Lower the Cost of Your Prescription Drugs

Pharmaceutical companies are raising the costs of many prescription drugs. Here are your options

By Barbara Pierce

Prices keep rising.

In the U.S., it’s outrageous that we pay more than three times what people in other countries pay for the same medicines.

Five of the 10 most profitable businesses in the U.S. are pharmaceutical companies.

Here’s how to keep more money in your pocket and still get the medications you need:

• Try an over-the-counter drug for some problems. For some common conditions, like heartburn, insomnia, allergies, migraines, an OTC might work as well as a prescription drug, because many now-OTC drugs were once prescription-only.

• As your health care provider chooses the right drug for your condition, look at the list of prescription drugs covered by your health insurance plan, called a formulary. Not all health plans cover all prescription drugs. If you need a drug that’s not covered, it can cost you hundreds of dollars out of pocket. Depending on the rules of your plan, you may be able to request an exception for a specific medication.

• Don’t automatically use your insurance. Many commonly used generic medications can be purchased for as little as $10 for a three-month supply at major chain drugstores or big-box stores. Even drugs covered by your insurance can be less expensive if you don’t use insurance; ask the pharmacist.

The reason is because, behind the simple act of buying a bottle of pills, a host of players — drug companies, pharmacies, insurers and pharmacy benefit managers — are taking a cut of the profits. A pharmacy benefit manager handles the prescription drug part of your health insurance plan on behalf of your insurer. In short, you don’t pay the actual cost of the drug; you pay the amount set by your insurance company.

• If you’re uninsured, or will be paying without insurance for a particular medication, check out discount programs, such as Good RX, CommunityCaresRX.com, WellRX.com. These programs offer deep discounts on thousands of medications by working with drug manufacturers directly.

• Substituting generics for brand name drugs can cut costs dramatically. The federal government grants 20-year patents on new drugs that give companies the exclusive right to market the medication. Because it takes years to get the drug to market, manufacturers end up with a monopoly lasting years before generic drugmakers can begin selling competing versions.
Generics are equally as effective and safe as the original brand name medication. Ask your provider or pharmacist if there is a generic option available.

• Often, there’s more than one medication that treats the same condition. When your provider is deciding what to prescribe, they may not know the costs. If you get to the pharmacy and your cost is high, ask your pharmacist if there are any alternatives you can suggest to your provider.

The insurance formularies specify medications they prefer, to keep costs down. Sometimes, it is as easy as switching from one drug to another equally effective drug that is on your insurance formulary, resulting in savings to you.

• It may shock you how much the cost of the very same medication can differ between pharmacies. For example, the out-of-pocket cost for Atorvastatin, the generic version of Lipitor, a cholesterol medication, may be $4.50 at one pharmacy and $140 at another.

Sometimes, the smallest pharmacies offer medications at lower rates than the larger retailers. While jumping between pharmacies may not be wise, it can pay to speak to different pharmacies to see if they can help reduce your out-of-pocket costs. To guard against any possible drug interactions, let any pharmacy you use know every drug you take.

• Find out if the pharmaceutical company that makes your drug offers help to pay for it. Many companies, to keep their medications accessible, offer coupons to make your copay comparable to less expensive options. Best place to find information regarding this is the website of the drug manufacturer or search at RXAssist.org.

• Look into using mail-order pharmacies. Home delivery is a convenient way to get the medications you take regularly. Some insurances offer this option. Some offer three months supply for the cost of a two months supply if you use mail order.

• Opt for a 90-day supply, which can get you a significantly lower price and is also convenient. Be sure to ask your health care provider to write your prescription for 90 days.

• Look into assistance plans. For generic medications, RXOutreach.com is a nonprofit mail-order pharmacy offering generic medications at a discount to low-income patients.

The New York Prescription Saver (NYP$) is a free discount card that saves on the cost of prescription drugs. It’s designed for low-income persons aged 50 to 65 or persons of any age with a disability and not on Medicaid. Apply at http://nyprescriptionsaver.fhsc.com or call 800-788-6971.

The Elderly Pharmaceutical Insurance Coverage (EPIC) program is a New York State program for low-income seniors, to supplement their out-of-pocket Medicare Part D drug plan costs. See details and apply at https://www.health.ny.gov/health_care/epic/application.