Prescription Drug Coverage

Frequently Asked Questions

Your private health coverage will help you pay for your prescription drugs. If you don’t have private health coverage right now, these are the most common ways to get it:

  1. Private health coverage is often offered as part of your compensation for work. You may also get it through a spouse's or parent's job. This employer-sponsored coverage varies greatly in terms of how much it will cost you and the extent of prescription coverage it includes.
  2. Individual health coverage can be purchased for you and your family at Healthcare.gov. If you can't get employer-sponsored coverage and don't qualify for Medicare or AHCCCS, the government may help you pay your monthly premium through tax subsidies.

For more details, read DB101’s articles on Employer-Sponsored Health Coverage and Buying Individual Health Coverage on Healthcare.gov.

Most AHCCCS enrollees pay a small $2.30 copayment for their prescription drugs.

There are no copayments for prescription drugs if you are:

  • Under 19
  • In a long-term care facility
  • Getting family planning, emergency, or pregnancy-related services
  • Diagnosed as Seriously Mentally Ill (SMI) by the Arizona Department of Health Services
  • Getting hospice care
  • American Indian and getting services through an Indian Health Service (HIS) facility, tribal 638 facility or urban Indian health program

To learn more about AHCCCS copayments, click here.

Note: If you are eligible for Medicare, your AHCCCS will probably cover your Medicare Part D premium and any deductibles in your Part D plan.

AHCCCS Freedom to Work benefits are the same as for standard AHCCCS. With AHCCCS Freedom to Work benefits, you will only have to pay a small $2.30 copayment for most prescription drugs.

Note: If you are eligible for Medicare, your AHCCCS Freedom to Work will probably cover your Medicare Part D premium and any deductibles in your Part D plan.

Medicare Part D is also called Medicare Prescription Drug Coverage or MedicareRx. In the Part D program, private companies offer prescription drug coverage to people on Medicare. Each plan has a list of drugs that the plan will help pay for if you sign up with that plan. This list is called a formulary.

Part D coverage will not supply you with entirely free medications. Generally, you will be responsible for paying these expenses:

  • A monthly premium. That means that you will have to pay a certain amount of money each month for your Part D plan, whether or not you purchase any medications.
  • A deductible. That means that your Part D plan will not pay for any of your medications until you have spent a certain amount of money on medications yourself.
  • Copayments or co-insurance. Copayments are a certain amount of money you have to spend each time you purchase a medication. Co-insurance means you have to pay a certain percentage of a medication’s price out of pocket.

The premium, deductible, copayment, and co-insurance levels change each year on January 1. If you qualify for Medicare’s Low Income Subsidy, you may not have to pay all of these expenses.

If you get AHCCCS or AHCCCS Freedom to Work and are eligible for Medicare, you will automatically be enrolled in a Medicare Part D benchmark plan. Being enrolled in Medicare at the same time as AHCCCS or AHCCCS Freedom to Work also automatically qualifies you for the Part D Low Income Subsidy. This means you won’t have to pay a premium for your Part D or any deductibles. All you would pay for your prescription drugs is a copayment of $1.35 – $3.95 for generics or $4.00 – $9.85 for brand-name prescriptions. Persons who are enrolled in Part D and are enrolled in the Arizona Long Term Care System (ALTCS) have no cost-sharing for Part D covered drugs.

AHCCCS also offers Medicare Advantage Special Needs Plans that have Part D prescription drug coverage. You may want to talk to your AHCCCS plan about joining their Medicare plan. By enrolling in the same plan for Medicare and AHCCCS, you will have a single point of contact for all Medicare, AHCCCS, and prescription drug questions you may have.

There are many variations among Part D plans, so it is important to find one that works for your needs. The Medicare Prescription Drug Plan Finder is an important tool that can help you find out which plans cover the drugs you need, learn what your current plan covers, or enroll in a plan.

Drug companies offer PAPs to offer free or discounted prescription drug coverage to uninsured and underinsured people. These include people who have Medicare coverage or Arizona Health Care Cost Containment System (AHCCCS) coverage and those who have private health insurance but do not have adequate prescription drug coverage.

Eligibility requirements for individual PAPs vary widely, so be sure to check the requirements for each program before applying.

Depending upon the PAP, medical eligibility requirements may require you to have a specific diagnosis. However, many PAPs do not. Be sure to check with each PAP for specific medical eligibility requirements.

Here are a few ways to search for PAPs:

  • Search using the Medicine Assistance Tool.
  • Look at RxAssist’s database of PAPs, with up-to-date information on how to access assistance from nearly 100 companies and more than 700 medications.
  • Go to Medicare.gov and check out its list of PAPs. This list is also useful for anybody, not just people on Medicare.

ADAP supplies HIV/AIDS-related prescription drugs to uninsured and underinsured persons living with HIV/AIDS.

If you qualify, ADAP may pay for some or all of the cost of HIV/AIDS-related medications that other insurance does not cover.

To get ADAP in Arizona, you must meet the following eligibility guidelines:

The ADAP Drug Formulary is the list of medications the AIDS Drug Assistance Program (ADAP) pays for. Arizona’s formulary includes all primary HIV treatment drugs, opportunistic infection drugs, and many drugs for treating side effects. To see the entire list of medications in the Arizona ADAP Drug Formulary, click here.

Learn more