Manufacturer copay cards and Medicare Part D

What are manufacturer copay cards?

Drug manufacturers — companies like Pfizer, Eli Lilly, Novo Nordisk, and others — often offer copay cards (sometimes called copay assistance, savings cards, or coupon cards) to help patients pay for their brand-name drugs. These cards typically reduce a patient's out-of-pocket cost to as little as $0–$25 per prescription, with the manufacturer covering the rest.

Copay cards are a major reason brand-name drugs stay affordable for people with private commercial insurance. But there's a catch when it comes to Medicare.

Why copay cards don't work with Medicare

Federal law prohibits drug manufacturers from offering copay cards to Medicare beneficiaries. This is because of the federal Anti-Kickback Statute, which makes it illegal to offer financial incentives that could influence Medicare or Medicaid spending decisions.

Drug manufacturers know this and explicitly exclude Medicare beneficiaries from their copay card programs. Look at the fine print of any manufacturer copay card and you'll see language like:

If you try to use a copay card with Medicare anyway, your pharmacy's computer system will typically reject it. If somehow it goes through, you could be committing fraud — even unintentionally.

What this means in practice

If you're used to paying $25 for a brand-name drug with a copay card on private insurance, then turn 65 and switch to Medicare, you might be shocked to find your copay jumping to $100, $200, or more without the manufacturer's help.

This is one of the biggest "Medicare surprises" people face when transitioning from employer coverage. The good news: there are legitimate alternatives that can dramatically reduce your costs.

Legitimate ways to lower brand-name drug costs on Medicare

1. Extra Help (Low-Income Subsidy)

If your income is below approximately $23,475 (single) or $31,725 (married couple) in 2026, you likely qualify for Extra Help. Extra Help caps brand-name copays at about $12.15 in 2026 — far better than any manufacturer copay card. Learn more about Extra Help →

2. Patient Assistance Programs (PAPs)

Many drug manufacturers offer Patient Assistance Programs that do work with Medicare beneficiaries — but only for people with incomes below certain limits (typically 400-500% of the federal poverty level). PAPs provide free or deeply discounted drugs directly from the manufacturer, bypassing your Part D plan entirely.

Examples of PAPs:

• Eli Lilly's LillyCares
• Pfizer RxPathways
• Novo Nordisk Patient Assistance Program (NovoCare)
• Bristol Myers Squibb BMS Access Support
• Sanofi Patient Connection

Search "[drug manufacturer name] patient assistance program" or visit Medicare.gov's pharmaceutical assistance lookup.

3. Medicare Prescription Payment Plan (M3P)

Starting in 2025, the Medicare Prescription Payment Plan lets you spread your annual out-of-pocket drug costs into monthly installments instead of paying large amounts at the pharmacy. It doesn't lower your costs, but it makes them more manageable. Learn more about M3P →

4. The $2,100 out-of-pocket cap

For 2026, your maximum out-of-pocket drug costs under Part D are capped at $2,100 per year. After you hit the cap, you pay $0 for the rest of the year. This protects you from the worst-case scenarios that used to be possible. Learn more about the cap →

5. State Pharmaceutical Assistance Programs

Many states have their own programs that help Medicare beneficiaries pay for prescriptions. Income limits and benefits vary by state. Your state's SHIP counselor can tell you what's available where you live.

6. Switch to a generic or therapeutically equivalent drug

Talk to your doctor about whether a generic version or a similar drug in the same class would work for you. Generics are often 80–90% cheaper than brand-name drugs.

7. Choose your Part D plan carefully

Plans vary widely in how they cover specific brand-name drugs. The same drug might cost $50 on one plan and $400 on another. During the Annual Enrollment Period (October 15 – December 7), use the Medicare.gov Plan Finder or work with a SHIP counselor or licensed Medicare agent to compare what your specific drugs would cost across all plans available in your area.

What about GoodRx and other discount cards?

Discount cards like GoodRx work differently from manufacturer copay cards. They're not financial incentives from the manufacturer — they're negotiated discounts at participating pharmacies. You can use GoodRx and similar cards on Medicare, but with one important caveat: any amount you pay using GoodRx does not count toward your Part D out-of-pocket cap. So while GoodRx might give you a lower price on a single prescription, it could leave you paying more over the course of the year.

The general rule: if you have Part D, run prices through your plan first. Use GoodRx only if it's significantly cheaper than your Part D copay AND you're unlikely to hit the $2,100 cap.

Frequently asked questions