You Can Save Money On Prescription Drugs

Prescription drug costs have become a major area of concern especially during the current economic climate. Senior citizens have been provided some relief through the Medicare Part D (unless you have enough drug costs to fall through the "donut hole") but the rest of the country either pays some portion of the cost through an employer health plan or has no prescription coverage at all.

For those fortunate enough to have prescription coverage through an employer, their payment is typically either a Co-pay, a fixed amount based on the type of prescription or Co-insurance, a fixed percent of the cost of a prescription.

For example, if your Lipitor costs $50/prescription, your co-pay might be a fixed $20 for a brand name drug or $10 if you pay a fixed 20% prescription cost. Co-pays are generally part of a tiered system. The tiers are based on the type of prescription namely brand, generic, preferred brand and lifestyle.

(1) Brand name prescription - Drug companies spend $10-20 million dollars over 8-10 years to produce a new drug. Once the drug has been patented and passed Federal Drug Administration approvals, the new drug is launched into the marketplace with a brand name such as Aricept. The drug company has seven years or less to cover all of the costs of research and marketing and make a profit before the patent expires. Therefore, brand name drugs are typically extremely expensive but, hopefully they bring new benefit to users.

(2) Generic prescription - Once a drug goes "off patent", its formula is available to any company that wants to produce it. The non-patented version of the drug is called the generic version. For example, ibuprofen is the generic name for Motrin. These drugs are typically very inexpensive.

(3) Preferred brand - There are many drugs available that perform the same function, such as Lipitor and Zocor, two cholesterol lowering drugs. They are considered to be "therapeutically equivalent". While drugs within the same therapeutic category aren't actually identical, many people who benefit from one of these drugs could just as easily benefit from another of the drugs. Health plans make buying deals with various pharmaceutical manufacturers. Often, they make a deal with a few drug manufacturers within each category and "prefer" their members to use those drugs.

(4) Lifestyle - There is a new and growing area of drugs that may be controversial in terms of being covered by health plans. Viagra, Cialis and Levitra, all prescribed for erectile dysfunction, fall into that category. Some health plans are willing to pay for these prescriptions but at a lower level of coverage.

Insurers want to encourage their beneficiaries to use the least expensive drug that works for the situation. Therefore, they cover differing drugs at differing levels to encourage cost-conscious choices. Obviously insurers prefer generic if possible, the least expensive alternative.

Those Americans without insurance face the high cost of prescription drugs without any cushion. In 2007, a brand name prescription cost $119.31 on average and a generic prescription cost $34.34. Given that Americans use on average 12.6 prescriptions per capita, that's a good deal of cost to absorb.

Do you need to simply be one more unwilling victim of prescription drug costs? Not necessarily. If you understand how drug pricing works, you may be able to make some choices that will reduce your drug bill. We know that in general, the generic form of a drug works just as well as the brand name drug. In fact, though there may be differences in appearance, the therapeutic formulation is identical. Most health plans and many states require that the generic form of a drug be dispensed unless the prescribing physician specifically opposes the generic version. Interestingly, although 75% of all available drugs are available in generic form, only 65% of drugs prescribed are generic.

It's time to take a look at your medications. First of all, determine whether your current prescriptions are for generic or brand name drugs. You may be able to tell from the label. If not, you can query on-line or ask your pharmacist. If you find brand names among your prescriptions, find out if there is a generic version available. Speak with your doctor about why you are taking a brand name drug when a generic is available. Recognize that there may be a legitimate reason related to your specific situation. However, if the reasoning has more to do with the doctor's comfort level and he or she cannot provide you with reasonable evidence that the brand is needed, you can think about asking to try the generic version.

If you must take a brand name drug, it may be worthwhile to check with your health insurer to determine whether the plan has a preferred alternative brand that would cost you less. If so, talk with your doctor about whether it would be appropriate for you to try the preferred brand drug. Importantly, your doctor may have chosen the particular drug you are using because of its specific formulation, dosing availability or for some other very good reason. As always, your doctor is your partner in care. You should feel comfortable asking these questions - you certainly have a right to know - and your discussion should make you confident in the choices that have been made.

Many health plans offer the opportunity to fill prescriptions by mail. Often, there is a cost advantage to using the mail order method, such as getting a three months' supply for a one month or two month co-pay. If you can get a break on the co-pay, it's almost always worth the initial extra work to get into the program. That extra work is typically asking your doctor to write a prescription for a three month supply of your medicine and sending that prescription to the mail Order Pharmacy along with all of your personal information and a payment mechanism.

Half-tabbing is a little known but sometimes excellent way to reduce prescription costs by fifty percent. In most cases, the price of the drug is almost entirely related to research, manufacturing and marketing costs. The ingredient costs are typically minuscule. That's why you may find that the cost for Aricept 5 mg and Aricept 10 mg is the same, $165.95. Even though the 10 mg tab has twice as much drug, the price is the same because the ingredient cost has so little bearing on the price.

This oddity presents an opportunity. If you are taking a medication that comes in a variety of dosages, find out if you can buy that medication in double the dosage. If that's possible, you may be able to split the tabs in half and make your prescription go twice as far. Only your physician can decide if half-tabbing will work in any particular circumstance. There are some drugs that must be dosed with so much precision that an inadvertently poorly cut tablet would jeopardize the benefit. There are also some medications that can't be split or are shaped in a way to make it difficult to accomplish effectively.

If you have no insurance at all, you should look into the acceptability of healthcare discount cards in your area. These cards do not represent an insurance plan. Instead, the card company has negotiated discounts with healthcare providers on your behalf. When you buy into the card plan, you will receive discounts at participating providers.

In order to decide if this strategy is useful to you, you have to find out which cards are accepted at the pharmacies you use. Your pharmacy may not have a list of programs in which they participate. Once you find the programs that are accepted, you need to compare the cost of belonging to the program, usually a joining fee and a monthly fee to the savings you will enjoy by receiving the discount. If you must spend substantial sums of money on prescription drugs, a discount card may save you money.

Just Think!

Let's say you currently pay $46/month or $552/yr for a non-preferred brand drug. With your physician's help, you discover that the preferred brand works well for you. Your cost is reduced to $26/month or $312/yr. Furthermore you discover that you can purchase a three month supply by mail order for one co-pay. You now pay $26 four times a year or $104 and if your medication can be half-tabbed, doubling your prescription's duration you now pay $52/yr.

You have saved over $500/yr on one prescription! It's unlikely that you will find all of these opportunities in one prescription, but it's certainly possible.

Yes, prescription drugs are expensive, but they are often the key to living a healthy, high quality life. It's worth taking the time to learn about your prescriptions and your health plan so that you have the best opportunity to make the cost more affordable. If you do not have health plan coverage for prescriptions, you absolutely owe it to yourself to do this research and save money if you can.