9 Ways to Save Money on Prescription Drugs
Yes, you can win the war on drugs.
While out-of-pocket drug costs have been rising for decades, there are often ways to get meds at more affordable prices — most people just don’t know about them. “Until recently, we didn’t expect an average patient to know this, or to shop around, or even to ask these types of questions,” says Jalpa Doshi, a pharmaceutical economics professor at Penn. “We’ve been so used to the model of defaulting to our insurance coverage.”
“People have blind trust in their insurance companies; people have blind trust in their doctor,” says Robert Frankil, a pharmacy owner in Sellersville for 30 years. “They need to start questioning what’s going on in their lives with health-care costs.” Major reform is needed, but there are things you can do right now. Here’s your checklist.
1. Ask your doc if you really need the drug. You might be surprised by the answer. In a 2017 survey, Consumer Reports found that 70 percent of patients who asked their doctors if they could cut down on drugs were advised they could ditch at least one of them.
2. While you’re at it, ask how much it will cost. “Often, patients bring their prescriptions to the pharmacy and neither they, the doctor nor we know ahead of time if the drug will be covered by insurance,” says Kimberly Kulick, a pharmacy manager at a Rite Aid in Northeast Philly. And even if the drug is covered, you might still have a high co-pay if that particular medicine isn’t “preferred” in your formulary. (That’s the list of drugs your insurance company has agreed to pony up for. It typically comes in tiers, with preferred drugs at the cheapest level.)
Such “surprise” out-of-pocket costs can have consequences. Penn’s Doshi found in her research that high prices have led patients to completely abandon their medications at the pharmacy counter — even if those meds are life-saving treatments for cancer.
The fix: “Ask your doctor to call your insurance company while you’re in the office to find out your expected co-payment, or to call your pharmacist to run a test claim before you leave your appointment,” says Kulick. “That way, you’ll have all of your prices up front and can make your decision before leaving.”
3. Go generic — even if it means switching meds. Another question to ask your doctor: Is there a generic drug that does about the same thing, or a lower-cost one that’s covered by your formulary? Generics often cost 80 to 85 percent less than brand-name and have the same active ingredients. You can also ask for “older” drugs that are similar; newer drugs are probably top-of-mind for doctors, but they tend to be more expensive.
“Familiarize yourself with your formulary,” advises Richard Snyder, chief medical officer at Independence Blue Cross. “And when you need a medication, ask your doctor to prescribe at the lower tiers of the formulary, to have the lowest out-of-pocket costs.”
If you must get a certain drug that’s not generic and not covered in your formulary, ask your doctor to reach out to your insurance company and explain why it’s necessary for your health. If the company still denies coverage, you can appeal (though this can be an arduous and time-consuming process).
4. Ask if it’s cheaper to pay cash. Believe it or not, it could be. Due to the weirdness of our health system, you might have, say, a $40 co-pay if you buy a drug using insurance, while that same drug bought with cash is $13.
Until recently, pharmacists couldn’t volunteer that information. But last fall, President Trump signed two bills into law to ban “gag order” clauses in contracts between pharmacies and pharmacy benefits managers working on behalf of insurance companies. Such clauses prevented pharmacists from disclosing cost-saving information to patients. Worth noting: Pharmacists still aren’t required to tell patients there’s a lower-cost option. So it’s best for you to ask.
Also worth knowing: Walmart, Target, and some large grocery chains carry generic medications that they offer cheaply with no insurance. Search their websites to see if what you need is available.
5. Compare pharmacy prices before you fill your prescription. Philly Mag’s survey found wildly different prices for drugs at different pharmacies — with no consistent winner when it came to costs. To beat the system, be sure to compare the cash prices at three to five pharmacies, either by calling pharmacies directly or using Pennsylvania’s Prescription Price Finder at PARxPriceFinder.com. It’s an incredibly useful tool that gives you the cash prices of 300 commonly prescribed medications at individual drugstores near you.
There are other apps that will do the work for you; WeRx, GoodRx and RetailMeNot’s Rx Saver are three to try. And digital pharmaceutical disruptors abound: BlinkHealth.com, for example, negotiates with pharmacies for a price on your needed med and then takes a cut.
6. Consider manufacturer discounts and other coupon cards. Always ask for a discount card when you’re getting a prescription, since your doctor might have one available. You can also request one from the manufacturer or search online for one from companies like Discount Drug Network or Single Care. Many of the popular prescription-search apps discussed above also offer discount cards and coupons. Using a GoodRx discount card, for instance, could save you $20 on a generic version of Lipitor that lists for $30.
But keep in mind: Never blindly trust any of these discounts to be the right deal. Ask your pharmacist what the cash price is, what the insurance price is, and what your discount price is with a coupon to determine your best way to buy.
7. Try pill-splitting or buying in bulk. Find out from your doctor or pharmacist if your medication can be split in half with a pill splitter. If it can, have your doctor prescribe a higher dosage of the same medication — for example, 20 milligrams rather than 10 milligrams. This method can help lower your overall cost, because dosages are often similar in price. You’ll need to buy a pill splitter to do this — don’t just use a knife.
You can also ask your doctor to prescribe a three-month supply, so you’ll be stocked for longer. This reduces how often you have to pay co-pays. Large big-box stores, grocery-store pharmacies, and some mom-and-pop pharmacies also offer discounted generic medications in 30- or 90-day supplies.
8. Check if you qualify for pharmaceutical assistance programs. If you need to take meds you can’t afford (and you’ve already pleaded with your doc and insurance company), there are organizations to help pay high drug premiums. Pennsylvania options include the Pharmaceutical Assistance Contract for the Elderly (PACE) and the Pennsylvania Drug Card. You can apply for extra assistance on a federal level through Medicare, and you can also go through nonprofit organizations like Needy Meds and the National Patient Advocate Foundation. (It’s easy to search for more patient assistance programs on websites like RXAssist.org.) Additionally, you can reach out to the drug manufacturers directly; many have assistance programs.
9. Buy abroad. This isn’t technically legal, but plenty of people still do it. The FDA, which considers imported medicine dangerous because it often hasn’t been FDA-approved, may seize packages as contraband but typically doesn’t prosecute consumers buying for personal use. The savings can be substantial: Medicines from pharmacies in Canada and overseas often cost half what they do here, or even less. Websites like Pharmacychecker.com can facilitate buying drugs from other countries, but keep in mind that there’s a risk. “You can get meds cheaper this way, but in my opinion, it’s not as safe,” says Frankil.
Published as “Win the War on Drugs” in the May 2019 issue of Philadelphia magazine.