Part D Costs: What You Really Pay for Medicare Prescription Drugs

When you sign up for Medicare Part D, the federal program that helps cover the cost of prescription drugs for people on Medicare. It’s not just about the monthly premium—you’re also paying deductibles, copays, and sometimes thousands out of pocket before your coverage kicks in fully. Also known as Medicare drug coverage, Part D is offered through private insurers approved by Medicare, and what you pay can vary wildly depending on your plan, meds, and income.

Many people assume their Part D plan is affordable because the premium is low—but then they get hit with a $500 bill for a single medication. That’s because drug tiers, how insurers group medications by cost, from generic to specialty drugs determine how much you pay at the pharmacy. A $10 monthly plan might have a $500 deductible and require you to pay 30% of the cost for your blood pressure pills. Meanwhile, catastrophic coverage, the stage where your out-of-pocket costs drop sharply after you’ve spent a certain amount only kicks in after you’ve spent over $8,000 in 2025. If you take expensive drugs like those for cancer or autoimmune conditions, you could spend years in the coverage gap—also called the donut hole—paying most of the cost yourself.

But here’s the thing: you don’t have to guess what you’ll pay. Extra Help, a federal program for low-income beneficiaries that cuts Part D costs dramatically can reduce or eliminate your premiums, deductibles, and copays. Even if you think you make too much to qualify, you might still be eligible—many people miss out because they don’t apply. And if you’re on multiple medications, switching plans during open enrollment could save you hundreds—or even thousands—per year. Some plans cover your top three drugs for under $10 each, while others charge $100+ for the same pills.

What you pay isn’t just about the plan—it’s about your meds. If you’re on a drug like alpelisib for breast cancer or enzalutamide for prostate cancer, your Part D costs could hit $10,000 a year before any assistance. But if you’re taking generics like hydrochlorothiazide or simvastatin, you might pay under $5 per month with the right plan. That’s why knowing your exact medications and comparing plans side-by-side matters more than picking the cheapest premium.

There’s also the matter of formularies—lists of drugs each plan covers. A plan might cover your asthma inhaler but not your diabetes pill, or vice versa. And if your doctor switches your medication mid-year, your out-of-pocket cost could jump overnight. That’s why checking your plan’s formulary every year isn’t optional—it’s essential.

Below, you’ll find real-world guides on how to reduce your prescription costs, whether you’re on Medicare, struggling with high copays, or trying to manage side effects from long-term meds. These aren’t theory pieces—they’re practical steps people have used to cut their drug bills by 50% or more. From finding copay assistance for generics to understanding how Part D interacts with other programs, you’ll see exactly how to take control of what you pay.