Alternatives to Part D Drug Coverage: What Medicare Members Need to Know

This blog explains four alternatives Medicare plan members commonly explore when trying to drive down their drug costs. Please note that none of these options should replace your Part D plan. These are tools to use selectively. Keep reading to understand why.

Option 1: Cost Plus Drugs (Mark Cuban's Pharmacy)

In 2022, entrepreneur Mark Cuban launched the Mark Cuban Cost Plus Drug Company (costplusdrugs.com) with a simple pricing strategy with no negotiating, no middlemen, and no surprises:

• Publish exactly what a drug costs to acquire

• Add a fixed 15% markup

• Include a $5 pharmacy fee

• Flat $5.25 for shipping

  
  

Cost Plus offers over 2,300 generic medications and works best for those in these categories: blood pressure medications, cholesterol drugs (statins), diabetes medications, thyroid medications, antidepressants, cancer generics, multiple sclerosis generics, and gout medications.

Potential Benefits

• Savings on some medications versus Medicare plans; cancer and MS drugs in particular

• Transparent pricing with no surprises

• No membership required

• Convenient home delivery

  
  

Things to Keep in Mind

1. Payments for medications through Cost Plus Drugs do NOT count toward your Part D deductible or out-of-pocket maximum (MOOP).

2. Mail-order only, so no same-day local pickup. Shipping takes 5-7 business days.

3. Many brand-name and specialty drugs are not available.

   
   

Key Takeaways

Cost Plus is most valuable when: (1) a drug you need isn't on your plan's formulary at all, (2) you take specialty generics like cancer medications where savings can be $500 or more per month, or (3) you like the medical befits of an MAPD plan but that plan doesn't offer the best pricing on a specific medication covered by Cost Plus. Always check costplusdrugs.com before assuming your plan offers the best price.

Option 2: Amazon

Amazon's prescription drug offering is not a single product. It has two options that operate in very different ways, and it's important to understand which mode you're using. Note that with either option, mail order is the only way to fulfill your prescriptions.

Amazon Pharmacy

Amazon Pharmacy is an in-network option for many Part D/MAPD plans, and it functions just like a bricks-and-mortar pharmacy like CVS or Walgreens. Your plan's copays, deductible, and cost-sharing all apply, and your payments count toward your MOOP just like any other in-network pharmacy. The main advantage here is convenience: home delivery, easy prescription management, and fast shipping for Prime members.

Amazon RxPass

For Amazon Prime members, RxPass offers roughly 60 common generic medications for a flat $5 per month. This is completely separate from your Medicare plan. Like Cost Plus Drugs, payments here do not count toward your deductible or MOOP.

Things to Keep in Mind:

• RxPass costs do not count toward your Part D deductible or MOOP

• RxPass requires an active Amazon Prime membership (currently $139/year)

• The RxPass drug list is limited, so you will need to verify that your medications are included before signing up

Option 3: Prescription Discount Cards (GoodRx, WellRx, and Others)

GoodRx and similar discount cards work by accessing pre-negotiated rates from their pharmacy benefit networks. There's no monthly cost to you and no membership required. GoodRx makes money by collecting a small fee from the network on each transaction.

Other programs in this space include WellRx, RxSaver, Blink Health, and NeedyMeds. They all work on the same model: Different network contracts, sometimes better prices on specific drugs at specific pharmacies. It's worth checking a few using their online search tools when comparison shopping.

Discount Card Programs and Medicare

Please note that discount cards work differently with Medicare versus other health care coverage. Federal law prohibits Medicare beneficiaries from using a discount card at the same time as their Part D coverage for the same prescription. You must choose one or the other, and if you choose the discount card, that purchase does NOT count toward your deductible or MOOP. This is the most commonly misunderstood rule among Medicare members who used GoodRx before turning 65, where the rules are different.

Potential Benefits

• Free to use with no membership or subscription required

• Works at local pharmacies for same-day pickup

• Excellent price comparison tool across nearby pharmacies

• Can be cheaper than Part D copays on certain specific drugs

• Useful for short-term prescriptions like antibiotics

• Good backup option when a drug isn't on your plan's formulary

  
  

Option 4: Canadian Pharmacies

It's no secret that many prescription medications cost much less in Canada. Canada regulates drug prices at the federal level, and brand-name drugs there often cost 50 to 80 percent less than US list prices. For a Medicare member paying hundreds of dollars a month for a medication that costs $40 across the border, the financial motivation is real.

This is especially true for brand-name drugs that haven't gone generic yet, which is the one category where Cost Plus Drugs and discount cards offer little help.

The Legal Reality

Under the Federal Food, Drug, and Cosmetic Act, importing prescription drugs into the United States from foreign countries, including Canada, is illegal for individuals. The FDA has historically exercised what's called "enforcement discretion" for personal-use quantities, meaning they generally don't pursue individual patients. But this is a policy choice, not a legal right, and it could change at any time without notice.

Not All "Canadian Pharmacies" Are What They Appear

Legitimate Canadian pharmacies are licensed by provincial regulatory authorities and actually dispense real, regulated medications from Canada. These are genuine operations, but selling to US customers still creates the import violation on the American side.

Many websites, however, use Canadian branding purely for credibility while routing drugs from India, Vanuatu, or other countries with minimal regulatory oversight. The drug you receive may not be what it claims: Wrong dosage, wrong ingredients, or counterfeit entirely. The FDA has found that a significant percentage of drugs ordered from foreign online pharmacies are mislabeled, subpotent, or counterfeit.

Serious Risks to Understand

• It is illegal under US federal law to import; enforcement policy could change at any time

• Many sites claiming to be Canadian are not

• The risk of counterfeit drugs is real

• These purchases do not count toward your Part D deductible or MOOP

• There is no FDA quality control or regulatory recourse if something goes wrong

• Federal enforcement policy can change without warning

Option 5: Medicare Extra Help (Low Income Subsidy)

Extra Help is a federal program run by the Social Security Administration that helps Medicare members with limited income and resources pay for Part D prescription costs. It covers premiums, deductibles, and copays, and unlike every other option in this blog, every dollar works within your Medicare plan and counts toward your MOOP.

The Social Security Administration estimates roughly 1 in 3 people who qualify are not enrolled, most because they assume they won't qualify. But that assumption is often wrong. Income thresholds are higher for Extra Help versus other Medicare programs.

What It Covers

For full Extra Help recipients, the program pays your Part D premium entirely or significantly reduces it. Extra Help eliminates your deductible, and caps generic copays at under $5 and brand-name copays under $13.

Who Qualifies (Approximate Limits, Adjusted Annually)

• Individual income: up to ~$22,590/year | Assets: up to ~$17,220

• Married couple income: up to ~$30,660/year | Assets: up to ~$34,360

Your home, car, personal belongings, and most life insurance do not count as assets. Many people disqualify themselves in their heads before checking the actual numbers. Extra Help is the most powerful drug cost tool available to qualifying Medicare members; more impactful than any cash-pay pharmacy or discount card. Even if you are in the grey area as related to income or assets, you are encouraged to apply. Visit ssa.gov/medicare/part-d-extra-help

(NOTE: If you already receive Medical Assistance or Medicare Savings Program benefits, you're automatically enrolled.)

A Word About Your Medicare Plan's Drug Coverage

Before exploring any of the alternatives in this guide (aside from Extra Help), it's worth remembering what your Part D plan already provides, because it's more protection than most members realize.

• Every Medicare drug plan has a Maximum Out-of-Pocket limit ($2,100 in 2026). Once you hit that cap, Medicare covers 100% of your covered drug costs for the rest of the year. If you take expensive medications, that ceiling matters, and every prescription you fill through your plan moves you closer to it. If you take medications out of the system, you risk jeopardizing the savings you could realize by hitting your MOOP, in some specific instances.

• Plans are also required to offer a Prescription Payment Plan option, which lets you spread your drug costs evenly across the year rather than absorbing a large hit early when deductibles are in play. If cash flow is the issue rather than total cost, this is worth asking about.

• Your Medicare plan is generally chosen with your specific drug list in mind. While there may be options for cost savings using alternatives, the starting point in plan selection is the most appropriate plan from a cost-minimizing perspective based on your unique medications and your needs.

  
  

The Bottom Line

No single cost-saving alternative is right for every Medicare member when it comes to prescription drugs. The best approach depends on which medications you take, which tier those drugs fall on in your specific plan, and how close you realistically get to your MOOP each year.

For help in understanding your coverage, determining whether you are a candidate for the Extra Help program, or to discuss alternative options,