The Affordable Care Act has been around since 2010, but there are still millions of Americans living without health insurance. According to the United States Census Bureau, over 27.5 million Americans, including more than 77,000 children, lacked health insurance in 2018. Just figuring out how to see a doctor without insurance is a challenge, but in many cases, that’s only the first step in treating a problem. Many conditions also require treatment with prescription drugs, and without insurance, those drugs can be very costly.
According to a 2018 study published in the Journal of the American Medical Association, the average per-person cost for prescription drugs in the U.S. is $1,443, much higher than in any other country. Of course, most Americans don’t pay that full amount out of pocket. A 2019 Kaiser Family Foundation (KFF) survey found that about two-thirds of all Americans spend $50 or less per month on copayments and other prescription drug costs.
However, an unlucky minority of Americans — about 1 in 4 adults — find it difficult to afford their prescriptions, and about 1 in 10 find it very difficult. Some don’t have insurance, and others have health plans that don’t cover their prescription costs. According to the KFF survey, roughly 30% of people with health insurance in 2019 were told their plans wouldn’t cover a drug their doctor had prescribed for them.
Many Americans deal with this problem by not taking their medications. Nearly 3 in 10 adults surveyed by KFF said they didn’t take their medications as prescribed during the past year because of the cost. They either didn’t fill a prescription, took an over-the-counter drug instead, skipped doses, or cut their pills in half. Unfortunately, these strategies are likely to harm your health. About 3 out of 10 patients who tried them (8% of all respondents) said their health condition worsened as a result.
A better approach is to look for ways to get your prescription drugs for less. Search tools and discount programs can help you find the medications your doctor prescribes at a lower cost. However, your first steps involve those responsible for your prescriptions in the first place.
Ways to Reduce Prescription Drug Costs
1. Talk to Your Doctor
When your doctor prescribes a new medication, be honest about what you can afford. A doctor who knows about your situation upfront has multiple options for keeping your prescription cheaper, such as:
- Using Samples. Drug companies often provide physicians with free samples of their drugs to give to patients. If you’re only going to take a drug for a short time, your doctor might be able to supply the full amount you need from their available stock of samples. Samples also offer your doctor a way to test a new medication for you to make sure you can tolerate it before making you pay for a whole month’s supply.
- Prescribing the Generic Version. Some doctors habitually write prescriptions for name-brand drugs. If your doctor knows you don’t have insurance, they can save you a significant amount of money by prescribing a generic medication instead.
- Substituting a Cheaper Drug. If there’s no generic equivalent for a drug, your doctor can sometimes save you money by prescribing a different, cheaper drug that does the same thing. The cheaper drug may have more side effects or be harder to use, but it could be worth the hassle if the savings is big enough. For instance, according to Drugs.com, the EpiPen, a lifesaving device for treating severe allergic reactions, costs $650 to $700 for a pack of two. In contrast, a similar injector pen sold at CVS costs only $110.
- Prescribing a Different Dosage. Some drugs are available in multiple dosages, such as 10- and 20-milligram tablets. If you need a 10-milligram dose, but the 20-milligram pills cost less than twice as much as the 10-milligram ones, your doctor can save you money by prescribing the 20-milligram pills and instructing you to split them in half. Ask your doctor or pharmacist for instructions on how to split pills safely and accurately.
2. Talk to Your Pharmacist
Even if your doctor has prescribed a name-brand drug, you can usually ask the pharmacy to fill the prescription with a generic version. According to the U.S. Office of Personnel Management, every state has a law allowing pharmacists to substitute generic drugs for brand names. The only time they can’t do so is when the doctor has specified you can only use the brand-name drug. However, in this case, your pharmacist may be able to consult with the doctor and suggest a cheaper medication.
Asking your pharmacist for a generic drug can save you a significant amount of money. According to the U.S. Food and Drug Administration, when there are multiple generic versions of a drug, price competition drives down the cost to around 85% below the brand-name price.
By law, generic drugs must have the same active ingredients and dosage as their brand-name equivalents. However, the inactive ingredients in the generic drug can be different. In rare cases, that causes the generic to be less effective or cause different side effects.
For example, a 2017 study in the American Journal of Therapeutics found that patients who switched from brand-name to generic drugs for epilepsy had more side effects and higher overall costs of care due to increased doctor visits. These antiepileptic drugs have a narrow therapeutic index, which means even small differences in the dose or absorption rate can cause big changes in how the body reacts to it. Other drugs in this category include blood thinners, thyroid medications, and anti-arrhythmic drugs.
So, when you get a prescription, ask your doctor if the drug is one that has a narrow therapeutic index. If it is, stick to whichever version is on the prescription — either generic or brand-name.
3. Shop Around
Where you shop for a drug can make a big difference in the price. Drug manufacturers can suggest a price for their products, but they don’t actually control how much pharmacies charge, and the cost can vary significantly from one pharmacy to another. For instance, GoodRx lists retail prices for metformin, a diabetes drug, ranging from $3.11 to $13 at pharmacies in central New Jersey.
You can call around to pharmacies in your area to check prices, but search tools like GoodRx, Pharmacy Checker, and RxSaver By RetailMeNot offer a more accessible alternative. Simply type in the name of the drug you need, and these tools can show you how much it costs at different pharmacies in your area. They can also help you find online coupons to lower the price.
When you’re shopping around for medications, don’t overlook online pharmacies that deliver drugs by mail. Because these mail-order facilities have lower overhead costs, they can often provide the same drug at a significantly lower price. They also save you the trouble of going to the pharmacy to pick up your prescription. Just make sure to stick to legitimate, licensed online pharmacies like those listed on Pharmacy Checker.
4. Look for a Community Charity Pharmacy
Community charity pharmacies (CCPs) are licensed drug pharmacies that dispense drugs to low-income, uninsured, and underinsured people at no cost. They receive donations of medications from drug manufacturers and nonprofits, such as Rx Outreach, Dispensary of Hope, and Americares.
CCPs typically stock more than 100 of the most commonly used medications, including drugs for asthma, diabetes, high cholesterol, high blood pressure, anxiety, and depression. These are exactly the same drugs you’d get in a retail pharmacy, and they come with the same level of service and education. All you have to do to receive them is complete a short enrollment form showing you qualify for the service.
You can find CCPs in your area through the National Association of Free and Charitable Clinics. Enter your location on the main page, then search the list of providers that pops up for those that list “Rx” among their services.
If you can’t find a local CCP, try searching for the drug you need on Rx Outreach. It’s a nonprofit mail-order pharmacy that makes more than 1,000 medications available to low-income people at an affordable price. It’s open to qualifying individuals and families (with or without insurance) with incomes up to 400% of the federal poverty level.
5. Apply for a Patient Assistance Program
If your income is low enough, you can receive a discount on your medicine through a patient assistance program (PAP). These are programs run by pharmaceutical companies that offer their products at low or no cost to people who can’t afford them. According to RxAssist, most brand-name drugs are available under these programs.
Each PAP has its own rules about who’s eligible. However, for most programs, you need to show you are a U.S. citizen or legal resident and your income is below a certain level. You must also confirm you have no insurance coverage for prescription drugs. Some PAPs accept patients with insurance if they can show their insurance plan doesn’t cover the particular drug they need.
There are several ways to find a PAP for a drug you’re taking. You can visit the manufacturer’s website or search for the name of the drug on RxAssist, RxHope, NeedyMeds, or the Medicine Assistance Tool created by the Pharmaceutical Research and Manufacturers of America. You can also do a basic Internet search for the drug’s name with the phrase “patient assistance program.”
Most PAPs have application forms you can fill out online, but some companies require you to apply by phone, fax, or mail. You must answer questions about your household, your income, your insurance, and your health. In most cases, you also need confirmation of a prescription from your doctor.
If you’re approved, the company ships a supply of your medication to your home or doctor’s office. The whole process can take several weeks. If you’re on any long-term medication, you must make sure to renew your prescription well before you run out to make sure you get a new supply in time.
6. Seek Out State Programs
In addition to the PAPs run by drug companies, 20 states currently have state pharmaceutical assistance programs (SPAPs). These programs help low-income senior citizens and people with disabilities cover the cost of prescription drugs. Coverage varies by state, but most SPAPs provide Part D “wraparound” coverage — that is, coverage for medication costs that Medicare Part D doesn’t pay.
SPAP eligibility rules vary by state. Some programs provide aid only to Medicare recipients who don’t qualify for a Part D low-income subsidy. Others offer assistance to people with certain chronic conditions, such as HIV. Check Medicare.gov to see what programs are available in your state and who is eligible for them.
7. Use a Prescription Drug Discount Card
If you don’t qualify for any PAPs or SPAPs, there’s one other way to lower your medications’ cost: a prescription drug discount card. These cards are available from various organizations, including state governments, nonprofits, membership associations, and for-profit companies. The card issuers negotiate directly with pharmacies, offering to get them more customers if they agree to provide drugs to all cardholders at a discount.
A 2019 study in the Journal of the American Pharmaceutical Association found that patients who used a prescription drug discount card in 2016 got a discount 78% of the time. The median savings on each prescription was $17.80, or about 48% of the regular price.
However, that doesn’t mean using a discount card saves you 48% on every drug you use. Savings can vary widely depending on the drug you need and the stores where you shop. The savings from a drug discount card isn’t always better than you’d get by buying a generic drug or using a cheaper drug.
Additionally, some drug discount cards cost money to use. According to RxAssist, some cards charge an annual fee ranging from $30 to $60 per family, while others charge a monthly fee of $4.75 to $7.95. Other cards charge only a one-time enrollment fee, and many are free.
Prescription drug discount cards also vary in their eligibility requirements. Some are available only to people over a certain age or below a certain income level. Sometimes, associations like AARP offer them exclusively to their members. Some cards cover the cardholder only, while others make benefits available to all the cardholder’s immediate family members.
With so many variables, it can be hard to figure out which drug discount card is best for your needs. To further complicate matters, most pharmacies don’t tell you how much you can save with a discount program unless you already have both the card and a valid prescription.
Your best bet could be to get several different free cards, take them to the pharmacy at a time when it’s not too busy, and ask the pharmacist which one can give you the best discount on the drug you need. Cards that are free and available to everyone include:
There’s no one strategy for saving on the health care costs of prescription drugs that works best all the time. For instance, generic drugs are often much cheaper than name brands, but sometimes, a name brand is less expensive if you can get it through a PAP. SPAPs and CCPs can sometimes make your prescription completely free, but they’re not available to everyone, and they don’t cover every drug.
To keep your prescription costs as low as possible, try to stack as many of these strategies as possible. Start by talking to your doctor about which drugs are affordable and get a prescription you can fill as cheaply as possible. Once you have your prescription in hand, see if there’s a CCP in your area that can fill it for nothing.
If not, turn to tools like GoodRx, RxAssist, and NeedyMeds to look for the cheapest possible place to fill it. They can help you find the best price, factoring in tools like PAPs, coupons, and mail-order pharmacies. Finally, bring your prescription drug discount card — or multiple cards — to the pharmacy when you pick up your medication to see if it can reduce the price even more.
Do you know any other strategies for saving on prescription drugs?
Originally posted at https://www.moneycrashers.com/ways-save-cost-prescription-drugs/