Sunday, February 8, 2009

How to Save on Prescription Medications

In these tough economic times, people both rich and poor are looking for ways to save a few bucks. The New York Times just published an excellent piece on Strategies for Saving on Prescription Drugs. Though many patients have health insurance that covers prescription drugs, even co-pays on preferred drugs can add up. I actually blogged about some of these things back in June before the economic crash in my post Save Thousands On Your Health Care.

The Times offers several suggestions, including:
Use generics when you can. In many cases, a generic will do just as well as a more expensive brand name medication. You should ask your doctor whether a generic could be used instead of a branded prescription. Generics are just as good as the "real thing" and patient's fears about getting an inferior product are unfounded. Please see my post Generics Just As Good As Brand Name for more details.

Use a preferred branded drug. Generics don't work all the time. However, there are usually several options for branded prescriptions and your insurance likely has one it prefers, based on the deal your insurance company made with the drug manufacturer. Non-preferred brands will cost you more than a preferred brand, so if you need a branded drug, make sure it is a preferred one.

Split Pills. Pill splitters are relatively accurate and only cost a few bucks. For example, if your bad cholesterol level needs to be lowered by 50%, even the highest dose of simvastatin won't cut it. If Crestor is a preferred drug, rather than taking 20mg of Crestor, have your physician write for 40mg of Crestor and split this in half. This will save you and your insurance company money.

Use mail order. Most insurance companies use mail order prescriptions. Buying in bulk saves them lots of money, and they will pass some of these savings to you in the form of lower co-pays. If you are on medications you take every day, use a mail order to send you 90 day supplies. This will not only cost less, but also save you on trips to the pharmacy.

Here are a few others that I have come up with:

Really know your formulary. As mentioned above, there are a variety of branded drugs of which one will usually save you money. However, the process is so complicated that unless your physician uses an electronic medical record that communicates this information to the doctor and updates it frequently, there is virtually no way your doctor will know which drug is preferred, and will usually take his/her best guess. More importantly, pharmacies will know which drug is preferred, but have no obligation to tell you this. In addition, they get kick backs from the drug manufacturers as well, so are often incentivized to give you the more expensive prescriptions. I have written before about the albuterol HFA confusion. Some pharmacies are actually illegally switching patients prescriptions to a more expensive product, which costs the patients more while the pharmacies make more profit. The way to protect yourself and save money is to go to your insurance company's web site and look of their formularly. See if the prescription you have is the preferred one BEFORE getting it filled by a pharmacy technician. If it is not, ask your doctor for an alternative.

Look for coupons. In addition to political pressure, more and more drug companies are doing away with samples because it simply costs them a lot of money. Making pills are expensive, and the drug companies know that most samples never get used. Especially in light of pharma's economic problems, coupons are rapidly taking place of samples. They accompany a prescription and are usually in the form of a free 30 day supply, or money off the co-pay. This is one way that branded products that are not preferred go around the insurance companies, but issuing coupons. You need to look at the economics yourself, because it depends on the coupon value and the cost you pay for branded vs. unbranded prescriptions. For example, let's say you need a branded cholesterol medication. Lipitor is preferred on your insurance at a monthly cost to you of $20 and Crestor is the non-preferred brand at a cost to you of $35. You would obviously go with the Lipitor. However, if you can get an up to $25 coupon off your co-pay, the non-preferred drug actually becomes cheaper. Many coupons are renewable (last for 6-12 months), but some are not so be careful.
If your physician does not have these coupons in their office, most drug company web site have them. Before you fill a branded prescription, check for coupons.

Ask if pills can be combined. Many physicians don't like combination pills, single pills that have two medications in one pill, because they feel if there are side effects they won't know which one to change or if the medication is not working, they won't know how to increase the dose. Though this is not entirely untrue, it probably isn't that important. In addition, once you are on a stable dose of two pills, if they can be combined, they should. It is easier to take one pill instead of two, and this will be one fewer co-pay for you. There are many pills that now come in combination, including some generics. One example is Caduet which combines Norvasc and Lipitor. Norvasc is now generic, Lipitor is generally at a preferred tier, and the preferred statues of Caudet varies from insurer to insurer. You need to look at what you pay for each tier, because sometimes the price of a generic plus the price of a preferred drug is still more than the price of a non-preferred drug.

Start on samples. There is no question that drug companies make samples so that doctors will use their medications, and this will ultimately increase the overall cost of prescriptions. Also, the notion that samples go to the poor has been debunked, and I have commented on this in the past. That said, I have had more and more requests for samples from my patients with good insurance during this economic crunch, as co-pays add up and really cost. In my opinion, the reasons samples are beneficial is because they allow doctors and patients to try out a new drug before committing. If you are starting on a new drug, go to the pharmacy and pick up a prescription of a 30 day supply, and then have sided effects after the first few doses, you have wasted almost a month of medication. Your doctor can write for something else, but your insurance company will not re-fund the money you paid.

5 comments:

Mr. MedSaver said...

Dr. Mintz,

If your readers are interested in saving money on their prescription drugs, they might want to check out my blog: http://blog.mrmedsaver.com/ This blog's entire focus is managing prescription costs.

Jacob Milbradt, PharmD
www.MrMedSaver.com

Icedlatte said...

Great post!

I use samples for branded drugs to "discount" for patients. For combo asthma products there isn't good generic available. It's not unusual anymore for the cost of a branded med to be $50/month. If I can supply a free month, patient buys two, gets one free. It helps.

Coupons in the age of pharmacy benefit managers often don't help beyond a month or two as most of the plans I accept insist on switching to the mail-in pharmacy, most of whom do not accept the rebate/coupon traffic.

Shout out to the $4 generic programs. They've made managing the un/underinsured much easier.

Lastly, I detest free trial coupons. Using them means writing two or even three prescriptions: one for whatever the trial covers (e.g. 7 days); one for a 30 day supply, then one for a 90 day supply. If I'm already writing 10 prescriptions for chronic meds, etc. I start to think about gnawing off my hand.

Thanks again for a great post!

Lily said...

Everyone has to watch out for themselves. No-one else is going to take care of you. Even folks with insurance should pay attention. If you've got a $10 co-pay on a generic ask what the cash price is because it might be less than $10!! I found a prescription discount card to help with my meds. It's at www.rxdrugcard.com. They tell you right there on the website what you'll be paying if you use their card. And the membership fee is only $4.95 a month for the whole family. Don't pay more than you need to. Do some research. It's YOUR money.

Anonymous said...

Lily -- I tried RxDrugCard and saved $400 the first month. Yeah, I probably take more meds than most, but it worked for me. Thanks!

Anonymous said...

I got a discount card at www.rxdrugcard.com and now I pay only $21 for my generic Lipitor!