Medicare Rx Affordability Navigator
Find prescription payment help for a Medicare patient in about a minute.
Medicare patients walk away from prescriptions they could get help paying for — not because the programs don't exist, but because nobody at the counter has time to check five different programs with five different rule books. This tool runs that check in five guided steps and hands back a plan: ranked options, estimated savings, the forms required, and ready-to-share notes for the patient, the prescriber and the pharmacy.
How the five steps work
- Enter dataCapture from the chart, or type it in.
- ChecklistSee exactly what is still missing.
- Eligibility checkOne click runs every program rule.
- RecommendationBest option first, with savings.
- ShareHandout plus referral notes.
What it screens for
- Medicare Prescription Payment Plan (M3P) — spreads out-of-pocket drug costs across the calendar year instead of paying in full at the counter.
- Extra Help / Low-Income Subsidy (LIS) — the federal subsidy that covers most Part D premiums, deductibles and copays for people within the income limits.
- State pharmaceutical assistance programs — state-run wrap-around coverage such as New York EPIC and Pennsylvania PACE/PACENET.
- Independent charitable copay foundations — Medicare-safe assistance. Manufacturer copay cards are deliberately excluded: federal rules prohibit them for Medicare patients.
- Pharmacy copay review — verifying the claim adjudicated correctly, comparing 30- against 90-day pricing, and setting up payment management.
Why the reasoning is visible
Every result shows which rules passed and which failed, and a program whose determination depends on information nobody has entered yet is reported as needs more information rather than as a “no”. Program rules are plain JSON configuration — thresholds and new state programs can be edited in the tool's own settings screen without changing any code.