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If you think your prescription-drug costs are soaring, it's not your imagination. Drug prices increased 11.3%, on average, last year for Americans under the age of 65 -- over four times more than the average wage increased. The increase is expected to be even higher in 2017. Average price hikes for older Americans aren't much better.
There are multiple reasons behind soaring prescription-drug costs in the U.S. Medicare and Medicaid can't negotiate drug prices, and it can sometimes take the U.S. Food and Drug Administration (FDA) a long time to approve lower-cost generic drugs. The bottom line, though, comes down to market dynamics. If insurers, pharmacy benefits managers, and patients will pay more, drugmakers will charge more.
Although solving the problem of rising prescription-drug costs will be challenging and complicated, there are some relatively easy ways for you to keep your costs lower. Here are nine unique tips that should help you cut your prescription-drug costs.
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1. Ask about generic alternatives
The first thing you should do when a physician brings up prescribing a new medication is to ask about generic alternatives. Generic drugs are generally less expensive than the equivalent brand drug. According to the FDA, the average generic costs 80% to 85% less than the brand drug. That's a huge savings.
Don't worry that the generic won't be as effective, or safe, as the brand drug. Generic drugs are required to use the same active ingredient as the brand equivalent. Generic drugs must pass the same quality standards for manufacturing, packaging, and testing as those of brand name drugs. In many cases, the generic drugs are actually made in the same facility as the brand drugs.
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2. Ask about over-the-counter alternatives
If there's no generic version available, ask your doctor about the possibility of using an over-the-counter (OTC) product. Pharmaceutical companies sometimes have an OTC version of a prescription drug. OTC medications often have a lower dosage than the prescription version, but can still be effective.
Of course, many prescription drugs don't have OTC alternatives, so this might not be an option for you. Also, keep in mind that health-insurance plans usually don't pay for OTC medications. Make sure you compare the costs, because it's possible that your out-of-pocket expense could be higher with an OTC drug than the prescription version.
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3. Ask for samples
Before you leave your physician's office, be sure to ask if any samples of the drug(s) you have been prescribed are available. Pharmaceutical sales representatives frequently leave samples with doctors to give to patients at no charge.
Be on guard, though. The reason the sales reps leave these free samples is to encourage doctors to prescribe their companies' products. Sometimes, there are less expensive drugs available (including generics).
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4. Combine or split
Check out the prices of different dosages of your prescription drug. Sometimes, it could actually be cheaper to get a lower dosage and combine two pills. Other times, it could be less expensive to get a pill with double the dosage that you've been prescribed and then split the pill in half.
Not all pills can be split, however. Ask your pharmacist if this might be an option with the prescription drugs that you take.
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5. Look at your insurer's drug formulary
You might be surprised at the differences in how health insurers pay for drugs that treat the same indications. There can be a wide variety in copays for similar drugs. Insurers are trying to lower their costs, too, and often negotiate better deals with specific drugmakers. The insurers then try to encourage use of the lower-cost drug by charging a higher copay for higher-cost alternatives.
The best thing to do is to have your insurer's drug formulary handy when you visit your doctor. (Most insurers have their formularies available online, so you could pull it up with your smart phone.) Ask your doctor if the drug being prescribed has alternatives, then check the formulary to see which one is the least expensive for you.
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6. File an appeal
It's possible that the drug your doctor prescribes for you isn't on your health insurer's drug formulary at all. Don't worry. In many cases, insurers must cover a drug that's medically necessary for your condition, even if it's not on their formulary.
If this is the situation, the first step is to file an appeal with your health insurer. Either check the company's website, or call customer service to find out how to submit the appeal. If your appeal for coverage is denied, you can contact your state insurance regulator to request an independent medical review. It's possible that the state regulatory agency will require the insurer to pay for your prescription drug.
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7. Change your insurance plan
If you regularly take the same prescription drugs, research different health-insurance plans to see what their benefits are for those drugs. For example, some plans will charge lower copays than others for the same drug. Some plans will include a given drug on their formularies, while others won't.
This is an especially good idea if you're enrolled in a Medicare Part D prescription-drug plan. These plans can have very different benefit structures. Keep in mind that you're limited as to when you can change health insurance, however.
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8. Comparison shop for a pharmacy
Just as you should shop around for the best health-insurance plan, you should also comparison shop for the best pharmacy. Some pharmacies will have better prices on a given drug. Definitely research the possibility of using a mail-order pharmacy. These pharmacies often have lower costs for prescription drugs.
However, it's a good idea to fill all of your prescriptions at the same pharmacy. The computer systems used by pharmacies help check for potentially dangerous drug-to-drug interactions. This only works, though, if the pharmacy is aware of all of the drugs you're taking.
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9. Research financial-assistance programs
There are more financial-assistance programs to help with high prescription-drug costs than you might think. Many drugmakers have patient-assistance programs that help uninsured and low-income individuals obtain prescription drugs at low, and sometimes even no, cost. You can go to the RxAssist website to find out if a patient-assistance program is available for the drugs you take.
Medicare beneficiaries could qualify for the Extra Help program that assists seniors with paying for prescription drugs. Many states also provide financial assistance to help low-income seniors with prescription-drug costs.
