Prescription drugs put a strain on many family budgets across the country. According to a 2013 report from the IMS Institute, Americans use an average of 12.2 prescriptions a year. 2012 data from the same organization shows the average amount spent on prescription drugs per person is about $900.
With the passage of the Affordable Care Act, prescription drug coverage is now considered an essential health benefit. All health insurance plans sold on the marketplaces — and any new plans sold off the marketplaces as of Jan. 1, 2014 – must cover prescriptions.
Health law wasn’t a ‘silver bullet’
However, prescription drugs are still far from affordable for many people. Despite the recent drop in the uninsured rate, millions of people still do not have health insurance. And for those who signed up for coverage during the last open enrollment period, the prescription plan may not have been much a factor in what insurance you selected.
You may not know what your prescription plan covers – even if you looked hard for that information. An April 2014 report by Avalere Health said it was difficult to impossible for people to find out which drugs were covered in nearly half of the policies included in the study.
The good news is that, whether you are insured or uninsured, anyone can utilize a few simple tips to get significant savings – in many cases more than 50 percent – on the price of many prescription drugs.
Price vary – a lot – by pharmacy
The amount you’ll pay for a prescription can vary – a lot – from one pharmacy to the next. That’s because the prices pharmacies pay to wholesalers varies. Independent pharmacies, chain pharmacies, and big-box stores like Costco or Wal-Mart all have different buying power and purchasing agreements.
Some stores might use certain prescriptions as loss leaders – offering deeper discounts on a commonly used drug and marking up other drugs or using them to pull in shoppers to spend money on other products. Even if you’re insured you could be affected by these pricing variations if the drug isn’t covered or if you haven’t yet met your deductible.
Since there are so many variables that affect what you pay at a given pharmacy for a given prescription, it pays to call or visit several local pharmacies. Not all pharmacies will give price quotes, but many are willing to help you.
If you do have your prescriptions filled at several pharmacies, be sure to keep track of all the prescriptions you use. You’ll want any doctor you see and every pharmacy you use to know what medications you’re taking so they can screen for potential dangerous interactions between drugs.
Easier than ever to compare prices
That doesn’t mean you have to schedule a day to drive from pharmacy to pharmacy – or even to spend time on the phone asking for drug prices. You can leave much of that work to prescription discount cards made available by a variety of organizations, including drug stores, drug manufacturers, and membership organizations like AARP.
Savings may be significant – 50 percent or more – on particular drugs. On average, savings are in the range of 15 percent.
There are many varieties of cards, and they all work a little bit differently. In general, you present your card when you fill a prescription, and the pharmacy gives you a discount off the cost of the drug.
Some cards may only work at a certain pharmacy chain or on a specific list of particular drugs. Or, a card may only apply to brand-name drugs. Some cards – like the discount prescription tool offered by this site – are free, while others require a monthly or annual fee.
If you take a drug on an ongoing basis, you might find better pricing at an online pharmacy.
However, be cautious. Before placing an order, make sure the online pharmacy is a legitimate business that follows safety standards and is appropriately licensed.
The National Association of Boards of Pharmacy (NABP) maintains a list of reputable online pharmacies. The list also indicates if a particular online pharmacy is open to the general public or requires that you be enrolled in a particular health plan.
Buy generics when possible
While this tip tops every list of prescription cost-saving strategies, it’s worth repeating. Using generics is the single most effective way to save money on prescription drugs.
Generic drugs have the same active ingredient and pass the same quality standards as their brand counterparts, yet they cost much less. According to the U.S. Food and Drug Administration (FDA), the average cost of a generic drug is 80 to 85 percent less than the brand equivalent.
Ask about drug alternatives
Not all brand drugs are available as generics. If that’s the case for a drug your doctor has prescribed, ask if there is another drug that could treat your condition.
This concept is called sometimes called therapeutic substitution. The idea is to use a drug that isn’t the exact same chemical, but works similarly to treat a medical condition. The substituted drug may be a lower-cost brand, or it may be available as a generic.
For example, Nexium is a drug that treats gastroesophageal reflux disease (GERD) – which is commonly referred to as heartburn – and it is only available as a brand-name drug. However, Prilosec is a similar drug that treats GERD, and it is available as a generic, omeprazole. Depending on the pharmacy you use and/or your insurance plan, using omeprazole could save you money.
As always, any decision about an alternate drug should be made only with the consultation of your doctor.
Pay attention to your formulary
If you have health insurance that covers prescriptions, pay attention to the formulary, which is the list of drugs covered by your plan.
Many plans now use three-tier formularies, with a different copayment amount for each tier. Generic drugs are on the first tier and have the lowest copay. Preferred brands are on the second tier and have a moderate copay. Non-preferred brands are on the highest tier and have the highest copay. Or, you may have to pay the full cost of a non-preferred brand, minus any discount negotiated by your insurance company.
Copay differences can be significant. According to the PBMI 2013-2014 Prescription Drug Benefit Cost and Plan Design Report, the median copays for a one-month supply of medication in employer-sponsored, three-tier plans were $10 for generics, $30 for preferred brands, and $50 for non-preferred brands.
To save money, ask your doctor to check your formulary and prescribe a drug with a lower copay. Or, if you learn about a high copay at the pharmacy, ask the pharmacy staff to contact your doctor on your behalf.
How NOT to save money
Finally, here’s a tip on what you should NOT do: While taking your medication less often or taking a smaller amount may seem like a way to stretch your budget, don’t do it.
Not taking a medication as prescribed can harm your health and cost you even more in the long run. One study found that not taking prescription medications as prescribed contributes to 125,000 deaths a year and adds $2,000 per patient in doctor visits.
If you don’t have insurance and you can’t afford your medications, visit the Partnership for Prescription Assistance (PPA) or call 1-888-477-2669. PPA helps qualifying individuals get prescriptions free or at greatly reduced prices.