Friday, June 20, 2008

Save Thousands On Your Health Care

ABC News recently posted a story about how you could Save Thousands On Your Health Care. Though theoretically, a helpful story with a few good suggestions (like negotiating your co-pay for a hospital admission with the hospital), many of the suggestions really only apply to patients who don't have health insurance (or the few that use an HSA), and some are not good, such as saving money by splitting pills which can work, but can also be ethically tricky for the doctor who is being asked to write an incorrect prescription. Most of the patients that I see use their health insurance to pay for their health care. There biggest cost is their out-of-pocket expenses, which (since you can't bargain down your deductible or monthly payments) is usually co-pays for prescriptions. Here are a few suggestions that might actually help patients save money by lowering their out of pocket expenses.

Know your formulary
Your insurance company generally will use a Pharmacy Benefits Manager (PBM) to negotiate prices with the drug companies. Most patients have a three tiered prescription benefit such that generics are the lowest co-pay, preferred drugs cost more ($15) and non-preferred drugs cost a lot ($35). Unfortunately, differentiating which drug is on which tier is not always easy, and it changes on a regular basis (just like in the supermarket when Coke is on sale one week and Pepsi the next). We use an electronic medical record which gives us this information and updates it regularly. Most physicians don't have that luxury, and it is impossible to keep up. My previous post on the new CFC asthma inhalers is one example of how crazy this can be. Another example is for federal employees, the nasal steroid Veramyst is a generic co-pay, but the generic for Flonase (fluticasone) is a non-preferred tier: prescribing a generic will cost these patients more in this case! Since physicians can't keep up, you need to know your formularly. This can usually be found on your insurance's web site. If you are paying the highest co-pay, there is almost always another alternative. Before you fill a new prescription, be sure you know where it is on your formulary.

Don't Wast Money on Things That Don't Work
Patients take a lot of over-the-counter medicines, supplements, and other things that may not have any benefit, and may even harm them. I can't tell you how many patients have asked me about colon cleansers which provide no benefit, and may even produce harm. Tell your doctor about everything you take for your health. Don't be embarrassed. Many of the products out there are not clearly harmful, and may even be beneficial, but if you are trying to save money, may not be worth the price of your hard earned dollar. I have blogged previously about the lack of proven benefit of vitamins and supplements. At most, a generic multi-vitamin (plus calcium and vitamin D for women) is likely all you need.

Shift Things Back
One of the reasons insurers are so glad that Zyrtec and Claritin are over the counter, is because they don't have to pay for them. They have thus shifted the cost back to you. These branded medicines are quite expensive. If you have to takes these infrequently, the generic equivalents are probably OK. If you are taking them on a regular basis, most guidelines would suggest that the more effective agent would be a prescription nasal inhaled steroid (like fluticasone). The inhaled steroid market is now fiercely competitive with Veramyst and Omnaris added to the others (Nasonex, Rhinocort, Nasacort). With both of these new drugs, you can actually get coupons so that your co-pay will be as low as a generic. Thus, you will be getting appropriate and better treatment for a fraction of the cost. Antacids (Prilosec, Zantac) are another example.

Ask for Coupons
As above, your physician not only has samples for medications, but also will often have coupons to defray your co-pay cost. Ask for these. Lipitor is the number one cholesterol drug in the country, and with simivistatin now generic, insurers will be pushing you to use this instead of Lipitor to lower your cholesterol. However, both Pfizer and Astra Zeneca (makers of Crestor) have coupons to offset the cost differential for you (it may even be cheaper then what you would pay for the generic). There is no question that samples and coupons increase the overall cost of prescriptions by encouraging physicians to write newer drugs and fewer generics. Thus, you may have a moral objection to this method. However, if you are trying to save money for yourself, this is one way.

Use Generics
Speaking of generics, you SHOULD use them when possible (especially if their is no formulary or coupon disincentive not to). I have many patients fearful of using generics, because they think they are less effective. Generics are almost always just as good as the branded products. Certain medications where the dose needs very fine adjustments, such as hormones (estrogen, thyroid) and blood thinners (warfarin/coumadin), this difference may make a difference. However, most of the time the generics are just as good, and some retailers are now charging you only $4-5 for them.

Stop Smoking
I know this has nothing to do with saving money on prescriptions, but 21% of adult Americans still smoke. With a pack of cigarettes averaging about $5 a day, patients could save over $1800 a year if they just stopped smoking.

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