$1,200 for a Prescription? What Caregivers Should Know Before Paying

I recently went to CVS to pick up my diabetes medication. While I was waiting, an older woman was picking up a prescription that had been specially ordered for her.

Her cost?

$1,200.

I thought, That is INSANE!! How is an older person living on Social Security or a fixed income supposed to afford that?

But as a caregiver, another thought comes to mind.

What happens when it's your parent, spouse, or loved one standing at the counter?

Many caregivers become involved in managing medications, picking up prescriptions, dealing with insurance companies and trying to figure out why something that cost $40 last month suddenly costs hundreds of dollars.

A $1,200 price at the pharmacy counter doesn't mean that there is nothing you can do about it.

Before your loved one pays it, start asking questions.

Caregivers: Medical Open Enrollment Is the Time to Check Those Prescription Bottles

Medicare Open Enrollment started October 15 and runs through December 7, making right now a good time to sit down with the person you care for and review their medications for next year.

Don't just ask, "How much is the Medicare plan?"

Ask, "How much will this plan cost once we include Mom or Dad's prescriptions?"

Gather the prescription bottles and make a list of:

• Medication name

• Dosage

• Frequency it's taken

• Preferred pharmacy

• Any especially expensive medications

Then check each prescription against the plans being considered.

• Is the medication covered next year?

• What tier is it on?

• Has it moved to a more expensive tier?

• Is there a deductible?

• Is the cost of a flat copay or a percentage of the drug price?

• Does it require prior authorization or step therapy?

• Is your loved one's regular pharmacy still in the plan's network, and is it a preferred pharmacy?

Don't assume the plan that worked well this year will work just as well in the upcoming year.

Plans can change their formularies, costs, pharmacy networks and coverage requirements.

The inexpensive monthly premium isn't a bargain if Dad's medication suddenly costs several hundred dollars a month.

When the Pharmacist Gives You a Shocking Price, Don't Be Afraid to Ask Why

Caregivers don't have to be Medicare experts.

Sometimes, you just need to know what questions to ask.

If you're told a prescription will cost hundreds or even thousands of dollars, ask the pharmacist:

• Did Medicare Part D process the prescription?

• Is this a specialty or high-cost tier drug?

• Is this amount going toward the deductible?

• Is it coinsurance rather than a regular copay?

• Does the medication require prior authorization?

• Would it cost less at a preferred pharmacy?

• Is there a generic, biosimilar or lower-cost alternative we can ask the doctor about?

Don't be embarrassed about holding up the line.

A $1,200 prescription deserves a few questions.

Call the Drug Manufacturer Too

You may see advertisements for manufacturer coupons offering medications for $10 or $25 and assume you can use it for Mom or Dad.

Traditional manufacturer copay cards most of the time cannot be used to pay the copay for a drug covered through Medicare Part D.

Call the manufacturer and ask if they have a Patient Assistance Program, it is not the same thing as the manufacturer copay card.

Some pharmaceutical companies have Patient Assistance Programs, often called PAPs, that provide medication free or at a reduced cost to people who meet the program requirements.

If you're helping someone with an expensive medication, contact the manufacturer and ask specifically:

"Do you have a Patient Assistance Program for someone enrolled in Medicare?"

It's worth asking.

What About GoodRx and Other Discount Cards?

You can also compare your loved one's Medicare Part D price with a pharmacy's cash price or a prescription discount service such as GoodRx.

But understand what you're comparing.

A prescription discount card can't be combined with Medicare Part D. It's an alternative way of saving money for that particular prescription.

Sometimes the cash or discounted price may be lower. But purchased made outside the Part D benefit will not count toward the Part D deductible or annual out-of-pocket spending.

Cheaper today isn't always cheaper over the course of the year.

Caregivers Should Know About the $2,100 Part D Limit

This is especially important if the person you're caring for takes expensive medication.

For 2026, Medicare Part D has a $2,100 annual out-of-pocket limit for Medicare Part D medications. Once a beneficiary reaches the qualifying limit, they pay nothing for Part D drugs for the rest of the calendar year.

There is also the Medicare Prescription Payment Plan, which can spread qualifying out-of-pocket prescription costs throughout the year.

It doesn't lower the cost of the medication, but it may prevent a caregiver or older adult from suddenly needing to find $1,200 at the pharmacy counter.

Don't Forget Extra Help

If your loved one has limited income and resources, look into Medicare's Extra Help program.

It can help eligible beneficiaries with Medicare Part D costs.

As a caregiver, don't automatically decide that Mom or Dad "probably make too much."

Check.

Many assistance programs go unused simply because families don't realize they exist or assume their loved one won't qualify.

New York Caregivers: Put EPIC on Your List

For those of us in New York, caregivers should know about EPIC, the Elderly Pharmaceutical Insurance Coverage program.

EPIC works alongside Medicare Part D and helps eligible New Yorkers age 65 and older with prescription drug costs.

If you're helping an aging parent or family member with their finances and medications, EPIC is absolutely something worth investigating.

Most Importantly, Don't Let Cost Lead to Silence

This is the part that worries me.

Your parent may not tell you that their medication suddenly costs $300 or $500.

They may be embarrassed.

They may not want to burden you.

Or they may simply decide:

I'll skip a few pills. I'll take it every other day. I'll just stop taking it.

That's why caregivers need to ask: "Are you having any trouble paying for your prescriptions?"

It may be one of the most important questions you can ask.

If cost is a problem, don't have your loved one cut pills, skip doses or stop taking the medication without speaking with their doctor or pharmacist.

Instead, start making calls.

• Call the Part D plan.

• Call the doctor's office.

• Check the manufacturer's Patient Assistance Program.

• Look into Extra Help.

• For New Yorkers, check EPIC.

And while Medicare Open Enrollment is happening, pull out those prescription bottles and check every medication against next year's coverage.

One Afternoon of Homework Could Save a Lot of Money

That $1,200 prescription at CVS has stuck with me.

I don't know what medication the woman needed but what I do know is that she didn't leave with it.

But it reminded me of something caregivers know all too well: Sometimes caregiving means asking the questions our loved ones don't know to ask.

Do during Medicare Open Enrollment, sit down with your loved one. Pull out the prescription bottles, check the medications, check the plan, check the pharmacy and ask about assistance.

Because when someone tells your loved one that their prescription will cost $1,200, that shouldn't necessarily be the end of the conversation. It should be the beginning of one.