Editor's Note: This article is not meant to be interpreted as personalized medical advice. Always talk to your doctor or pharmacist about the best options for your individual situation.
Prescription medications costs are on the rise, which can place a significant financial burden on families during a recession and pandemic.
“We’ve seen incredible increases with the cost of medications both with just simple generic medications that have gone up significantly in price but also drugs, new drugs,” said Gina Moore, an associate professor at the University of Colorado Skaggs School of Pharmacy and a past president of the Colorado Pharmacists Society.
Medications are more expensive in the United States than anywhere else in the world.
Nevertheless, more than 131 million Americans rely on prescription medications, according to a Georgetown University study.
Denver7 spoke with pharmacy experts about how to save money on prescription medications.
Savings start with your health insurance plan
Long before you head to the pharmacy, the choices you make affect how much you’ll eventually end up paying for your prescriptions.
“Choosing the wrong plan really has an impact on their overall financial health,” said Analisa Cleland, an insurance broker for Coto Insurance and Financial Services.
Cleland said there is a big difference between the various levels of coverage.
“If you have an expensive prescription medication, I don’t recommend that with a HSA,” Cleland said. “If you have a chronic prescription, look at the co-pay plan.”
She said she encourages people who rely on regular medications that are more costly to get help picking the best insurance plan from a professional who knows the intricacies of health insurance and formularies.
“When someone comes to me for health insurance, it’s not about looking for the cheapest plan,” she said. “I help people find the best plan for them.”
Questions to ask your doctor
When you are prescribed a medication, there are some questions you can ask your doctor to try to cut down on costs.
Moore said one example is asking if there is a generic version that might be a better price through an individual's insurance.
If you are trying a new medication for the first time, it also might be possible to ask for some samples so you can see how your body interacts with the medications first before committing to buying an entire month’s supply.
“If you have a prescription that is not covered under formulary, you can have your doctor try to do a formulary exception,” Cleland said.
A formulary is the list of medications that are covered by your insurance. There are three tiers that help determine the amount the patient is responsible for paying and what the insurance company will cover.
Typically, generic medications are in Tier 1 and are the cheapest. There are instances, however, where a medication is not covered and has no alternative.
In that case, you might be able to fill out a formulary exception to ask the insurance provider to cover some or all of the cost. However, the process can be lengthy and isn’t always approved.
Another question worth asking your doctor is whether there are any discount cards available that they have in their office.
“It’s not uncommon for a physician, for example, to get coupons from a manufacturing company," Cleland said.
Depending on your insurance plan, another way to lower the cost is to go through a company like Express Scripts, where multiple months worth of the medication is shipped to your door as a lower cost.
These are pharmacies run through the Pharmacy Benefit Managers associated with a patient’s health care plan.
Help from the pharmaceutical company
If there is not a cheaper medication, another option to try to lower the cost is to check to see if the pharmaceutical company that manufactures it can help cut the cost.
Many companies have patient assistance programs (PAPs) which offer free or discounted medicine for people who can’t afford the cost.
In order to qualify, patients will usually have to fill out an application and get a doctor’s signature on it.
However, these applications take time, so if the medicine is needed right away, this option could be difficult.
Copay reduction cards are also an option through the pharmaceutical company to try to save money.
Manufacturers coupons might cut down on the price, if even only for a few months. These coupons are available online through the company’s website and may require some of the patient’s personal information, which pharmacies and doctors are not allowed to give out.
Questions to ask your pharmacy
Before you go to the pharmacy, make sure it is in-network. A non-network pharmacy can increase the cost of your medications substantially.
Gina Moore, associate professor at the University of Colorado Skaggs School of Pharmacy and a past president of the Colorado Pharmacists Society, recommends calling the pharmacy before you go to find out how much it’s going to be, if it’s covered and if they have any co-pay cards.
Another question to ask your pharmacy is how much the medication would cost if you don’t use your insurance.
“What people often don’t realize is if I go outside of my insurance and just pay cash, it might be cheaper and you can ask that question of your pharmacist,” Moore said.
Part of the reason for that is that pharmacy benefit managers (PBMs) are required to change certain prices for medications. Going around your insurance takes the PBMs out of the equation and could result in a lower cost.
Asking if there is an option to get multiple months-worth of the medication at the same time could also help cut down on costs.
“It’s always a good question to ask whatever pharmacy you use if they have a discount program in place that you can be enrolled in,” said Jen Palazzolo, the owner of Flatirons Family Pharmacy in Longmont.
Recently, Amazon announced it was starting its own prescription fulfillment program with free delivery for Prime members.
“We think Amazon is a great disruptor,” Moore said. “They may change a lot of the landscape in terms of prescription drugs.”
Moore said she believes the change could result in the prices of medications beginning to eventually decrease. She went as far as to say the announcement could even take PBMs out of the equation altogether.
What about GoodRX and similar companies?
GoodRX and similar companies are another option to cut down on cost. These are independent companies that have established deals and rebates with pharmaceutical manufacturers on their own.
The pricing can be found online and patients don’t need to pay anything or even be a member of some of these programs in order to see the cost savings.
However, not all pharmacies accept GoodRX coupons because it can actually cause them to lose money.
“It’s often times not so advantageous to the pharmacy, but it’s a great deal for the consumer,” Moore said.
The bigger companies that do accept these discounts might choose to do so hoping to gain more of the patient’s business in the future and recoup some of the lost money.
GoodRX has also been criticized for collecting patient data and, until recently, was sharing some of it with Google, Facebook and other social media companies.
In February, after receiving criticism for sharing the data with tech companies, GoodRX announced it was going to change its practices to share less information with these websites.
It also launched an opt-out button for users and a data deletion option, however it’s the patient’s responsibility to do both.
Advice from a saver
Laura Daily is a lifelong saver. She runs Mile High on the Cheap, which is a Colorado-specific website designed to help people find deals.
Daily also relies on numerous medications each day and has learned a few tricks to pay less.
One of her hacks is to call around to different pharmacies to see how much they charge for a particular medication. Because pharmacies have different negotiated deals with manufacturers, some might charge less.
Daily uses three different pharmacies to fill all of her prescriptions, which means more driving but also more savings.
However, Moore warns this can be dangerous depending on the types of medication you’re using. Some of the medications interact with one another poorly and getting prescriptions filled at different places could mean that the pharmacist doesn’t catch the danger.
If shopping around the only way to save money, however, Moore advises patients to be very clear with each pharmacist about all of the medications you are taking.
She also asks pharmacies if they have a list of medications they sell at a fixed rate.
Another way Daily has learned to save money is by using the pharmacies inside some warehouse stores.
“In Colorado, you do not have to have a membership at a Costco or Sam’s Club in order to avail yourself of the pharmacy there,” Daily said. “They can negotiate a really good rate with a drug manufacturer.”
In the end, however, the best advice from pharmacists and savers alike is to ask questions, do your research and understand your health insurance.
