Rx Savings

All the talk about health care reform is making me a little nervous.  Being a part of the health care field, I am the first to admit that the current system is not perfect.  However, the thought of having a government run health care system has me worried enough to have contacted my Senator and ask her to vote against it.   With all of it's flaws, people from other countries are still coming to the United States for the best medical care.

In the last 15 years, I have seen the out of pocket costs for pharmacy patients increase.  Even patients with prescription insurance are struggling with the cost of their monthly medications.  In order to manage increasing costs, insurance companies and Medicaid have put in place stricter formularies*.   The role of the pharmacy has become a liaison between the insurance company and the prescribing physician to find a medication that is covered on a patients plan. 

*A list of medications that are covered by your health insurance plan. Formularies can include both generic and brand-name drugs. They are often organized into "tiers" that indicate how much your copay will be for each drug. Medications in a preferred tier will cost you less out-of-pocket than medications in other tiers.
(If a drug is not on your plan's formulary, your insurance company may not cover it at all. If that is the case, you will have to pay the full cost of the medication out-of-pocket.)

I do not have the answers on how to fix the current system, but I can offer suggestions on how to get the most out of our current situation.

Many people are under the assumption that prescription medications cost the same, no matter where you have them filled.  More than likely if you have a co-pay* it will be the same, but if you are paying out-of- pocket,  call a couple of pharmacies in your area to find out the cost.

*The amount an insured person is expected to pay for a medical expense at the time of the visit.

If you have been prescribed a drug that is not on your formulary or on a higher tier, contact the insurance company to find out which medication is covered or covered for a lower copay amount.  If your doctor can not switch the medication to one that is covered, find out if there is an appeals process, such as prior authorization, that would allow the medication to be covered.

A few chain pharmacies have taken it upon themselves to help lower the cost of prescription medication.  WalMart  and Target, for example,  offer prescriptions for as low as $4 (even if you are insured) on many generic medications.  Walgreens has the Prescription Savings Club that offers a savings on 90 day supply of medications for $12 with an annual enrollment fee of $20 individual or $35 for family.  (The enrollment fee is generally worth the savings that can incur.)  Check their websites to see the list of medications that are included.

If your medication is not on the list, take it along with you to your next visit with the doctor.  The doctor is not always aware of the cost of the medication he/she is prescribing.  They just might be able to switch a more costly name brand medication to a similar one that has a generic available.

Partnership for Prescription Assistance  is an excellent resource for those medications that aren't available in generic form.  This site provides access to many drug manufacturers Patient Assistance Programs (PAPs).  Most of these have income guidelines and forms to be filled out by the patient and prescriber, but well worth it if you qualify.  The website is user friendly and allows you to search available programs for a specific medication.

Another option to save on name brand medications is to search the web for coupons.  That's right, coupons.  Some drug companies offer a savings coupon that can be used with or without prescription insurance, Medicaid excluded.  These need to be dropped off with your prescription or refill and the pharmacy will deduct the amount from the cost of the prescripton.  These can only be used a limited number of times, but it will at least provide the patient a buffer to the wallet while determining if the medication works for them.

When being prescribed a name brand medication for the first time, it never hurts to ask the doctor if the office has any samples.  Many drug companies offer samples to the office, just for this purpose, as part of the marketing campaign for a new drug.

My advice is to work with your doctor and pharmacist to find the best, most cost effective, treatment for you.  Not everyone responds to medications the same way, so what works for one might not work for all.

I hope that this information is helpful!