Prescription medications can be frighteningly expensive, even with insurance coverage. Have you ever suffered sticker shock? It’s happened to me on several occasions, including a co-pay of $450 for a medication we didn’t even end up using! These high prescription medication prices are hurting our collective health and our wallets. How widespread and serious is this issue? Very. Read this post to learn about the impact of pricey medications and how to save money on prescription medications.
Americans struggle with high prescription medication costs.
If you struggle to pay for prescriptions, patient surveys show you are not alone. Results of a recent survey by GoodRx are concerning. Although almost all of the 1,000+ respondents had some sort of health insurance for medication (47.5% through employer sponsored insurance), many reported it was difficult to pay for their medications.
Here are a few of the GoodRx survey’s findings:
- 42% reported that paying for medications was somewhat or very difficult, even though 94% said they have health insurance to help pay for the cost of their prescriptions.
- Money concerns led 33% to skip filling a prescription at least one time.
- 36% said they are paying more for prescriptions this year, while 6% reported they spent less.
- 18% said that the high cost of medication made it difficult to pay for basic needs, like food or housing. And 18% have borrowed money from friends or family, taken out a loan, or declared bankruptcy because of high medication expenses.
Another survey illustrated patient struggles:
Similarly, a 2017 survey by the National Center for Health Statistics found that many people struggle with the costs of prescription medications.
Among patients with private insurance:
- 18% asked their doctor for a lower-cost medication
- 8.4% did not take their medication as prescribed
- 4.4% used alternative therapies to reduce spending on prescriptions
As one would expect, patients without insurance struggled more:
- 39.5% asked their doctor for a lower-cost medication
- 12.5% did not take their medication as prescribed
- 13.9% used alternative therapies to reduce spending on prescriptions
Why is this a big issue now?
The out-of-pocket expenses for patients have been steadily increasing. More and more people are covered by insurance plans that have high deductibles and/or increased co-pay fees. And sometimes insurance companies stop paying for medications that they covered in the past.
Why should we worry about these high prices?
If costs are keeping patients from getting their medications, the consequences can be serious. Skipping prescriptions is a dangerous practice which cause health complications, which can lead to otherwise unnecessary hospitalizations, surgeries and emergency care. Not only is this bad for an individual patient’s health, the additional, expensive healthcare is bad for our collective wallets. In fact, experts estimate that the costs associated with patients not taking medications as prescribed may be as high as $300 billion/year. Just to be clear, that’s billion with a “b”.
What can you do?
If you are struggling to pay for your prescription medications, don’t give up! There are several ways to reduce your out-of-pocket costs for your medications, as described below. Note that each option is not mutually exclusive – you can try more than one option for each medication.
Talk to your doctor.
- Ask your doctor about less expensive medications, including generics. It’s important to realize that doctors often have no idea how much money each medication costs, so they might prescribe expensive medications out of habit, when less expensive alternatives could get the job done.
- Find out from your doctor if you can order a higher dosage of a medication that you can then cut in half. Sometimes increasing the dosage adds little expense, and you’ll get twice as many pills at your needed dosage. If you choose to do this, buy a pill cutter at your pharmacy – they’re not expensive and they make it easier to get an accurate split.
- Ask your doctor if he/she has manufacturer coupons.
Buy in bulk.
Getting a 3-month supply of medication in one prescription can save you money, including only paying one co-pay instead of 3.
Talk to your pharmacist.
Ask your pharmacist is you are getting the cheapest price. Specifically ask about “all available” discounts. Additionally, if you have insurance coverage, ask your pharmacist how much a medication would cost if he/she doesn’t put it through your insurance. Surprisingly, sometimes your share is more when the insurance company pays a portion. It doesn’t make any sense, but it happens. It’s important to note that if you don’t go through your insurance for a medication, the money you spend will not go towards your deductible or out-of-pocket maximum spending limit. Learn more about this issue in my previous blog post.
Prices vary for the same medications, depending on where you shop. You can call area pharmacies, grocery stores and warehouse stores to get pricing. Be sure you know the dosage and exact name of the medication when calling.
Alternatively, you can use the website/app GoodRx to find prices (and discounts) for prescription drugs at more than 60,000 local and mail order pharmacies in the US. Look up your medications to find the cheapest price for your geographic location. And, you may be able to get coupons for further savings. If you have insurance coverage for your medication, the price you find through GoodRx might be cheaper than your co-pay with your insurance coverage.
You can also use the website/app from WeRx.org to look up prices for prescription medications from retailers near you and from online pharmacies.
Use coupons and discount services.
A discount prescription card might help you save money. FamilyWize offers a free discount card that gets you discounts on prescriptions at thousands of chain and independent pharmacies in the US, including Walgreens, CVS, Rite-Aid, Kmart, Walmart. There are no fees or eligibility requirements. If you don’t have insurance coverage, this is a great way to save money. However, you might save money even if you have insurance if you buy medications your insurance plan doesn’t cover. And sometimes the price with the discount card is lower than your co-pay with your insurance coverage.
BlinkHealth uses the power of bulk purchasing to provide lower priced prescription medications to its users. You order and pay online, and either pick up your medication at a local pharmacy or select free home delivery. This is available for people with and without health insurance.
RxSaver, by LowestMed.com, searches pharmacy discount sources to find prescription discount cards, coupons and Rx assistance programs that can save you money. Rx Saver can help you find discount prescriptions with insurance or without.
Seek help from organizations.
There are organizations that help patients pay for prescriptions. For a list of places that might be able to help you, visit Zaggo’s Resource Center page for financial help for prescriptions.
Get help from pharmaceutical companies.
Did you know that pharmaceutical companies have programs to help patients pay for their medications? These programs, called patient assistance programs (PAPs), provide co-pay cards that allow eligible patients to receive their medications for little or no cost. In general, to qualify you must have no prescription insurance coverage (private or public) and meet financial need criteria. However, some programs do not require patients to prove financial need, and some provide help to those with insurance coverage. To participate, the patient and/or doctor must apply. To find a PAP program that might help you, visit NeedyMeds.org and/or RxAssist.org.
And here’s a little known secret – if your co-pay card fails to work for any number of reasons, you might be able to get money from a pharmaceutical company to reimburse you for money you spent on their medication. These payments, called direct reimbursement, are legal if the patient isn’t enrolled in government insurance programs like Medicare or Medicaid.
Not everyone is happy about these programs.
Insurers and lawmakers are pushing back, claiming the programs could increase prices in the long run. For example, California recently passed a law last year limiting their use and federal prosecutors are evaluating pharmaceutical co-pays and reimbursements closely.
Additionally, pharmacies are fighting back. In some pharmacies, when patients use co-pay cards, the medication is not processed through insurance – the entire cost of the medication, not what would be their share if insurance paid a portion, is charged against their co-pay card. Clearly, in these cases, the co-pay card doesn’t last as long. Moreover, these pharmacies are not letting any of this spending go towards a patient’s deductible or out-of-pocket maximum spending. So, when the co-pay cards runs out, patients may be responsible for the full cost of the medication until they reach their deductibles.
And, you should know, there may be tax consequences for patients who receive payments from pharmaceutical companies.
Use caution when shopping online.
If you want to shop for medications online, beware. There are fraudulent websites selling dangerous black-market medications. To learn more, read my blog post.
NOTE: I updated this post on March 25, 2019.