With
drug prices high, many struggle to cover the costs. Follow these five ways to
save (hint: it's easier than you think)
by Karen Cheney |May 16, 2019
With each passing
decade, your pillbox fills up a bit more—and makes a bigger dent in your
budget.
A recent report from Congress found that 12 of the 20
most-prescribed brand-name drugs for seniors had seen price hikes of more than
50% over the past five years; the price of six of the 20 had more than doubled.
12 of the 20
most-prescribed brand-name drugs for seniors had seen price hikes of more than
50% over the past five years
Those include popular
pills like cholesterol drug Crestor (up 76%), nerve pain medication Lyrica (up
127%), estrogen therapy drug Premarin (up 117%), and the angina med Nitrostat
(up 477%).
Even with excellent
health insurance, steep price hikes can be tough on your wallet, thanks to high
deductibles and the spread of coinsurance, which leaves you paying a percentage
of a drug’s cost, not a flat copay.
The high cost of
prescription drugs has left many struggling to pay for medications. In a Kaiser Family Foundation poll, nearly one in four people said
that they or a family member had already skipped doses, cut pills, or failed to
fill a prescription.
This burden can get
tougher over time. From age 65 on, nine out of 10 people take at least one
prescription drug a month, according to the National Center
for Health Statistics.
But the big leap
occurs well before retirement age. While 37% of 18- to 44-year-olds take
one or more prescriptions, that portion surges to 69% among 45- to
64-year-olds.
Fortunately, there
are simple things you can do to lower your drug costs—without putting your
health at risk.
1. Use out-of-pocket
drug costs to help pick a health plan
There are dramatic
differences in how health insurance plans cover even the same prescription
drugs, and failing to take those differences into account during your company,
Medicare, or Obamacare open enrollment can leave you paying more for the
medications you take for the rest of the year.
What you need to
focus on is your plan’s formulary, or the list of covered drugs. You want to
make sure your medication is included, of course. But what’s really driving
out-of-pocket costs is tiered pricing.
Most plans group
medications into three or more price tiers. The higher the tier, the more you
will pay in either coinsurance (a percentage of the cost of the drug) or a flat
copayment. Tier 1 drugs are generally preferred generics, whereas Tier 3 drugs
may include more expensive brand-name or specialty meds.
The average co-pay
for a Tier 1 drug is $11, according to the Pharmacy Benefit Management
Institute, while the average for a Tier 3 drug is $59; the average co-insurance
rises from 14% for Tier 1 to 33% for Tier 3.
The other piece of
the price puzzle is your deductible, and increasingly a high-deductible health plan will be on your menu of choices at
work on the individual market. (Your Medicare Part D drug plan may have a
deductible too, a maximum $405 in 2018.)
Deductibles have long
been common for doctor visits and hospital stays, but today nearly four out of
10 plans also require you to meet a deductible before covering any of your
prescription drug costs. Usually the pharmaceutical deductible is bundled with
your medical deductible, but not always.
No matter what kind
of insurance plan you’re shopping for, factor in what you would pay for your
medications before making your choice. For a Medicare plan, you can use this tool to
compare options in your area. On the job, see if your health plans
offer online comparison tools.
“Consumers need to
arm themselves with information and be their own true advocate,” says Daniel
Nam, executive director of federal programs at America’s Health Insurance Plans
(AHIP), a trade group.
2. Do research at the
doctor’s office
Of course, even if
you choose a plan with your current medications in mind, what happens if your
doctor orders a new one?
Doctors tend to
prescribe well-known generics when they can, but studies show that in general
they don’t know the cost of the medications they are prescribing.
Fortunately, many
insurers have apps that tell you what meds are covered and how much they cost.
Before your next check-up, download the app onto your smartphone. Then while
you’re with your doctor enter the drug name.
If it is a costly
Tier 3 drug or not covered at all, you can ask your doctor on the spot if there
are alternative meds with the same therapeutic effect.
Of course, you may
not feel comfortable doing that (or, given how fleeting your time with your
doctor may be, even have the chance). You could ask the doctor’s office to look
up the drug on your plan’s website while you’re checking out. Or talk to your
pharmacist, who can call the doctor and suggest an equivalent medication if
your out-of-pocket will be prohibitively high.
3. Give your
prescriptions a check-up
“You may have been on
a medication for years that you no longer need,” says Mohamed Jalloh, a
pharmacist and spokesperson for the American Pharmacists Association.
For instance, your
doctor may have started you on one medication for your condition, added a new
one when the first wasn’t working, and never cut out drug No 1. By eliminating
it, you can reap instant savings.
Generic drugs
typically cost 85% less than brand-name drugs, but you won’t necessarily
find out when one becomes available unless you ask your doctor or pharmacist.
Last year generics came out for the cholesterol drug Vytorin and the blood
thinner Effient, to name a few.
“Consumers
need to arm themselves with information and be their own true advocate.”
Daniel
Nam America’s
Health Insurance Plans
Unfortunately, you
may have to wait a long time for a generic. “A manufacturer will have a drug
for 10 years, do a slight change to the drug, and re-market it with a new
patent,” says AHIP’s Daniel Nam. But even with no direct generic, he adds,
there may be a generic alternative that is just as good.
Finally, even if you
are already taking a generic, you might find a less expensive one that treats
the same condition.
4. Get creative
You probably already
know some common tricks like getting a higher-dose pill and taking it less
frequently or splitting it. But sometimes you can save money simply by changing
from a capsule to a liquid form of a medicine, or the other way around. Ask
your pharmacist if that’s an option.
Combo pills—typically
a brand-name reformulation of two generic pills—may be easier for you to take.
But they’re typically more expensive. “You may get a better deal if you’re
willing to take two generics instead of one combo,” says Jalloh.
5. Don’t assume
you’re paying the lowest price
Sometimes the cash
price for a prescription is less than what you’ll pay out of pocket with
insurance. A common generic might go for $4 or $5 in cash, while you’d pay $11
or so with your insurance plan.
However, you may have
to speak up to find out. Some insurers discourage sharing that info by
including so-called gag clauses in their contracts with pharmacies. More often,
the pharmacy’s computer system simply defaults to processing your prescription
through insurance, says Jalloh.
You can also use the GoodRx app or website to
search pharmacies in your area for the best cash price and compare it to your
copayment. Keep in mind, however, that when you pay in cash, your outlay won’t
automatically count toward your deductible. Save your receipts and submit them
to your insurer, though that doesn’t always work.
https://considerable.com/stop-overpaying-for-prescription-drugs/
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