By Elizabeth O'Brien
Navigating drug coverage demands brain power in our DIY retirement system, and it isn't getting any easier.
While President Donald Trump has launched TrumpRx and other initiatives to lower costs, Americans are still spending far more each year on prescription drugs. Consumers are largely on their own in an increasingly complex world of online pharmacies, discount pitches, and insurance hurdles to navigate.
For retirees, the stakes are high for one's health and financial well-being. Seniors can expect to spend about 15% of their overall budget on healthcare costs. For those who take generic drugs for common conditions like high cholesterol, medications represent a small share of spending. For those who mainly take brand-name drugs or medications not covered by insurance, it can be much higher.
Costs can be so steep that one in five adults say they have not filled a prescription because they can't afford it, according to surveys by KFF, a health-policy nonprofit. One in seven people say they have cut pills in half or skipped doses in the past year because of the cost.
Complicating matters is that drug-insurance costs for retirees have implications for your broader personal finances. It isn't enough that you have to optimize Social Security or figure out how to make your savings last through retirement. You also have to pick the best Medicare drug plan and most effective way to fill your prescriptions.
"It's become such a complex system," says Ruthie Rowe, president of NeedyMeds, a nonprofit that compiles information on medication patient assistance programs. "It's important for people to look at each option."
Per capita prescription-drug spending is expected to grow at an average annual rate of 4.3% through 2033, according to Peterson-KFF Health System Tracker. That's faster than the overall inflation rate, though it has come down from 2024 and 2025. Net spending on medicines grew to $487 billion in 2024, up 11.4% from the prior year, according to IQVIA, a healthcare data and analytics firm. Over the next five years, spending will grow 5% to 8% for list prices and 3% to 6% after discounts and rebates, IQVIA estimates.
Drug costs remain a priority of the Trump administration, which developed TrumpRx to bring some relief. That program essentially offers coupons on 44 popular, predominantly brand-name drugs, including those not commonly covered by insurance like weight-loss and fertility drugs.
More importantly, the administration has continued drug negotiations started under the Joe Biden--era Inflation Reduction Act, which for the first time gave Medicare the power to negotiate directly with drug manufacturers. This year, lower prices went into effect for the first 10 medications selected for the program, including Merck's Januvia and Enbrel, a diabetes drug for rheumatoid arthritis and psoriasis made by Amgen subsidiary Immunex. Since 2023, another provision of the law has required Part D plans to charge no more than $35 a month for all covered insulin products.
Negotiated drug prices will help bend the cost curve further. Medicare enrollees will save an estimated $1.5 billion under the 2026 negotiated prices, according to CMS.
Here's how to navigate the drug maze and some ways to lower your costs:
Start With the Right Drug Plan
However tedious, it's smart to review your drug coverage annually.
Each fall during open enrollment, Medicare enrollees have the chance to select a new stand-alone Part D drug plan or Medicare Advantage plan that includes drug coverage. Most people do nothing and get automatically re-enrolled in their existing plan. But insurers can and do change their list of covered drugs every year, and patients may get new prescriptions, as well, so comparison shopping is a good way to make sure you're still in the best plan to meet your needs.
To research plans, go to Medicare.gov's Plan Finder tool. The site allows you to input your exact medications and their dosage to see what you would pay for them under the plans available in your ZIP Code -- both stand-alone Part D plans that pair with traditional Medicare and Medicare Advantage plans that include drug coverage.
The site also requires you to choose local pharmacies. Select a mail-order option and at least five pharmacies in your area, says Mary Johnson, an independent Medicare and Social Security policy analyst who is on Medicare herself. If you pick only the place closest to you, you might miss the preferred pharmacy that will give you the cheapest costs. Once you input all of your medications and pharmacy options, the Plan Finder tool will chart your drug costs under each option.
One positive: Since 2025, there has been a cap on out-of-pocket drug spending for Medicare enrollees. For 2026, the limit is $2,100. That includes copayments, coinsurance, and deductibles but excludes monthly premium costs.
About one in five Medicare beneficiaries should save money with the cap, since their total spending is projected to exceed the $2,100 limit. For those whose out-of-pocket spending is below or just above the cap, it's unclear if total spending will go down. Part D drug plans must now absorb a greater share of drug costs. Some plans have raised monthly premiums to help offset this expense, according to KFF.
Moreover, premiums don't tell the full story. Your total costs could be lower in a plan with a higher monthly premium if it covers your drugs more comprehensively. When selecting a plan, look beyond the premium to see how prospective plans cover your particular medications.
One exception: If you're certain you'll hit the annual spending cap, then you can shop on premiums alone, says Kylie Stengel, principal at Avalere Health, a consultancy. In that case, the particulars of how each medication is covered -- whether it's a copay or coinsurance, for example -- don't matter. Just make sure that all the medications you take are on your plan's formulary, the list of covered drugs, since the spending cap applies only to drugs on the coverage list.
If you expect to hit the cap early in the year, the Medicare Prescription Payment Plan can help you stretch your costs throughout the calendar year. While it doesn't save you money, it does break down your costs into more manageable monthly amounts.
Lower-income patients may want to try assistance programs, especially for drugs that don't have a cheap generic equivalent. Typically sponsored by pharmaceutical manufacturers, these programs provide free or deeply discounted prescription medications for a limited amount of time. Income criteria to qualify vary by program. NeedyMeds.org operates a clearinghouse of patient assistance programs.
Make the Most of Coupons and Generics
For the best price, you have to do the math on a prescription-by-prescription basis. Most of the time, you'll find the best prices through your Part D plan. But a plan may cover only the branded version of a drug when a lower-cost generic equivalent is available.
This could happen when drug manufacturers give incentives to pharmacy-benefit managers -- the middlemen between drug companies and insurance plans -- to include the pricier drug in the formulary. In February, Congress passed reforms to curtail these incentives; its core provisions will take effect in 2028.
In some cases, prices for the same medicines diverge widely. Johnson's Part D plan only covers Ventolin, for instance, the brand name of the inhaler that she takes. She would owe $160 for a 90-day supply through her drug plan's mail-order pharmacy. A generic version (albuterol) would cost $100 through the same pharmacy.
Poking around online, Johnson found albuterol for $85 with a coupon from GoodRx. She ultimately wound up paying $36 after her doctor's office routed her prescription to a separate mail-order pharmacy with a special savers program.
Coupon sites like GoodRx and TrumpRx can offer savings, with caveats. GoodRx is a web platform that aggregates drug discounts and provides coupons, while TrumpRx is a portal for drug savings on select drugs that uses GoodRx as a source of pricing info. Both operate outside of insurance on a cash-pay basis.
Neither one is a pharmacy, though. And they commonly require patients to get prescriptions filled in person. GoodRx offers home delivery for Gold Members paying $9.99 a month. A handful of medications listed on TrumpRx can be bought on the manufacturer's website and shipped to your home.
That may not be worth the hassle to save a few bucks on a single prescription, but it can pay off for multiple drugs taken regularly.
If you use those sites, bear in mind that the purchase won't count toward a Medicare drug plan's annual deductible or the $2,100 out-of-pocket cap. Estimate what you'll spend over the course of a year to see which way you'd come out ahead.
The cost of a brand-name drug with a coupon may also still be more than a generic. About half of the brand-name medications on TrumpRx, for instance, are available elsewhere in lower-cost generic form.
"Some patients might not know there's a cheaper alternative out there," says Rachel Sachs, a law professor at Washington University in St. Louis, who worked on Medicare drug pricing in the Biden administration. For example, Farxiga, a prescription medicine on TrumpRx for Type 2 diabetes and heart and kidney disease, is available as generic dapagliflozin.
An easy way to check if there's a generic is through Medicare's Plan Finder tool. When you input a brand-name drug into the tool, it will name the generic and ask if you want to use that instead.
Online Pharmacies and Imported Drugs
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March 05, 2026 01:00 ET (06:00 GMT)
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