The rising prices of prescription drugs continue to be a significant issue for patients. According to the American College of Physicians, seven out of every ten Americans are on at least one prescription drug and 18% of retail prescriptions in 2012 were paid by the patient, rather than by insurance. The United States is one of the few developed countries that does not regulate drug pricing.
Medical insurance is paying less and less, requiring higher patient copays and sometimes excluding from coverage medications that patients have been treated with for decades. Even the cost of generic drugs has increased, and some generics also are not being covered by insurance. Unfortunately, physicians have no control over what insurance will allow and cover, and attempts to obtain overrides for patient prescriptions are often denied. The pharmaceutical industry negotiates with the insurance companies directly to get on the lists of preferred drugs that insurers will cover. To add to the confusion, at times it is less costly to obtain medications without using insurance.
What can you do? First of all, if you have a choice of insurance companies, check the preferred medications list before you sign up. Make sure each of your medications is covered and what your copay will be for that medication. Most companies have levels of coverage, with higher copays for branded medications. If you take three medications, for example, the difference between a $10 and $80 payment per month can add up quickly.
Even if you do not have a choice of coverage, you still have options. First, you can determine what your medication would cost without insurance. Sites like goodrx.com, lowestmed.com, rxpricequotes.com and others can list local pharmacies and what the medication will cost. A newer site, blinkhealth.com, negotiates with pharmaceutical companies directly to get their discounts. With Blink Health, you pay for your prescriptions online and pick them up at a local pharmacy.
Visit our office armed with information about your preferred drug list. Engage your local pharmacist to help you find the lowest priced alternatives to your highest priced medications. For some prescription drugs, there may not be an available generic alternative, but there may be a similar medication that is covered by your insurance (or is more reasonably priced without insurance). Only your doctor can decide whether another medicine can substitute for the one originally prescribed.
Some medicines can be purchased at a higher strength and cut with a pill splitter to get the dose you have been prescribed. Unfortunately, this won’t work with time-released drugs, so you must check with us or pharmacist to see which medications can be safely altered in this way.
Finally, if these strategies don’t help you find your medicine at a price you can afford, help may be available through the drug companies themselves. With proof of low income, many medications can be obtained directly from their manufacturers, often at no cost. The Partnership for Prescription Assistance (pparx.org) provides a central site to access these different programs.
Medications are a necessary, and sometimes life-saving, part of staying healthy for many Americans. Finding the right medication at a reasonable price may take some work, but affordable solutions are often available.
Cynthia Weinstein MD