Open Enrollment - Page 7 - The Rising Cost of Prescription Drugs

Open Enrollment
- Page 7
The Rising Cost of Prescription Drugs
Tools to help you save money at the pharmacy

By Carol Sorgen
Contributing Writer

Your doctor prescribes a medication, but the cost is putting a huge dent in your monthly budget. According to a survey by Consumer Reports of almost 1,200 adults who take a prescription medication, the high costs of drugs are resulting in people making difficult choices, such as cutting back on groceries, delaying retirement, taking on a second job, or rationing or not even taking their prescription drugs.

There are several reasons for the high costs of prescription medications in the U.S. To begin with, drug manufacturers can pretty much set their own price from the outset. When demand for a drug is high – as it is for medications that effectively treat such conditions as diabetes, high blood pressure and high cholesterol – prices are often routinely raised.

When it comes to newer drugs, which have generally been in an expensive research and development stage for at least 10 years, the manufacturer holds the patent right for 20 years, during which time it can raise the price as often and as much as it chooses (or as much as the market will bear).

If you only need the occasional prescription medication, cost may not be much of an issue. If you require long-term management of a chronic condition, however, you may be experiencing sticker shock. There are ways to cut costs though.

According to Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt, the PCMA supports the patient always paying the lowest cost, and Merritt offers these tips for cutting your medication expenses:

• Bring all your prescriptions to your primary health care provider to see if any of your prescriptions are duplicates, whether they are still needed, and if they are available in generic form, which is less expensive than brand names.

• Ask your pharmacist if there are less expensive options. Some medications, for example, become available to be sold over-the-counter (often at a lower dosage than the prescription form, so check with your doctor and/or pharmacist to make sure you’re getting the recommended dosage for your condition). Also inquire whether paying cash, rather than using your insurance, would cost you less. Your pharmacist cannot legally inform you on his or her own about less expensive options, but they can let you know if you ask them directly, according to Kaiser Health News.

• Compare pharmacies. The price of your medication can vary significantly from one pharmacy to another. In addition, not all health plans allow you to use any pharmacy you choose (like your choice of health care providers, some plans require you to use in-network pharmacies or pay an additional fee.) Healthcare.gov advises you to call your insurance company or visit their website to find out whether your preferred pharmacy is in your plan’s network and, if not, which pharmacies are.

• Explore home delivery options. Not only can this save you money (there may be no co-pay whatsoever), but the convenience of not having to go to a pharmacy and wait for a prescription to be filled may make it more likely that you’ll actually take the medication.

Prescription coupons from companies such as GoodRx may help you control your medication cost, but they require research on your part. While coupons that offer savings on prescriptions might sound attractive, Merritt notes that the savings is frequently time-limited and often applies only to the more expensive brand name version, when you could already be saving by taking the medication in generic version. (The U.S. Food and Drug Administration requires generic drugs to have the same performance and quality as brand name drugs. The difference lies in the cost to the consumer.) Nevertheless, it is worthwhile to ask your pharmacist if your medication would be cheaper with the discount or with your insurance or Medicare co-pay, or whether there is an even cheaper over-the-counter option. You cannot combine a discount coupon with your insurance or with Medicare or Medicaid.

There are prescription drug finder tools that can help you look for better prices. Medicare.gov, PlanPrescriber.com and ExtendHealth.com have questionnaires that allow you to compare prescription drug plans by entering information about your individual medications. Also, ask your physician for advice. Sometimes physicians may know of a pharmacy beyond your neighborhood grocery store that can fill a certain prescription for less. Your physician may also be able to offer some samples if he or she knows that the cost of the drug is posing financial hardships for you.

If your medication does not come in generic form, or your insurance company won’t cover your prescription, or you can’t afford your copays, there are also several other avenues to explore. Many pharmaceutical companies have a prescription assistance program for patients who are under-insured or cannot afford their medications. Contact the manufacturer of your medication and ask if they have such a program. Other organizations, such as the Patient Advocate Foundation Co-Pay Relief Program (copays.org), provide direct financial assistance to qualified patients, assisting them with prescription drug co-payments their insurance requires for their particular diagnosis. Telephone counselors work directly with the patient as well as with the provider of care to obtain necessary medical, insurance and income information. If approved, payments can be made to the doctor, the pharmacy or directly to the patient.

Cutting pills in half, skipping dosages or not filling your prescription at all are not the answers to saving money, says Merritt.

“There may be several options available that won’t result in your compromising your health care.” •