Subscribe
With each passing decade, your pillbox fills up a bit more—and makes a bigger dent in your budget.
A recent report from Congress found that 12 of the 20 most-prescribed brand-name drugs for seniors had seen price hikes of more than 50% over the past five years; the price of six of the 20 had more than doubled.
Those include popular pills like cholesterol drug Crestor (up 76%), nerve pain medication Lyrica (up 127%), estrogen therapy drug Premarin (up 117%), and the angina med Nitrostat (up 477%).
Even with excellent health insurance, steep price hikes can be tough on your wallet, thanks to high deductibles and the spread of coinsurance, which leaves you paying a percentage of a drug’s cost, not a flat copay.
The high cost of prescription drugs has left many struggling to pay for medications. In a Kaiser Family Foundation poll, nearly one in four people said that they or a family member had already skipped doses, cut pills, or failed to fill a prescription.
This burden can get tougher over time. From age 65 on, nine out of 10 people take at least one prescription drug a month, according to the National Center for Health Statistics.
But the big leap occurs well before retirement age. While 37% of 18- to 44-year-olds take one or more prescriptions, that portion surges to 69% among 45- to 64-year-olds.
Fortunately, there are simple things you can do to lower your drug costs—without putting your health at risk.
1. Use out-of-pocket drug costs to help pick a health plan
There are dramatic differences in how health insurance plans cover even the same prescription drugs, and failing to take those differences into account during your company, Medicare, or Obamacare open enrollment can leave you paying more for the medications you take for the rest of the year.
What you need to focus on is your plan’s formulary, or the list of covered drugs. You want to make sure your medication is included, of course. But what’s really driving out-of-pocket costs is tiered pricing.
Most plans group medications into three or more price tiers. The higher the tier, the more you will pay in either coinsurance (a percentage of the cost of the drug) or a flat copayment. Tier 1 drugs are generally preferred generics, whereas Tier 3 drugs may include more expensive brand-name or specialty meds.
The average co-pay for a Tier 1 drug is $11, according to the Pharmacy Benefit Management Institute, while the average for a Tier 3 drug is $59; the average co-insurance rises from 14% for Tier 1 to 33% for Tier 3.
The other piece of the price puzzle is your deductible, and increasingly a high-deductible health plan will be on your menu of choices at work on the individual market. (Your Medicare Part D drug plan may have a deductible too, a maximum $415 in 2019, increasing to $435 in 2020.)
Deductibles have long been common for doctor visits and hospital stays, but today nearly four out of 10 plans also require you to meet a deductible before covering any of your prescription drug costs. Usually the pharmaceutical deductible is bundled with your medical deductible, but not always.
No matter what kind of insurance plan you’re shopping for, factor in what you would pay for your medications before making your choice. For a Medicare plan, you can use this tool to compare options in your area. On the job, see if your health plans offer online comparison tools.
“Consumers need to arm themselves with information and be their own true advocate,” says Daniel Nam, executive director of federal programs at America’s Health Insurance Plans (AHIP), a trade group.
2. Do research at the doctor’s office
Of course, even if you choose a plan with your current medications in mind, what happens if your doctor orders a new one?
Doctors tend to prescribe well-known generics when they can, but studies show that in general they don’t know the cost of the medications they are prescribing.
Fortunately, many insurers have apps that tell you what meds are covered and how much they cost. Before your next check-up, download the app onto your smartphone. Then while you’re with your doctor enter the drug name.
If it is a costly Tier 3 drug or not covered at all, you can ask your doctor on the spot if there are alternative meds with the same therapeutic effect.
Of course, you may not feel comfortable doing that (or, given how fleeting your time with your doctor may be, even have the chance). You could ask the doctor’s office to look up the drug on your plan’s website while you’re checking out. Or talk to your pharmacist, who can call the doctor and suggest an equivalent medication if your out-of-pocket will be prohibitively high.
3. Give your prescriptions a check-up
“You may have been on a medication for years that you no longer need,” says Mohamed Jalloh, a pharmacist and spokesperson for the American Pharmacists Association.
For instance, your doctor may have started you on one medication for your condition, added a new one when the first wasn’t working, and never cut out drug No 1. By eliminating it, you can reap instant savings.
Generic drugs typically cost 85% less than brand-name drugs, but you won’t necessarily find out when one becomes available unless you ask your doctor or pharmacist. Last year generics came out for the cholesterol drug Vytorin and the blood thinner Effient, to name a few.
Unfortunately, you may have to wait a long time for a generic. “A manufacturer will have a drug for 10 years, do a slight change to the drug, and re-market it with a new patent,” says AHIP’s Daniel Nam. But even with no direct generic, he adds, there may be a generic alternative that is just as good.
Finally, even if you are already taking a generic, you might find a less expensive one that treats the same condition.
4. Get creative
You probably already know some common tricks like getting a higher-dose pill and taking it less frequently or splitting it. But sometimes you can save money simply by changing from a capsule to a liquid form of a medicine, or the other way around. Ask your pharmacist if that’s an option.
Combo pills—typically a brand-name reformulation of two generic pills—may be easier for you to take. But they’re typically more expensive. “You may get a better deal if you’re willing to take two generics instead of one combo,” says Jalloh.
5. Don’t assume you’re paying the lowest price
Sometimes the cash price for a prescription is less than what you’ll pay out of pocket with insurance. A common generic might go for $4 or $5 in cash, while you’d pay $11 or so with your insurance plan.
However, you may have to speak up to find out. Some insurers discourage sharing that info by including so-called gag clauses in their contracts with pharmacies. More often, the pharmacy’s computer system simply defaults to processing your prescription through insurance, says Jalloh.
You can also use the GoodRx app or website to search pharmacies in your area for the best cash price and compare it to your copayment. Keep in mind, however, that when you pay in cash, your outlay won’t automatically count toward your deductible. Save your receipts and submit them to your insurer, though that doesn’t always work.
