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The New York Times

Patient Money

Strategies for Saving on Prescription Drugs

By LESLEY ALDERMAN

Published: February 6, 2009

 

Drugs have never been so expensive — or so cheap.

 

Skip to next paragraphNews reports and anecdotal evidence indicate that the recession is prompting many people to skimp on prescription drugs, putting their health at risk now and setting them up for higher medical expenses in the long term. So now is a good time to take a hard look at what you spend on prescriptions and figure out how you can make that money go farther.

The average brand-name prescription cost an eye-popping $120 in 2007, according to the most recent data from the Kaiser Family Foundation. That was up from $111 the year before. The average generic in 2007 was a mere $34, according to Kaiser. These days you can buy many generic drugs for as little as $4 for a 30-day supply at WalMart or Target, and many other retailers are offering steep discounts.

Switching to generics is obviously one of the best options, if your doctor approves. But generics aren’t the answer in every case. So before you go to the pharmacy, or your drug Web site, consider these strategies for lowering your prescription bills.

Take advantage of your insurance. If you’re fortunate enough to have employer-sponsored health insurance, you probably have a prescription drug plan. These plans are generous, but they can be confusing.

Typically they offer coverage at three levels, or tiers. You might have a co-payment of just $10 or so for a generic drug, $25 for a preferred drug (meaning the insurer has negotiated a preferred rate with the drug company), and as much as $75 for a nonpreferred drug.

To learn how the drugs you take are reimbursed, go to your insurer’s Web site and print out the formulary, the list of drugs they cover. Or call the 800 number on the back of your insurance card. If you’re taking drugs in the top tier, talk with your doctor about less expensive options. (More about that below.)

If you take one or more drugs for a chronic condition, check out the drug insurer’s mail order system. That could save you hundreds of dollars a year. Many people fail to take advantage of this option, which involves relatively little paperwork.

“Nearly 40 percent of our customers are unaware that they even have a mail order benefit,” said Ken Malley, a vice president at Medco Health Solutions, one of the country’s largest pharmacy benefit managers, as drug insurers are known. Mr. Malley estimates that a person who takes four medications for a chronic condition could save up to $400 a year by simply switching to mail order. It’s also more convenient.

Talk with your doctor about less costly options. Whether you have insurance or not, make an appointment to speak with your doctor about your drugs. Bring a copy of your insurer’s formulary, as well as a list of the medications you currently take (or just bring the bottles).

Ask three questions:

•Are all these medications necessary? “Medicines from every class are overprescribed,” said Dr. Edward Jardini, author of “How to Save on Prescription Drugs” (Ten Speed Press, 2008). “Make sure you’re not taking duplicate therapies. And make sure the drug treatment you’re on has proven to be effective.”

•Am I on the correct dose? If you’ve lost a lot of weight or started a vigorous exercise routine, for instance, you may need a lower dose of a blood pressure or cholesterol lowering medicine.

• Is there a generic alternative that I can try? Roughly 75 percent of all premium drugs have a generic equivalent or alternative. Although the osteoporosis drug Actonel does not have a generic equivalent, for example, another one — Fosamax — does. By switching from Actonel to the generic version of Fosamax you could save hundreds of dollars a year.

“Generic drugs are much better than they were 30 years ago,” said Dr. Edward Langston, a family doctor, pharmacist and immediate past chairman of the American Medical Association board of trustees. “For the most part, switching to generics is seamless.”

You should also ask those questions any time a doctor prescribes a medication — especially if it’s for a cold or the flu. Remember, colds and flus are caused by viruses, which don’t respond to antibiotics. The federal Centers for Disease Control and Prevention estimate that consumers spend millions of dollars each year on ineffective antibiotic prescriptions for viral conditions.

And if you do need an antibiotic, for a bacterial infection, be sure to ask you doctor to look for a generic solution first.

And while you’re speaking with your doctor, ask whether long-term prescriptions can be written for 90 days, rather than 30 — which may cost less per dose.

In addition, find out whether your medications are available in a larger dose and whether the pills can be split. Instead of taking a 50-milligram pill, for instance, you would take half of a 100-milligram pill. The cost of the two prescriptions is the same, but one will give you twice as many doses. Simple and inexpensive pill-splitting devices are available at most drugstores.

If you are on a Medicare “Part D” drug plan . . . Talking with your doctor now, early in the year, is especially important if you are covered by a Medicare prescription plan. Discuss how you can avoid running up a large bill that will bring you to the coverage gap in Medicare Part D — the dreaded “doughnut hole,” in which you must pay full price for your medications.

This year Part D will cover medications until your own out-of-pocket expenditures and your plan’s outlays reach $2,700. After that, you’re in the doughnut hole and must pay the full cost of prescription drugs until the running total reaches $4,350. Only at that point does Medicare coverage resume.

Some of the strategies outlined above can help reduce your costs and possibly avoid the Medicare doughnut hole.

Compare costs at different retail outlets. Prices vary from drugstore to drugstore — sometimes a lot, depending on the medicine. If you don’t have insurance and you take a pricey name-brand drug, shop around.

A good place to start is at the comparison-shopping site Destination RX. Plug in the name of your drug and your ZIP code, and the site will show you how prices compare at a few venues, including a local pharmacy, a large chain store and a discounter like Costco. You should also check out the prices at other online retailers, like Drugstore.com or FamilyMeds.com. In addition, call your local pharmacy and ask for prices on the drugs you take. You might be surprised. I found, for instance, that a small pharmacy near my Brooklyn home had lower prices than Costco on several medications, while the nearby chain drugstore turned out to be the most expensive option. (See table for examples of my spot-check survey.)

Even if you take low-cost generics, bargain-hunting is worth it. Several national pharmacy chains, as lures for your broader business, are practically giving drugs away. (See table.)

If your drugs bills are high and your funds are low. Contact the Partnership for Prescription Assistance, (888-477-2669), a nonprofit organization run by the Pharmaceutical Research and Manufacturers of America. The partnership helps uninsured or low-income consumers get access to 475 public and private prescription assistance programs.

Needymeds.org also has information on medicine and healthcare assistance programs. Older people should contact BenefitsCheckUp, a service of the National Council on Aging, which locates benefits programs for seniors with limited income and resources.