We live in the most advanced times in medical history. According to the Centers for Disease Control and prevention (CDC) life expectancy in the United States has doubled from what it was just 100 years ago.
Medications, both prescription and non prescription have been a large part in that increase in life expectancy. According to BeMedWise, two out of every three visits to the doctor end with a prescription being written.
Yet, 1 in 4 americans struggle to afford medications according to a health tracking poll done by the Kaiser Family Foundation. The respondents said it was either difficult or very difficult to pay for their medication. This was strongly voiced by those who spend $100 or more per month.
What is even worse is that 29 percent of the adults surveyed reported not taking their medications as prescribed due to cost.
What to do if you find yourself in this situation?
The trend in the United States for prescription drug insurance has been a move toward high deductible health plans. Meaning you pay full cost for your medication until a deductible amount is met. If the deductible is $1500 per year that comes out to $125 per month out of pocket.
That is over the $100 per month threshold patients voiced as a concern in the Kaiser poll
If you find yourself without insurance or have a high deductible plan you need to know the best ways to get prescription savings without insurance.
#1 Generic drugs
Generic drugs are copycat versions created to be the same as a brand name drug. They work the same way in the body and are FDA approved on the basis of:
- Shown to be safe and effective
- Have the same amount of active drug, in the same dosage form
- Are bioequivalent, meaning they act the same when absorbed in the body
In 2017 generics were dispensed for 89% of all prescriptions per the Association for Accessible Medications.
That means that the majority of the time when you get a prescription filled it will be a generic. However, you need to make sure you verify that with your doctor or pharmacist. New drugs are being approved all the time and so just because most have generics today, doesn’t mean yours is.
Recent efforts to lower the cost of medications by congress has been to increase the number of generics the FDA approves each year. The more competition there is the lower the generic cost will be, just like with any product.
Not all generics are the same
When a patent expires on a brand name drug and generics are allowed to be made, only one manufacturer can start the process. The FDA gives the company who is willing to create the first generic a 6 month grace period where they are the only one who can sell a competing generic product.
That means that the first generic will not cause a dramatic drop in the price of the drug. It isn’t until many manufacturers enter the market that the prices start to fall. Eventually if enough competitors enter the market the prices becomes very low.
You want to look for generics in this sweet spot if you can. Often they will be part of $4 generic programs that many retail pharmacies offer. Make sure to shop around at these will end up being your best bet.
Generics that cost more?
In recent years certain drugs have been recalled due to tainted ingredients from foreign countries or other manufacturing problems. When things like this happen the drug makers can start to lose money on the generics they are manufacturing.
When that happens and many companies stop making a particular drug, then you can actually see generic prices increase. An example of this is the drug metoprolol, which is used for blood pressure. After a manufacturer left the market it had a price increase over nearly 70%. Other drugs that are examples of this include doxycycline an antibiotic drug that has been on the market for decades.
Don’t forget to ask if the drug is less than your copay
If you do have insurance and your copay is $10 or more for generics, then you should be asking your pharmacist what the actual price of the drug is. A recent practice that pharmacy benefit managers (PBM) used called a gag clause was just made illegal. The PBM prevented the pharmacist from telling you that the drug cost less than your copay.
Even though this practice was outlawed, you still need to ask just to make sure the pharmacist who may have been busy, didn’t miss a cost savings for you.
#2 Therapeutic Alternatives
Almost all medications will have another medication in the same therapeutic class that acts in a vary similar way.
When a brand drug is introduced on the market very often it will be what is called a me-too drug. A me-too is defined as a drug that is structurally very similar, has similar actions and sometimes similar side effects.
This is very important to know if you are stuck paying out of pocket for an expensive me-too brand drug. The good news is it likely has a therapeutic alternative that has been around longer and hopefully has a generic available.
Working with your doctor to let them know the cost of your medications is a priority and that you would like to try replacing the original drug with a drug that is chemically different can offer a huge return.
Will I get the same results?
Your doctor should expect to see similar level of effectiveness of the therapeutic alternative at a cheaper price. Couple that with your ability to actually afford the medication and stay on therapy the way it was prescribed is a ticket for better overall health.
This concept is often forced upon your prescriber by your insurance company in an effort to save money for their clients. However, when you speak to your doctor about this idea they will be more open. Doctors often feel like they are being told what to do by the insurance company. However, when a patient is seeking medication at a lower cost this will be seen by your doctor as the right thing to do for their patient.
Do your research
To find therapeutic alternatives there are a few things you need to do.
1. Type into Google the name of the drug you are on and add the words therapeutic alternatives. This should bring up a list of drugs that are similar to your drug within the first few search results
2. Call or visit your pharmacist and ask them if the names of the drugs you found are therapeutic alternatives to your drug. Also ask if they have a generic available. Finally, ask them which one your pharmacist thinks would be best for your specific situation.
3. Set up time to review the options your pharmacist told you about with your doctor. Make sure you tell them you are doing this so you can continue to take your medication and be healthy.
Multiple forms of the same drug
In certain scenarios some chemical entities have been marketed and sold under different brand names. When that happens if one brand of the drug has a generic but the other brand does not, your pharmacies can’t just give you the generic alternative of a different brand form. Take a look at the table below to see an example.
|Brand Name||Generic Name|
|Wellbutrin XL||Brupropion XL|
|Wellbutrin SR||Brupropion SR|
The bupropion XL can’t be substituted for the Wellbutrin SR or Wellbutrin.
These situations occur for drugs that have some of the following situations:
- Immediate release formulations
- Extended release formulations
- Formulations that are absorbed in different parts of the stomach or intestines
Your tip off to this type of drug is anytime it says XL, SR, extended, sustained or modified release. Luckily you can ask your pharmacist if this situation exists for a drug you take.
#3 Cash Pay
Paying cash is just what it sounds like. In this case you are not using insurance, discount card or any type of copay coupon or other assistance. You are literally just paying cash.
Certain drugs as discussed above have many generic manufacturers, which drives the price down and it is cheaper to pay cash than use insurance.
Over the counter
Another consideration for paying cash is drugs that are available over the counter. Many drugs are available in prescription strength and over the counter strength. You may find that the over the counter strength is a better deal even if you have to buy a higher quantity to get the same strength.
Many popular drugs in recent years have been categorized as over the counter by the FDA. Certain classes of drugs such as heartburn relief, allergy, pain relief, cough and cold symptoms and smoking cessation are available without a prescription. The FDA is also looking at making other classes of drugs over the counter in the future. One very highly used class of medications that FDA has looked at are called statins, used for high cholesterol.
Make sure you check with your pharmacist to see if any of your medications are available over the counter and if the prices are better than the prescription counterpart.
A recent survey by Consumer Reports noted that small chain or independent pharmacies often have better cash prices on medications than large chains. Eight of twelve drugs in the survey were found to have lower prices at smaller pharmacies. The cost savings ranged from 8-840%!
When talking about 840% differences in price you are talking about thousands of dollars a year in savings. Take the time to do some research and call around looking for pharmacy cash prices.
Your location can have a lot to do with prices, especially urban versus rural areas. Make sure you check pharmacy prices in both types of locations when looking to pay cash.
#4 Discount Cards and Apps
Think of discount card programs like coupons for the grocery. Some are free and others charge a small fee to use. They vary based on the amount of the discount, network availability, ease of use and cost.
Options one through three above should be tried before going to discount apps. The reason being that you always want to make sure you are getting a generic or the therapeutic alternative that is generic first. Then if you ask about cash the pharmacy might have a better deal than what they are willing to negotiate with the discount vendor. So after you check 1-3, get ready to check out discount cards.
Anytime you have to pay to use a discount card you should be cautious. There have been reports that patients end up paying more with a discount card.
Below is a small list of the most well known discount card options:
- Single Care
- US Pharmacy Card
- Discount Drug Network
- Needymeds Drug Discount Card
What to Know About Prescription Discount Cards
- Discount cards are not insurance, some can be used with insurance but most can not.
- Shopping around for the best price is made easy by user friendly websites and apps.
- Pharmacies enter contracts with the drug discounters and thus the price differences.
- Some plans may favor one pharmacy over another, example Target vs. Walmart
- Each will have there own requirements for use that is very important for you to read and understand.
Once you go online and find the best deal for you the next step is to obtain the card. This can be in the form of downloading on your phone, having it texted or emailed to you or printing it off. You may also have to wait around for the company to snail mail it to you.
The card may have been mailed to you and appear like a credit card. You may also see numbers on the card that resemble what is on your health insurance card. Some will have websites or apps you can use that allow you to search for medications and what pharmacies participant in their discounts.
Above I listed only a fraction of the total drug discount card options available. As with any consumer product there will be some bad actors out there looking to profit from you. Some discount cards are aligned with pharmaceutical manufacturers and do not always offer the patient the best out of pocket cost.
Always ask your pharmacist if this is the best deal for you before using a drug discount card!
#5 Patient Assistance Programs
Many patients may have heard of patient assistance programs but not fully understand what they are and who they are for. You may also hear of them referred to as pharmaceutical assistance programs or PAP’s.
These programs are run by non profit organizations. Sometimes they are setup by pharmaceutical manufacturers but not all are.
They help patients in financial need be able to obtain necessary medications or medical supplies. They allow patients to obtain these items at no or very low cost. Most often they are used by patients who do not have insurance or are underinsured. Underinsured is a term that means health insurance does not provide complete financial protection and the patient lacks the ability to cover their out of pocket costs.
Types of PAP’s
- Uninsured PAP’s
- PAP’s for underinsured
- For patients with government insurance such as Medicare or Medicaid
As you can see two of the three types have some form of insurance. In case you were wondering why pharmaceutical companies would set up a non profit to give away money to patients to pay for expensive drugs, let me explain.
PAP’s can still help you
Regardless of the reasons for manufacturers wanting to provide PAP money to patients they are still a great money saving tool for you. Each year millions of patients get assistance, but there are millions more who do not use the programs who could qualify.
Don’t believe the notion that these programs are only for the impoverished. With the explosion of expensive specialty medications in the market eligibility requirements based on income can accommodate patients who have a moderate to median income.
Typical eligibility requirements
Eventually your doctor or their staff will have to assist you in completing the paperwork required for most PAP’s. However, you can do research on your own by looking at the Needymeds.org website. This awesome tool will empower you with the knowledge of what assistance might be available based on your income and family size. Don’t forget to look back at #3 therapeutic alternatives as well since other drug may have PAP money available if they one you take does not.
Here are some typical items that will be needed for PAP enrollment.
- Proof of residence or citizenship
- Income below a multiple of the Federal Poverty level (based on income and number of people in household)
- Proof of income in the form of tax documents or other paperwork
- Proof of underinsurance or insurance rejection of coverage
- Reason for use of the drug based on medical information from doctor
- Doctor signature
Many doctors charge a fee for their office to complete PAP paperwork. That is why I stress that you should research PAP’s on Needymeds.org. Hover over the patient savings tab on the top and you will see patient assistance. From there you can easily search by drug brand or generic name. All requirements for that specific program will be listed and even a calculator to determine if you are at or near the income level required for the program.
The video below walks you through using the Needymeds.org site, a one stop shop for all things PAP.
Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!
Share your story
Have you tried one of these savings methods? Also, let us know if it worked for you? Please chime in below with your comments and thoughts.