cost of the medications in each tier is covered by the insurance plan and how much the insured individual must pay. 

Tier 1 typically includes generic medications, which may be 100% covered and cost the insured nothing. The higher tiers are for brand name medications, which carry a co-pay or co-insurance requirement that increases by tier, with the most costly ones being in the top “premium” or “specialty” tier. (For those unfamiliar with the terms: coinsurance requires the insured to pay a certain percentage of a drug’s full cost, while a copay is a fixed amount the insured must pay per prescription.)

How Often Do Formularies Change?

Some insurance plans change their formularies annually, but that doesn’t mean there won’t also be mid-year changes, though formulary changes are not permitted during the annual election period, which begins in October. New medications may be added, and medications already listed may be moved to a different tier or dropped altogether. 

Insurance plans sometimes place restrictions on certain high-cost medications as a condition for adding them to their formulary or as an alternative to dropping them.  For example, the insurer may require prior authorization, which means that health care providers must provide additional information to substantiate the need for the medication. Or they may limit the amount prescribed at one time for one co-pay, or even recommend that a different, less costly medication be prescribed initially for a trial period to see if it’s an effective alternative.  Any of these changes can affect what you must pay to fill your prescriptions.

Why Do Formularies Drop Medications?

The decision to reduce or eliminate coverage for a particular prescription drug is not made casually. Typically, the decision is made by a group of health care professionals including physicians and pharmacists in conjunction with the plan’s Pharmacy Benefit Manager (PBM). A number of factors can lead to a medication being moved to a different tier or dropped from a formulary, such as:

  • There is an equally effective but less costly medication.
  • A generic version of a brand-name medication has become available.
  • There are concerns about the effectiveness or safety of a medication.
  • A medication formerly available only by prescription is now being sold over-the-counter.
  • The medication is prescribed for some cosmetic purpose and is not medically necessary.

The Medications No Longer Covered

The formulary decisions made by the nation’s two largest PBMs–CVS Caremark and Express Scripts–affect what the majority of Americans pay for their prescriptions.  The following are the medications they dropped from their formularies in 2021.


What Can I Do If My Medication Was Removed?

You should receive a notification if a medication you take regularly is removed from your health plan’s formulary and is no longer covered. The worst case scenario is that you will have to pay its full retail price in the future. If your medication is still listed but has been moved to a higher tier, you will end up paying more for it than you were paying before that change. 

If your plan’s formulary does not include a comparable drug that your health care provider can prescribe without an adverse impact on your health, you can request that your health plan continue to cover your medication even though it is no longer listed on the formulary.  The prescribing physician will need to attest to the medical necessity of granting your request. Under the Affordable Care Act, there is an appeals process that may or may not produce the outcome you’re seeking.

You also might consider changing your health plan to one that includes your medication on its formulary. This may not be feasible for those insured by an employer-sponsored plan, but Medicare recipients have the option of switching plans between October 15 and December 7 each year—Medicare’s Annual Election Period (AEP). 

There are certain Medicare rules that apply when a medication is dropped from a Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug Plan within 90 days of a new member’s enrollment, as well as for members living in nursing homes or other institutional settings. In these circumstances, members are covered for a temporary supply of non-formulary medications while other options are considered, such as switching to a comparable formulary medication or requesting an exception that allows continued coverage of the dropped medication.

How Can I Save Money If My Medication Was Dropped?

Let’s assume that none of the strategies discussed to this point will enable you to get insurance coverage for a specific medication you need that has been dropped from your health plan’s formulary or moved to a higher tier. What other options do you have if you can’t afford to pay the medication’s full retail price or even a higher co-pay or coinsurance rate? You have a lot of company if you find yourself in that boat. 

Many patients’ finances are stretched to the breaking point by the medical expense and income implications of living with a chronic disease, such as:

Finding some financial relief may be essential to maintaining an uninterrupted supply of the medication(s) you rely on to manage your symptoms and slow or prevent disease progression. It can also ease the stress you and your entire household may be experiencing—stress that can have an adverse impact on your health. 

There are prescription discount cards that can take an average of about 30% off the retail cost of your medications. If you meet the income and other eligibility criteria, you may also be able to get prescription coverage through a government-sponsored insurance plan for the uninsured or underinsured, such as those that became available as a result of Medicaid expansion. And many people who are struggling to pay for non-formulary medications should qualify for prescription assistance from the manufacturers of those drugs.

Government-funded prescription coverage typically allows members to fill their prescriptions for only a nominal co-pay, and sometimes for no co-pay at all.  Continued membership in these government-funded plans requires a periodic requalification determination. 

Pharmaceutical companies that offer prescription assistance usually do so through a charitable foundation they’ve established for that specific purpose. If you qualify, you’ll most likely receive a supply of the medication you need at little or no cost for a specified period of time—usually six or twelve months, after which you’ll need to reapply and demonstrate an ongoing need for prescription assistance.

What Does Simplefill Provide?

Simplefill proudly bridges the gap between those who are in need of prescription assistance and the programs and organizations most likely to meet that need. Once you become a Simplefill member and engage with one of our patient advocates in a profiling interview, we’ll use the information you provide about your income, prescriptions, and insurance status to match your needs to the most appropriate prescription assistance options. 

Get started today, and before you know it, you’ll be paying little if anything for your non-formulary medications.

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Here’s What You Need to Know About the 2020 Changes to Medicare Part D Coverage

Here’s What You Need to Know About the 2020 Changes to Medicare Part D Coverage

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Medicare plans and health insurance coverage can be confusing. Below, we’ll provide you with a simple breakdown of what Medicare Part D is and what changes are in store for 2020 to help keep you updated.

What Does Medicare Part D Cover?

Medicare Part D is Medicare’s prescription drug coverage. It has its own list of drugs that are covered, which is called a formulary. Drugs are then placed in different tiers, which have different costs and coverages.

Medicare Part D Deductible Changes for 2020

In 2020, the Medicare Part D deductible will vary. In some plans, the deductible will go from $415 to $435. This means that you must pay $435 before Medicare begins to pay its share of the prescription cost.

Medicare Part D Initial Coverage Limit Changes for 2020

The Medicare Part D initial coverage went from $3,820 to $4,020 as of January 1, 2020. Once you and your prescription plan have hit $4,020 in 2020 for covered drugs, you’ve reached the Medicare “donut hole.” In the donut hole coverage gap, your prescription coverage is temporarily limited until you reach your out-of-pocket threshold.

Medicare “Donut Hole” Changes for 2020

In 2020, if your plan has a deductible, you’ll pay 25% of your drug costs (both generic and brand-name) while in the donut hole. If your plan is designed with a copay after the deductible but before the donut hole, what you’ll pay for prescriptions will change when you reach the donut hole.

Medicare Part D Out-of-Pocket Threshold Changes for 202o

In 2020, the out-of-pocket threshold will increase from $5,100 to $6,350. This is the amount of money you must pay to exit the Medicare “donut hole.” In other words, once you’ve paid $6,350 for prescriptions through your plan, you begin your catastrophic coverage benefit.

Medicare Part D Catastrophic Coverage Benefit Changes for 2020

In 2020, the minimum cost-sharing once you’ve met your out-of-pocket threshold of $6,350 Medicare will cover at least 95% of your prescription costs for the remainder of the year.

How Can Simplefill Help Those Who Can’t Afford Their Prescriptions?

Simplefill prescription assistance can often help people in the “donut hole” coverage gap, those who are uninsured, those whose copay is unaffordable, or people whose medication isn’t covered. If you’re having trouble affording your prescriptions for any reason at all, start an application online or call us at 1(877)386-0206. A Simplefill advocate will respond within 24 hours.


Baby Boomers Changing the Paradigms About Aging

Baby Boomers Changing the Paradigms About Aging


Shared with us from our friends at Silvernest

Ask any Baby Boomer to reflect back to their childhood and their general perception of their grandparents when they were in their 60’s or 70’s. Most usually widen their eyes and exclaim, “old!” Images of a grumpy old man or wizened old woman come to mind. Many of today’s 65 year-olds look nothing like that. In a short thirty years, we have extended our lifespan, and opened up a third phase of adult life 50+ that is often filled with vibrancy, possibility and health. Yet, our society continues to perpetuate the notion that the “peak years” of life are around age 28. It’s all downhill from there. Really?

Ever heard of the word “ageism?” According to Ashton Applewhite, author of “This Chair Rocks, a Manifesto Against Ageism,” it is the last socially sanctioned prejudice, and a cultural narrative that impacts almost every aspect of life after 50. Have you ever felt compelled to lie about your age, or had someone compliment you and say, “You look great for your age?” That’s ageism.

In the past few months after the release of her book, Applewhite has been named “Influencer of the Year” by Next Avenue’s Influencers in Aging list, featured in the New York Times, appeared at the United Nations and is traveling around the country. She is the voice of a new movement, and on a mission to highlight the pervasive narrative that reinforces aging as something to fear, deny or dread.

She opens her book with the confession, “I’ve never lied about my age – I have no problem saying ‘I’m sixty-three’ loud and clear – but I know a lot of people who do. People who lie on resumes and on airplanes and on dates.”

Applewhite admits ageism is something it has taken years to fully recognize. “Any time we make an assumption about what any person is capable of, what they’re thinking about or doing on a basis of chronological age – that defines ageism,” she says. “Chronological age is a lousy indicator of pretty much anything abut a person, and all “isms” are based on stereotyping – especially because the longer we live, the more different from one another we become.”

The term “ageism” was first coined by Pulitzer prize winning physician Robert Butler, founder of the International Longevity Center, in 1968 – around the same time as the terms racism and sexism. “We experience ageism any time someone assumes that we’re “too old” for something – a task, a haircut, a relationship – instead of finding out who we are and what we’re capable of,” said Applewhite.

This Chair Rocks is a wonderful and fast read; full of powerful insights, and would make a fantastic book-club pick. Applewhite humorously breaks down pre-conceived notions about what it means to get older, and paves the way for trailblazing Boomer activism. Her zany style made me laugh out loud on numerous occasions, and nimbly poked to the inner core of what it means to get older in today’s society. In addition to the book, Applewhite has created a blog called, “Yo is this Ageist?” and a “conscious-raising” booklet to promote grassroots discussion called, “Who Me Ageist?”

“No one is born prejudiced, but attitudes about age – as well as race and gender – start to form in early childhood,” she writes. “Over a lifetime they harden into a set of truths: “just the way it is.” Unless we challenge ageist stereotypes – old people are incompetent. Wrinkles are ugly. It’s sad to be old – we feel shame and embarrassment instead of taking pride in the accomplishment of aging. That’s internalized ageism.”

SimpleFill Featured on The Balancing Act!

SimpleFill Featured on The Balancing Act!


SimpleFill was recently featured on The Balancing Act, a popular talk show that focuses on bringing balance to our daily lives. The Balancing Act highlights ways that viewers can better manage day-to-day tasks that might otherwise be stressful or time-consuming. One such problem for many Americans is prescription fulfillment. At SimpleFill, we make it easy to research prescription assistance solutions, find the most affordable options and enroll our members into these programs so that you can be happy, healthy, and stress-free. Watch our feature on The Balancing Act, and learn more about the SimpleFill prescription assistance program. Continue reading

5 Heart-Healthy Habits for American Heart Month

5 Heart-Healthy Habits for American Heart Month


Did you know February is American Heart Month? While it’s important to practice heart-healthy habits all year long, February is the perfect month to start prioritizing your heart health by implementing these habits into your routine.

Take a Daily Walk

Starting an exercise routine doesn’t have to be a huge chore. For now, you can skip the gym membership and complicated lifting regimen and just try to take a walk every day. Tie in your walk with something you do every day so that it’s easy to keep up the habit. If the weather is keeping you from walking, try heading to a big box store or the mall to do your walking indoors.

Try Meditating

While you may be picturing someone sitting cross-legged on the hardwood floor and chanting, meditating can be casual and fun. Plus, meditating can help alleviate stress, which can exacerbate many heart problems like high blood pressure and heart disease. Don’t know how to get started? There are some great meditation apps for your phone that offer short guided meditations and meditation reminders.

Eat More Fruits and Vegetables

You already know that eating healthier contributes to heart disease prevention but starting to eat healthier can also be overwhelming. Unless your doctor has expressly forbidden certain foods, try getting into better diet habits by eating more fruits and vegetables rather than restricting yourself from foods you love. This is a natural and non-intrusive way to start changing your diet for the better.

Get a Good Night’s Rest

The importance of a good night’s rest is obvious but actually making it happen can be hard. Try healthy sleeping habits like turning off screens an hour before bed, implementing a relaxing sleep routine, and choosing a nightly bedtime and sticking to it. If you suffer from sleep apnea, be sure to use your CPAP machine, as untreated sleep apnea can be detrimental to your heart health.

Follow the Doctor’s Orders

One of the best ways to keep your heart healthy is to follow the doctor’s orders, including everything from maintaining diet restrictions and exercise requirements to making sure you’re taking your heart medications as prescribed. If you’re having trouble affording your pills, Simplefill Prescription Assistance has programs to help pay for medications. In fact, we offer financial assistance for eligible heart medications likes Diovan, Effient, Isordil, Plavix, and Toprol XL. We also provide plenty of resources to help you navigate the health care system and live a healthier life, including our guide to the 2019 Medicare Part D changes and these tips for dealing with chronic medical issues while on Medicare.

If you’re having trouble affording your prescriptions for any reason at all, start an application online or call us at 1.877.386.0206 and a Simplefill Advocate will respond within 24 hours.

5 New Year’s Resolutions for Family Caregivers

5 New Year’s Resolutions for Family Caregivers

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According to the Family Caregiver Alliance, nearly 44 million Americans provide “informal” (unpaid) care each year for family members and friends with chronic diseases or conditions. Informal caregiver duties can range from buying groceries and helping around the house to making important medical appointments and decisions. Depending on how much time and care is required, informal caregivers can find themselves burnt out, isolated, and with health problems of their own. These New Year’s Resolutions for informal caregivers can help you find your footing in 2019 and avoid caregiver burnout.

Take Care of Your Own Health

If you’ve ever flown on an airplane, you’ve no doubt heard the instructions to put on your own oxygen mask before helping your child. This same principle is important in caregiving: if you don’t take care of yourself, you’ll be unable to take care of your friend or family member. While this seems obvious, it’s easy to let your own needs slide, especially when they feel less urgent than the needs of your family member. Schedule your yearly check-ups, find ways to implement a workout routine, get the recommended amount of sleep, and prioritize your own emotional, physical, and spiritual needs whenever possible.

Find a Support Network

Taking care of someone else can be isolating, but it’s important to realize you’re not alone. Not only are there plenty of people in the same situation as you, but there are organizations that exist to help you connect with them. Even if you can’t find a caregiver support group in your area, there are online caregiver support groups designed to help you connect with others, even when navigating a busy schedule.

Ask for Help When You Need It

It can be hard to ask for help, but you’d be surprised how many people are willing to offer assistance, especially when they know what would be most helpful. Next time someone asks you if there’s anything they can do to help, be prepared to answer. Maybe you’d love an hour or two a week for a favorite workout class or for a date night with your spouse. Maybe you’d be better able to attend to your own needs if someone else took care of dinner one night a week. If it makes it easier, remember that you’re asking for help for your loved one, not just for yourself.

Take Advantage of Temporary Respite Care

Did you know that many nursing homes offer temporary respite care? Rather than waiting to plan a vacation until a sibling or other family member is able or willing to come into town to help, you can arrange short-term stays with professional caregivers who are prepared to properly care for your loved one. This can also be a great way to give full-time care a trial run before making any long-term decisions. You can even find in-home senior care providers to spend some time with your loved one in the comfort of their own home.

Be Aware of Available Resources

Whether you’re looking to better understand different health problems and caregiving issues or the 2019 changes to Medicare Part D Coverage, you can find plenty of caregiver resources online. There are even programs to help pay for medications, including Simplefill prescription assistance. Apply for prescription help online today!

How to Pay for Prescriptions Without Insurance

How to Pay for Prescriptions Without Insurance

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Unfortunately, if you missed the Medicare and marketplace open enrollment for 2019, you might find yourself without health insurance for the upcoming year. We understand how scary it is to face medical issues during a period of being uninsured, which is why we’re committed to helping you out during this trying time. If you’re without insurance and unable to afford your medication, here are some steps you can take for prescription help.

Ask About Generic Prescription Options

Wondering how to pay for prescriptions without insurance? One way to save money on prescription medication is by requesting generic options. Just like when you shop at the grocery store, generic prescription options are often more affordable than their name-brand counterparts. While the prices are different, they frequently have the exact same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. If you decide to use a prescription assistance program like Simplefill, we’ll even help you do the research to find affordable generic prescription options.

Sign Up for a Prescription Assistance Program

With or without insurance, Simplefill’s Prescription Assistance Program can help you afford your medications. Because we understand how complicated it can be to navigate the healthcare system, we do everything we can to simplify your experience. Not only do we take the time to learn about your specific medical and financial situation, but we take care of all the research and paperwork in order find the best possible option for you.

What to Expect from Simplefill

  • We research your situation and work with you to complete applications for any available prescription assistance programs, discount brand drug programs, discount generic drug programs, and/or available grant funding.
  • We help research alternative medications that serve the same purpose but have a lower price tag.
  • Depending on your specific illness, we help you research and apply for alternative funding programs, including government grants.
  • If you’re eligible, we can help you enroll in the Social Security Extra Help Program.
  • We assign you an advocate who monitors your medications and eligibility in the programs and continues to provide support even after the medication is received.

If you suffer from a chronic disease like cancer, HIV, diabetes, heart disease, asthma, or depression and are having trouble affording your prescriptions for any reason at all, start an application online or call us at 1.877.386.0206. A Simplefill Advocate will respond within 24 hours.

4 Tips for Dealing With Chronic Medical Issues While on Medicare

4 Tips for Dealing With Chronic Medical Issues While on Medicare

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Dealing with medical issues is always challenging but coping with a chronic illness is especially difficult. These four tips for dealing with chronic diseases while on Medicare can help you live your happiest, healthiest life.

Choose the Right Medicare Plan

The Medicare system can be confusing, and the internet is full of misinformation about how Medicare works and what it covers. When choosing your Medicare plan, be sure to check information against the official U.S. Government Site for Medicare to ensure that you’re getting the right information. That said, no one should be denied Medicare coverage based on a pre-existing, chronic condition, and if you’re having trouble securing coverage related to a chronic medical issue, there are people who can help. Groups like the Center for Medicare Advocacy can help answer your questions about Medicare coverage and skilled coverage, as well as helping you choose the right Medicare plan for your health journey.

Ask Doctors for Written Instructions

Especially if you have a chronic condition, it can be hard to keep track of changing treatment plans, medication schedules, and lifestyle instructions. Asking for written instructions from your doctor prevents confusion and ensures that you have the information you need to make smart medical decisions. It can also be reassuring for family members who might not be able to attend a doctor’s visit with you.

Take Small Steps Toward Better Habits

We’ve all heard the saying, “It’s hard to teach old dogs new tricks.” But just because you’ve developed bad health habits doesn’t mean you’re doomed to repeat them. Small changes can make a big difference, especially when it comes to chronic conditions, and it’s much easier to commit to a small habit change than a large one. Think about your health challenges and find low commitment habits that might help. You might, for example, try to take a short walk after dinner or make a certain day of the week “dessert free.” You can work toward bigger lifestyle changes in the future but starting small will help keep you from getting overwhelmed or discouraged.

Take Advantage of Prescription Assistance Services

Especially when you’re suffering from a chronic condition, it’s so important to consistently take any medications that have been prescribed to you. Still, millions of Americans are forced to ignore doctor’s orders because they can’t afford the medication they need. Even with the closing of the Medicare Part D Donut Hole Coverage Gap, you may still find yourself in need of Medicare prescription help, either because your co-pays are too high or because your medication is not covered by Medicare. Using a prescription assistance program like Simplefill can help you afford the medication you need to treat your chronic illness.

If you’re having trouble affording your prescriptions for any reason at all, start an application online or call us at 1.877.386.0206 and a Simplefill Advocate will respond within 24 hours.

How to Find Help with the Cost of ADHD Medication

How to Find Help with the Cost of ADHD Medication

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According to the American Psychiatric Association, attention-deficit/hyperactivity disorder (ADHD) affects an estimated 8.4 percent of children and 2.5 percent of adults. October is ADHD awareness month, and here at Simplefill, our prescription assistance program is dedicated to helping with the cost of ADHD medication for children and adults.

In fact, our Pediatric Assistance Program can even help with non-prescription medical expenses, including counseling services for children with ADHD. Here’s what you need to know about ADHD, its treatment, and how Simplefill can help.

What is ADHD?

ADHD is a mental disorder that typically manifests as trouble remaining still and/or a short attention span. Because it mimics typical childhood behaviors, it’s important to remember that these symptoms must be serious enough to cause distress or problems functioning at home or school. There are three types of ADHD: inattentive type, hyperactive/impulsive type, or combined type, which is some combination of the two.

Inattentive Type ADHD symptoms can include: trouble paying attention to details, repeatedly making careless mistakes, problems staying focused on tasks, trouble paying attention to people while they’re speaking, trouble following directions, problems organizing tasks, avoiding tasks that require long-term mental effort, frequently losing important objects, etc.

Hyperactive/Impulsive Type ADHD symptoms can include: fidgeting, tapping, and squirming, running and climbing during inappropriate times, an inability to be quiet, talking too much, blurting out answers or finishing other people’s sentences, trouble taking turns, frequently interrupting others, etc.

ADHD Medications Available with Simplefill Prescription Assistance

The cost of ADHD medication can be incredibly expensive, especially if you don’t have insurance. That’s why Simplefill prescription assistance offers low cost options for the following prescriptions for ADHD:

  • Vyvnase
  • Focalin
  • Concerta
  • Intuniv
  • Strattera
  • Quillivant XR
  • Quillichew ER

How Our Pediatric Assistance Program Can Help with ADHD Treatment

If your child has a chronic or life-altering condition like ADHD, our Pediatric Assistance Program can help! If you meet the income and diagnosis guidelines, Simplefill can help get funding up to $5,000 for nearly all medical expenses, including help with prescription drug co-pays, help paying for related counseling services, and help with other out-of-pocket costs that are associated with your child’s specific diagnosis.

At Simplefill, we work hard to help with medicine costs for the people who need it most. Whether you’re looking for discount prescriptions without insurance or help paying for unaffordable co-pays, Simplefill may be able to help relieve some of the financial burden. For help with paying for ADHD medication, insulin, or other eligible prescriptions, start a prescription assistance application online or give us a call at 1.877.386.0206 to find out if you qualify.