Most adults take prescription medications, either on a regular basis for a chronic condition or on occasion for acute problems. If you live in the U.S., you should be aware that you are going to pay 2-3 times what residents of most other countries pay for the same medication.
If you are wealthy and have great health insurance, you can stop reading and worry about something else. If you are like most of us, you may occasionally be faced with “sticker shock” at the pharmacy counter.
As health care costs and the cost of health insurance keep rising, one of the ways employers and insurers have reacted is by raising the co-pays that even those with health insurance are required to pay.
Many older adults and those with less-generous insurance plans have responded by skipping medication – simply not taking a prescribed remedy or trying to stretch it out by taking it less often than prescribed. This can result in seriously bad health outcomes.
How can you cut your prescription costs without risking your health? There are multiple ways.
First, be open with your doctor. Tell them if cost is a concern, as there are many things that the doctor can control. If you are prescribed a brand-name drug, ask if the same or a similar drug is available in a generic. There is usually a huge difference in price.
If the need for a medication is borderline, see if lifestyle changes can substitute for a prescription. For such conditions as mild high blood pressure or borderline diabetes, exercise and dietary changes may avoid the need for a drug. Obviously, only do this with careful monitoring and discussion with your doctor.
If only an expensive brand-name drug is needed for your condition and you have commercial insurance, ask about the drug-company provided co-payment cards, which your doctor will either have or can request. These are typically used as enticements to get doctors to prescribe new expensive drugs and are a last resort when the drug truly is best for you. (Note: these are not allowed under Medicare, only commercial plans).
Shop around! There will often be dramatic differences in price between different pharmacies. Local non-chain pharmacies (if you can find one!) and the big-box stores will usually have lower prices than CVS or Walgreens for identical products.
Use GoodRx for coupons. A large majority of prescription drugs are available this way.
Check out the Cost Plus Drugs online pharmacy, which sells many generic drugs at substantially lower prices than you will find at retail pharmacies.
Before reaching for your insurance card, ask the pharmacy what the cash price is. For many common generic medicines, this may be less than the co-pay you will be charged if you use your insurance.
If you are in Medicare with Part D coverage or in a Medicare Advantage Plan, be careful to scrutinize the plan’s formulary every open enrollment period. Just because your medications are covered this year does NOT guarantee they will be next year.
Don’t be passive and accept sticker shock. A little work can pay big dividends.
Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.
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