7 tips to cut your prescription costs

Last year the U.S. sustained the biggest increase in prescription drug spending since 2003, according to a report published this spring by pharmacy benefit manager, Express Scripts.  Hefty increases in drug costs are likely to continue as pharma prepares to launch new drug classes such as PCSK-9's for cholesterol and immuno-oncology products for cancer. At the same time, new product launches are driving up prices on older brands and many generics.

So what can someone do to prevent pharmacy bills from paving the way to the poor house when drug costs are rising faster than wages and insurance plans come with rising deductibles and co-pays that shift more expenses onto consumers?

Here are a few unconventional approaches that may help temporarily and around the margins.

1) Make sure this prescription is really necessary.

The pharmaceutical industry is fond of saying that people would be healthier if more of them filled all their prescriptions. As their principal example of this, they used to talk about all the people with hypertension and high cholesterol who neglect to regularly take medications for those conditions. In the last few years, however, as the antihypertensives and the statins for cholesterol became available as generics, pharma quit using those examples. So it seems that pharma considers under-prescribing and "poor adherence" as health problems only if those processes cut into sales.

But pharma is not the only pill pusher in health care. Many physicians seek to conduct their practices on an assembly line basis, rapidly shuttling patients in and out of the examination rooms. As part of the procedure, they give each patient a prescription on her way out. The thinking behind that consists of giving patients the feeling that they're getting something in return for their time, travel and the expense of a co-pay. As a result, prescriptions for pain, insomnia, anxiety and depression go out of some offices as easily as kids leave a neighbor's house with candy on Halloween.

Second guessing one's physician isn't easy in cases where he seeks to give a prescription and some avuncular reassurance along with it. Nonetheless, saving money in medical care often requires doing some research, gaining appropriate insight and developing a healthy skepticism concerning the fact that medical practice is a business.

2) Get a non-dispensing pharmacist to suggest a less costly alternative.

Finding an alternative, lower cost therapy regimen that can work as well as an expensive brand often requires something other than a generic equivalent of the brand. Physicians often don't bother to explore the availability of less costly alternatives, preferring instead to routinely prescribe therapy X for condition 1, therapy Y for condition 2. Many times their friendly drug reps encourage this easy reflex.

Not long ago a colleague mentioned a situation regarding his mother-in-law, Rose Marie, who was living in an extended care facility. The facility's physician prescribed a branded psychotropic for her agitation. Shortly thereafter Rose Marie's daughter started complaining about her mother's monthly medication bill. She mentioned it to her husband who suggested replacing the expensive brand with two generics that, together, could do the job for a small fraction of what the brand was costing. Rose Marie's daughter discussed it with the consulting physician who said, "You know, that's not a bad idea. Sure, we can do that."

The fact that this colleague has worked in pharma for 30 years enabled him to suggest alternative medications that could help his mother-in-law and save the family money. Few people have that capability. That's why it is worthwhile to cultivate a pharmacist who doesn't want to sell you drugs as a therapeutic consultant. If someone receives a prescription for expensive medication, it can be worth paying a pharmacist for his advice because it can result in savings several times larger than anything he will charge.

3) Fill the prescription at a well-recommended, Canadian pharmacy.

Another acquaintance recently received a prescription for topical fluorouracil to eliminate an actinic keratosis – a pre-cancerous mark – on his cheek. Three years ago he filled a prescription for a branded fluorouracil and his co-pay was $25. This spring he said the co-pay for the generic was $189. It seems his insurer now maintains a tiered formulary for generics as well as brands. Topical fluorouracil was in Tier 4 of generics, the most expensive group.

As another pharma veteran, he asked around and found a pharmacy in Vancouver that many pharmacists and physicians in the Delaware Valley recommended. He phoned the pharmacy in Vancouver and spoke to the pharmacist there. The result was that he was able to get the same fluorouracil for $64 that would have cost him $189 here.

4) Raise holy hell with member services at your insurer.

Most times that won't really do any good because people there are paid according to the extent they deny benefits. But once in a great while a claims supervisor or a pharmacist there will be in a decent mood or just figure that you're wasting so much of their time that he or she will suggest a way of reimbursing your medication.

5) Get your doctor to prescribe a brand that offers a co-pay card.

For the time being, co-pay cards are pharma's way of offering discounts to consumers. Insurers are starting to counter that maneuver by using more restrictive formularies, but it still can work in some cases. A co-pay card simply reduces or eliminates the co-payment someone has to pay for a medication. Here's how it works.

Let's say your insurer has a deal with a drug company to pay $1,000 for 30-days worth of its brand. The insurer pays the drug company 80% of that, i.e., $800, and the patient pays the other $200. With a co-pay card, the drug company effectively waives that $200, so the consumer gets her prescription filled for free.

That sounds pleasant and it is, until the drug company discontinues covering the co-pay after a certain number of refills or until the insurer simply excludes that brand from their formulary, meaning they won't pay a penny for it. Then the pharmacist says, "I'm gonna have to charge you $1,000 for this."

6) Demand a lot of samples from your doctor.

Some physicians know what's going on with unaffordable drug prices and they try to help their patients by providing them with abundant samples. In some cases that can ease the expense burden, but the drug companies calculate very closely the extent to which sampling can help and hurt sales, so they're not about to lower their revenue by giving away too many freebies.

7) Call your Congressman and Senators, tell them to support legislation allowing Medicare to             negotiate drug prices and extend Medicare coverage to everyone.

All the suggestions stated above are really just stopgaps and ways for slipping through the cracks.  For the most part, higher drug costs will hit most people in the wallet, most of the time. Until an aroused citizenry in this country gets fed up with paying two or three times what people in other advanced countries pay, and getting worse health care in return, even the most diligent and informed consumers here will catch it in the neck.

As Harry Truman once said, "How many times do you have to get hit in the head before you realize that the guy who's doing it isn't your friend"?

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