Managing the Costs of Prescription Drugs

According to the Natural Conference of State Legislatures, prescription drug transactions in the United States make up ten percent of total healthcare spending.¹ Because of this, states are beginning to enact legislation related to the pricing, payment, and costs associated with prescription drugs. In most cases, states are anxious to shift the cost burden away from patients.

In the meantime, there are ways that we can help mitigate our drug costs by becoming informed consumers. There are a variety of resources available that might help us reduce our copays or the cost of the drug itself.

Prescription Drug Formulary

Have you heard of a Prescription Drug Formulary? It is something new to me and that fact could be costing me money.

A drug formulary is a list of medications covered by your insurance plan. The insurance company separates prescription drugs into tiers that determine their cost. To keep things interesting, every insurance company has its own formulary.

The drug formulary typically includes most Food and Drug Administration (FDA) approved generic drugs and brand-name drugs. Newer, specialty drugs generally are in higher tiers than older, generic drugs. The number of tiers a formulary has varies by insurance company.

If you do not already have one, get a copy of your drug formulary or learn where you can access it. This information is usually available on your insurance company's Website, but you might need to call them and request that they mail you a printed copy.

During the annual open enrollment period for your insurance, I encourage you to look closely at the Drug Formulary for the insurance companies you are considering. Obviously, if you take a number of expensive pharmaceutical drugs, it is to your benefit to choose the company that will provide the most coverage for those particular drugs.

Tips for saving money on prescription drugs

There are a few ways you might be able to decrease your out-of-pocket costs for prescription drugs:

• Check to see if your insurance company provides a Meds by Mail program. Using this program allows you to receive three to six months of medicine at one time, generally at a greatly reduced cost.
• Ask your doctor if there are generic or alternative medications that will work instead of the higher tier drugs that cost more. For example, I had intense pain in my shoulders caused by nerve problems. My doctor prescribed Lyrica which, according to GoodRX, costs over $650 a month. Gabapentin works similarly but at a cost of only around $11 a month.
• Speak to your doctor and/or pharmacist about Prescription Assistance Programs.
• See if GoodRX.com has coupons available for the drug you need.
• Call the pharmaceutical company that makes your drug. Ask for the Patient Assistance Support Team. Explain your circumstances. They may be able to help.
• Ask your doctor if he or she has samples of brand-name drugs available to share.
• Be sure to use GoodRX.com to shop around for the pharmacy that has the best price for the drugs you need. However, keep in mind that more and more insurance companies are forming deals with pharmacies so you may be forced to shop at a particular store, regardless of its prices.

Websites that might help

Besides going directly to the pharmaceutical company that makes the drugs you need, you might also be able to find help with prescriptions through the following programs:

• NeedyMeds - a national non-profit information resource that helps people find assistance programs to help them afford their medications and other healthcare costs
• Partnership for Prescription Assistance - helps connect qualifying patients with the assistance programs that are right for them
• RxAssist - a comprehensive database of patient assistance programs offered by pharmaceutical companies
• RxHope - gives a helping hand to people in need of obtaining critical medications that they would normally have trouble affording
• Medicare Pharmaceutical Assistance - links you to the manufacturer of specific drugs so that you can see if they offer an assistance program
• State Pharmaceutical Assistance Programs - check to see if your state has a program to help pay drug plan premiums and/or other drug costs

Organizations that may provide copay assistance

Just making the copay on expensive drugs can be completely out of reach for many of us. There are organizations that may be able to help you with copay assistance:

• CancerCare
• Patient Advocate Foundation
• Healthwell Foundation
• Patient Access Network Foundation
• Good Days Foundation
• The Assistance Fund

Please let us know in the comments if you know of other resources that might be beneficial to those of us who need help affording prescription drugs.