The cost of prescription drugs in the U.S. has long caused frustration and, worse, presented financial barriers for some consumers. According to the Organisation for Economic Co-operation and Development, the average American pays $1,200 per year for medications, more than in any other country in the world. A recent poll from Kaiser Family Foundation found that 29% of American adults are not taking medications as directed, either skipping or splitting doses, opting for over-the-counter medication instead or not filling their prescriptions at all, in order to cut costs.
Currently, the U.S. government doesn’t regulate drug costs, and while that continues to be a contentiously debated issue for lawmakers, insurers and the pharmaceutical industry, it’s unclear what, if anything, all that arguing will change. However, even with the current systems in place, there are still several strategies consumers can use to decrease their spending.
Here are six such ways to combat sticker shock at the pharmacy counter.
Find out why your medication is so expensive. “For us, it’s really important to get to the main root cause because you’ll ultimately find the best solution,” says Erin Bradshaw, the chief of mission delivery at Patient Advocate Foundation, a nonprofit that provides patients with case-management services and financial support.
Bradshaw explains that while your provider may not have the answers, pharmacists are often extremely knowledgable about the complexities of pricing and can provide valuable guidance. They may also be aware of short-term savings opportunities such as co-pay assistance programs, manufacturer discounts and third-party coupons.
Know your insurance
If you’re insured, whether through a state- or federally funded program, an employer or yourself, take the time to learn the details of your plan’s design. This includes the basics such as your monthly premium, deductible and specifics like the plan’s formulary—the list of covered generic and brand-name medications, including the tiered pricing structure under which different drugs that treat the same illness have different prices. You can find out your co-pay by using the medication pricing tool on your insurance company’s website. Commercial insurance companies may also restrict your choice of pharmacies or have a designated mail-order service.
According to Bradshaw, often, patients just don’t understand how their plans work. “They might think they’re getting denied, but in reality, it might be a covered prescription, but they have to meet an out-of-pocket deductible,” she says. Other plans may have co-pay accumulators, a feature that debuted in 2016 and eliminates some of the benefits of using a manufacturer assistance program or co-pay card when purchasing medication. Instead of counting the amount contributed by the manufacturer in the deductible, lessening a patient’s out-of-pocket costs before insurance begins to cover the medication, a co-pay accumulator requires the patient to pay the entire deductible themselves redistributing the discount to reduce the burden on the insurance company. “So you’ll maybe find a solution to help along the way, but then three months later you might find that you still owe that $5,000 deductible,” says Bradshaw. “For some people, it catches them off guard because they might have been using these systems before and they worked well.”
If you have Medicare Part D, fill your prescriptions at one of your insurance company’s preferred pharmacies—which should be listed on the company’s website—to pay a lower co-pay.
Switch to generic medication
A common piece of advice for reducing medication costs is to use generics rather than brand-name medications. “Generics are less expensive because the company who makes the generic did not have to spend the dollars for research and development,” explains pharmacist Theresa Tolle, owner of Bay Street Pharmacy in Sebastian, Fla. “Without that additional overhead, the generic company can ‘copy’ the formula and charge less to produce it than the company who brought it to market.”
Although FDA-approved generics and brand-name counterparts are generally thought of as identical, there can be slight differences that may affect some consumers. “The Food and Drug Administration has strict requirements and specifications for generics that must be met before they are approved to be on the market,” says Tolle. For the FDA to approve a generic, the two drugs must be bioequivalent—the active ingredient must be the same and get released into the bloodstream at approximately the same rate and quantity. Where they vary is in the inactive ingredients such as the fillers, coatings and flavorings. Although the FDA requires proof that these ingredients are safe, they may still cause side effects like allergic reactions.
If you have insurance, check the formulary list to determine the comparative coverage for the generic or brand-name medication and whether there are certain limits or restrictions for either.
And, of course, consult with your doctor before making any decisions.
Try charitable programs
There are currently eight national charitable relief programs that offer assistance to patients who meet the eligibility requirements. For example, to qualify for the Patient Advocate Foundation Co-Pay Relief Program, patients must have insurance, live and receive treatment in one of the 50 states or the District of Columbia, and have an income that meets the requisite guidelines of the fund for which they’re applying—in all cases, at or below 300% or 400% of the Federal Poverty Guideline with consideration given to the Cost of Living Index and size of household. Qualifications vary from program to program.
Be a savvy shopper
The prices of prescription medications can vary from store to store, and there’s no way of knowing your cheapest option unless you do your research. Even if you have insurance coverage, it’s worth doing your due diligence; you may find that the co-pay is actually higher than the discounted full price available through a membership program (some are free, others have an annual fee) or with a coupon. Again, while that out-of-pocket cost may not count toward your deductible, it may offer a short-term solution to a hefty price tag. Both Bradshaw and Tolle recommend Partnership for Prescription Assistance (pparx.org), an online resource for patients to search for assistance programs based on their medication needs as well as age, residence, income, size of household, and current health insurance and prescription coverage plans. Other shopping strategies include:
Coupons: Consult a site like GoodRx, which compares both generic and brand-name drug prices at nearby pharmacies and offers coupons for additional savings. But be careful: some of the coupons come with eligibility requirements—you might not qualify for a discount on brand-name medication if you’re able to receive coverage through a state or federally funded program. Since some coupons and discount cards are issued by marketing companies rather than pharmaceutical companies, check whether the company protects patient privacy before you submit any personal information.
Prescription discount cards: There’s a seemingly endless array of prescription discount cards promising ease of use and reduced prices for multiple drugs. However, they too come with a lot of fine print including possible restrictions based on income, state of residence and pharmacy. Familiarize yourself with those details.
Mail-order service: For medications you take routinely, using your insurance company’s mail-order service may be more cost-effective than filling the prescription at your local pharmacy, especially if you are able to purchase a 60- or 90-day supply. If you tend to do things at the last minute or need your medication immediately, mail order may not be the best choice, as new prescriptions can take around two weeks for processing and delivery. Be aware that mail-order services aren’t the same as online pharmacies—both deliver your medication, but online pharmacies may not accept your insurance.
Manufacturer savings programs: Some manufacturers have their own ways to assist consumers. For example, Pfizer Patient Assistance Program offers eligible patients who have an income starting at 400% of the federal poverty level free Pfizer medications through their doctor’s office. The Pfizer Savings Program also allows qualifying uninsured patients to receive discounts on Pfizer medications. If you don’t have state- or federally funded insurance but are insured, you may qualify for individual drug savings cards to lower the price of specific brand-name medications. The pparx.org site has a comprehensive list of available savings programs.
Free trial programs: First-timers may be eligible for a free trial of certain brand-name meds. Information about trial programs, including qualifications and duration, can usually be found on the brand’s website.
Order less of more
Some tablets can be broken. Depending on your medication, you may be able to save money by ordering fewer pills in a higher dose and then cutting each in half. Many tablets come with a score, or line down the middle, to ensure accuracy. Either way, a pill cutter, sold at drugstores or online, will help. But ask your doctor or pharmacist and consult the drug label before cutting any pill. Not all drugs—such as those with time-release formulations—remain effective when cut; others can result in problems like stomach irritation when broken. Pills with unusual shapes or those that are very small may prove hard to split into equal pieces. And capsules, of course, simply can’t be cut.
If you’re at the drugstore and faced with an insurmountable bill, explain your financial situation. Your doctor and pharmacist may be able to find an appropriate alternative. Tolle explains that if you need a brand-name medication with no alternatives, the prescriber may have samples, giving you the opportunity at least to test the drug’s efficacy before making the investment. “This would also allow time to determine if there were any programs that would help the patient afford their medication,” she says.
The right drug can change—and even save—your life. But it can’t do that work if you can’t afford it. Knowing your options can make sure you get the medications you need when you need them.