We Don’t Talk Enough About This: A Caregiver’s Guide to Prescription Challenges
Retirement Strategist Carroll Golden
Caregivers and care recipients share many concerns, but one always rises to the top: medications.
We’ve all seen headlines about pharmaceutical companies, rising drug costs, and legislative battles. Let’s be honest—most caregivers aren’t following legislative journeys through committees.
From surprise pharmacy denials to rising drug costs, the system often feels stacked against them. What happens when the medication your loved one depends on suddenly isn’t covered anymore or the cost has changed? Do you know what to do?
This isn’t just a healthcare issue—it’s deeply personal.
Their focus is far more immediate:
Will the medications we need be available?
Will they be covered by insurance?
What happens if the plan’s formulary changes, making a critical drug unaffordable?
How This Plays Out in the Real World
Here’s the harsh reality: Health plans often list approved drugs in formularies. These lists include medications that are covered, usually with lower-cost alternatives.
If the person you care for is prescribed a specific drug, ask their doctor if an alternative medication on the plan’s formulary could work just as well—it might save you money.
But here’s the kicker: Most caregivers are juggling a thousand things at once. Even if they review insurance coverage during renewal periods, prescription availability isn’t always top of mind.
So, what happens if you show up at the pharmacy only to discover the plan no longer covers the prescribed medication?
Practical Steps for Caregivers
These proactive strategies can help caregivers navigate the chaos:
Ask About One-Time Refills Some insurance companies offer a one-time refill for medications when coverage changes or during enrollment periods. This gives you time to work out the next steps with the doctor.
Understand the Drug Exceptions Process If an insurance company denies coverage for a prescription, you have the right to request a drug exception. Call your insurance provider to learn how to submit this request.
Appeal Denials If a drug exception request is denied, don’t give up! You can appeal the decision. By law, cases can be reviewed by an independent third party.
Be Proactive During Renewal Periods Before renewing your insurance, review the formulary to ensure critical medications are still covered. Don’t just assume—verify!
What Can We Do?
To tackle this complexity, I reached out to Dan Mangus, Vice President of Growth and Development at McNerney Management Group, Inc., for advice.
Here’s what he had to say: "Caregivers face an overwhelming number of choices when it comes to drug coverage. One of the best assets a caregiver can establish is a relationship with a trusted insurance professional who specializes in Medicare. These professionals can help with plan selection, enrollment, and even resolving issues with insurance carriers throughout the year. Plus, they’re compensated by the carrier, so their expertise doesn’t cost the caregiver/care recipient a thing."
Did you know that people with Medicare have access to an average of 15 stand-alone Part D plans per region? In addition, each county offers an average of 34 Medicare Advantage plans with prescription drug coverage.
Bottom line: You don’t have to navigate this alone.
Let’s Keep Talking
Medications are not just a healthcare issue—they’re a lifeline. For millions of caregivers and care recipients, navigating these challenges is an emotional and financial burden.
By sharing our experiences, tips, and resources, we can help each other reduce the stress and focus on what truly matters—caring for the people we love.
What has been your biggest challenge as a caregiver? Drop a comment below or reach out to me directly.