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, you are not alone.
A 2022 survey by the Kaiser Family Foundation found that money concerns prevent people from filling prescriptions. For instance, about 25% of respondents reported that they, or a family member, didn’t fill a prescription, cut pills in half, or skipped doses of medicine in the last year due to the cost. Moreover, respondents who lived in lower-income households, were women, and/or were Black or Hispanic, were more likely to report financial concerns kept them from taking medications.
Additionally, a January 2021 report by CoverMyMeds details the findings of a survey conducted in the fall of 2020. The survey results:
- More than 1/3 of patients reported they went without treatment or medications to pay for bills and basic needs.
- 48% sacrificed basic needs and bills to afford their medications.
- Over 40% reported skipping or reducing doses to make their medications last longer, potentially putting their health at risk.
Similarly, the results of a 2018 survey by GoodRx show reason for concern. 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.
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 can 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”.
How to save money on prescription medications.
If you are struggling to pay for your prescription medications, don’t give up! There are several ways to save money on prescription 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.
Your doctor may be able to help you save money on prescription medications. Surprisingly, many times doctors do not know the cost of medications they prescribe. However, with a little prodding, your doctor may be able to help you save money.
For starters, ask your doctor if he/she has access to a Real-Time Prescription Benefit (RTPB) tool. Your doctor can use this tool, while you’re still in the office or exam room, to look up pricing information, insurance coverage restrictions, and lower-cost alternatives for prescription medications. These powerful tools can save you a lot of money. Excitingly, an in-depth analysis of 78 million prescription transactions from 2022 found that in 47% of the cases, there was a free option available to the patient.
Additionally, you should ask your doctor about:
- Less expensive options, including generics.
- The possibility of ordering 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.
- Free samples, which can be helpful if you are only using a medication for a short term.
- Manufacturer coupons.
Check out Mark Cuban’s new CostPlus Drug Company.
Yes, billionaire Mark Cuban has started an online pharmacy with a mission to provide low-cost versions of high-cost generic medications. Right now, they carry over 100 medications, with savings ranging from a few dollars to several hundred dollars. Since these medications are generic, ask your doctor about any potential issues before ordering. Check out their offerings here.
Importantly, according to a Kaiser Health News article, the prices on this site can be higher than you’d pay at your local pharmacy. So do your homework!
Buy in bulk.
Ask your doctor for a 3-month prescription since getting a 3-month supply of medication at once can save you money, including only paying one co-pay instead of 3 co-pays.
Talk to your pharmacist.
Ask your pharmacist is you are getting the cheapest price. Specifically ask about “all available” discounts and the “lowest cash price”.
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. But be sure to do this before you pay!
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.
Finally, make sure the pharmacy has your insurance information entered correctly. To learn more, read Reduce Your Healthcare Expenses.
Prices vary for the same medications, depending on where you shop. So, call area pharmacies, grocery stores and warehouse stores to get pricing.
Make sure you know the dosage and exact name of the medication when calling. And, mention your insurance coverage so you can know your out-of-pocket expenses.
Finally, as noted above, ask about the lowest cash price without your insurance plan – it might be the cheapest way!
Search online for pricing information.
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.
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.
Buy medications online.
Medication can be cheaper when purchased online, but not all of the medications you purchase online are safe!
To minimize risk, only use a US-based online pharmacy located that requires a legitimate prescription. Check to see if an online pharmacy is legitimate on the National Association of Boards of Pharmacy’s Safe Pharmacy website. You can also visit BeSafeRx a registry of state-licensed online pharmacies.
If in doubt, don’t buy from an online source that you aren’t sure about.
A few things to consider with online medication purchasing:
Medication can be damaged in transit.
Unfortunately, medications can be damaged during transit from exposure to very cold or very warm temperatures and/or from mishandling.
To learn if the safety or efficacy of your medication could be harmed by temperature fluctuations, find out if your medication instructions say “store at room temperature”. If so, ask your doctor about the potential impact of exposure to cold or warm temperatures.
Accordingly, if you learn that variations in temperature can damage a medication you take, try to use a local pharmacy instead of using mail order. Note that if your insurance plan requires the use of mail order pharmacies, you may have to speak with them to prove your need for switching to a local pharmacy.
And if medications arrive with signs of damage, such as broken vials or crushed pills, call the pharmacy for a replacement.
Beware of black-market medications.
There are fraudulent websites selling dangerous black-market medications. Criminals sell fake and/or stolen medications to pharmaceutical distribution companies, which then sell the medications to pharmacies, doctors, and hospitals. Don’t be fooled by the sites that advertise “Canadian Pharmacy” – 85% of the time they are located in other countries, but advertise as Canadian to lure US buyers.
For information, read Dangers of Black Market Medications – More Common Than you Think.
Tips for safe online shopping from the FDA.
Visit BeSafeRx, an FDA initiative, for tips on how to safely buy prescription medicines online.
Find a health plan that will help you save money on prescription medications.
If your employer has more than one health plan option, review which one is best to cover all of your expenses, including your medications, particularly if you are on a very pricey drug.
For those who purchased insurance through the Affordable Care Act, consider your specific medications when choosing your coverage.
If you are covered by Medicare, invest some time to look at all of your coverage options to determine which plan will save you the most money. Review your Medicare options each year during the enrollment period to see if your existing plan is still the best choice for you.
Look into programs offered by your insurer.
Many large insurers have their own online pharmacy partners that can save you money. Be aware that it can take a week or so to get your first dose. You can often get further savings if you buy several months’ worth of medications at a time. However, if you are not 100% certain you will be taking a particular medication for an extended time, avoid bulk purchases.
Use your Health Savings Account (HSA) or Flexible Savings Account (FSA).
If you are offered one of these plans through your work, take advantage of it and use it to pay for your medications with pre-tax dollars.
Use coupons and discount services.
We all know about coupons at the grocery store. But, did you know coupons can help you save money on prescription medications?
You may be able to find online coupons or rebates online. Type in the name of your medication and the word “discount” or “coupon”. You can print these out and bring them with you to the pharmacy.
Additionally, 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 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.
Pharmaceutical companies can help you save money on prescription medications.
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.
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 run 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.
An important note.
When you only use one pharmacy, their computer system keeps track of your medications and signals potential issues. If you use more than one pharmacy to get your medications, you need to be careful about potentially dangerous drug interactions.
To minimize your risk, be sure that each pharmacy you use has a full list of all of your prescription medications, over-the-counter drugs and herbal supplements.
For more information…
Read these blog posts to learn more about medication:
Read these posts for more information on money related issues:
- Can You Comparison Shop for Healthcare Prices? Yes, and You Should!
- How to Shop Around for Healthcare Pricing.
- Reduce Your Healthcare Expenses.
- The Impact of the High Cost of Healthcare
- Tips for Handling Medical Bills.