Explore ways to reduce the high cost of medicines
Editor's note: This is the final column in a two-part series that began last Monday in Health & Fitness.
As a patient advocate, I find many of my clients become confused and even angry at how much it costs to fill their prescriptions, whether or not they have insurance. They're not alone.
Despite our current pandemic, the pharmaceutical industry raised prices on hundreds of medications by an average of 4.5% last year. The industry, whose prices are unregulated, has become a popular target for consumer advocates, insurance companies and politicians.
The Trump administration ordered a new pricing model in November, only to have it blocked by a court in January. The Biden administration promises to address drug prices; ideas include tying U.S. prices to those in other countries and letting the government negotiate prices.
Political solutions are all well and good, but if you're a health care consumer (and we all are health care consumers, either on our own behalf or that of a loved one), you can't wait to be rescued from high drug prices.
Know your formulary
In my last column, I explained the ins and outs of "prior authorization" required by insurance companies for certain medications. With another assist from Chicago-area pharmacy consultant Theresa Malvar, here are more tips for taking charge of your prescription costs.
Last time, I recommended that you familiarize yourself with the formulary your insurance company uses. This is a list of medications -- both generic and brand-name -- your insurance will pay for and how much.
The rating system for drugs, often called tiers, varies by insurer. A brand-name drug may be a Tier 3 or Tier 4 (meaning a bigger co-pay for you), but the generic may be available as a Tier 1 or Tier 2.
What if you are prescribed a new medication and, after you check the formulary, you find it will be prohibitively expensive? Speak up! Call your doctor's office and ask for an alternate medication.
Find out about generics
Does your new medication have a generic? If so, make sure your provider doesn't check "dispense as written" on the prescription form.
Generics can save you a lot of money. For example, the generic levothyroxine, used to treat hyperthyroidism, costs just a few dollars at the pharmacy for a 30-day supply. The brand version, Synthroid, may be as much as $50. In your formulary, you may find that the generic is a Tier 1 but the brand-name is a Tier 3.
Do you need all of those meds?
Ask your doctor or pharmacist to review all of your medications to make sure they are still needed. For example, proton pump inhibitors (PPIs), such as Prilosec (generic: omeprazole), are used to treat gastroesophageal reflux disease (GERD). A health care provider may renew the prescription over and over, but recent articles raise concerns about the long-term use of these drugs.
Stay in your network
Your insurance plan probably offers 90-day supplies of medications by mail order, sometimes with little or no co-pay. Save yourself a trip to the drugstore as well as money by taking advantage of these services.
Explore discounts, coupons
These can save quite a lot of money, especially if you don't have drug insurance such as Medicare Part D.
First, know what you're entitled to under the Affordable Care Act. The ACA requires that certain preventive medications be provided without a co-pay, coinsurance or deductible. The list includes contraceptives, tobacco-cessation products and cholesterol-lowering drugs.
Here are some options to explore.
• GoodRx is a reliable resource for drug pricing information. It's free to consumers and provides coupons for you to use at your local pharmacy.
• Walgreens Prescription Savings Club costs $20 annually for an individual membership and $35 for a family. Any medications purchased through the prescription savings club will not be processed through insurance. Using the example of omeprazole, the club price quoted on the website is $15 for a 30-day supply, versus $67 without the club discount.
• CVS pharmacies use a search tool to identify the best discounts and coupons for your medication. If you are on Medicare, you cannot combine Medicare benefits with coupons or discounts, but CVS will check prescription prices under the coupon option to see if it's lower than Medicare.
• Check with local independent pharmacies. Sometimes their cash prices are lower than copays and even lower than some coupon prices. They might be able to share a list of generic drugs offered at lower costs.
• At Cou-co.com, you can type in a drug name and pull up a manufacturer's page so you can see what coupons and discounts may be available.
• Insulin manufacturers offer affordability programs. Some examples are NovoNordisk, Sanofi and Lilly.
• Walmart has a $4 prescription plan.
• Costco also provides pharmacy pricing, and you do not need to be a member to use their pharmacy.
As you can tell from all of these services, there is great awareness of the high cost of prescription drugs and companies trying to alleviate the burden. Navigating all of these options can be a challenge; don't hesitate to ask for help from your doctor, pharmacist, family or a patient advocate.
• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She recently created a three-month training course for nurses who wish to become patient advocates (see https://nurseadvocateentrepreneur.com). You can contact her at (312) 788-2640.