Buying prescriptions

Photo Credit: "Spilled pills_1", © 2010 Ano Lobb, Flickr | CC-BY | via Wylio
Photo Credit: “Spilled pills_1”, © 2010 Ano Lobb, Flickr | CC-BY | via Wylio

Buying prescription drugs can be an adventure.

Are you insured? Is it covered? Does your plan cover not this medication, but another? was it $30 last month and now it’s $400? Yikes.

There are often not easy answers. But try this: For each medication you are taking, follow these simple steps. It won’t take too long, and you might save a ton of money.

1. Ask the pharmacist “How much will this cost me, on my insurance? And what is the cash price? Can I have that in writing?” If they won’t put it in writing, take notes, with names and numbers — it will make it easier to argue on the back end.

Don’t assume that your insurance gives you the best price. We hear over and over again, and have experienced cases ourselves, in which the insured price is actually HIGHER than the cash price.

2. Ask several pharmacies the same question — a chain, a local independent, a big-box store. Prices vary, a lot. Take notes, take names, take numbers.

3. Ask “Is there a generic? Is there an over-the-counter variant?”

A generic might be cheaper. But do not assume that a generic will automatically be cheaper.

4. Check websites like GoodRx.com and BlinkHealth.com to see if there’s a better deal. Again, take notes. Take screenshots if you can for proof.

5. Don’t forget Costco. We hear often that Costco has low prices, but most people don’t realize Costco has a pharmacy. I don’t believe you have to be a Costco member to use their pharmacy, although at mine they said that members get better prices than non-members. My Costco is marginally cheaper than my local independent pharmacy for the one regular medication I take — but I like supporting my local independent.

6. Do you have a coupon, or a discount card? Don’t assume that either is giving you a better deal. Sometimes they help, but quite often you can do better on cash without a coupon or a discount card. Think about it — with a coupon, there’s another mouth to feed. Also, many pharmacies won’t accept discount coupons or cards.

7. Patient assistance programs exist for some drugs. These are run by foundations or nonprofits (the Johnson & Johnson Patient Assistance Foundation, the Merck Patient Assistance Program Inc., for example) that have programs reducing out-of-pocket payments for patients, sometimes by a lot.

To find them: Google “patient assistance program” and the name of the drug.

Beware: They can be hard to access, and many have restrictions.

Also, the drug companies use these as a fig leaf: “Oh, we have patient assistance programs to help those in true need.” But the companies also use spending from these programs as a tax writeoff — inflating the drug prices, then giving a “patient assistance coupon” for a discount to the patient, and taking a hefty writeoff from the wildly inflated sticker price.

Meanwhile, the insurance company is paying its portion of the price.

8. If you still find it unaffordable, tell your doctor. Ask if there’s another medication. Ask the doctor to help you make your case if the insurance company is being difficult.

Take action: Tell us what you learn, and help us supply more strategies to others like you!

More resources for buying prescriptions

Doctors and patients often don’t know what’s covered under a patient’s insurance. So it can be a complicated process. Here’s an example from Martha Bebinger at WBUR public radio in Boston, of the search for insulin.

Goodrx is a web site with a search tool that lets you put in the name of a prescription drug and a location, then supplies a list of places that sell the drug and the prices.

Often a coupon is involved, and that means money’s changing hands somewhere. We have heard frequently that pharmacies don’t accept coupons, or may give a better price than the coupon price.

The prices aren’t the lowest we’ve seen, but it certainly gives you an idea of how to shop around.

GoodRx omits prices from Costco. We find on spot-checking that Costco prices tend to be the lowest or among the lowest in many metro areas. We surmise that GoodRx does not have a business relationship with Costco, as it does with the pharmacies whose prices it lists. I asked a GoodRx executive about this one time during a phone interview, and he ended the conversation. (Update: When this was originally written, in 2012, there were no Costco prices; then for a while they were there, so we assume the two companies arrived at an agreement. Now, the Costco prices are listed both in locales where Costco exists, and as part of “GoodRX Gold,” which seems to be a discount card or club-type membrship)

Do not overlook Costco as an option, if there’s one in your area. The policy for many years has been that a customer at a Costco pharmacy does not need to have a Costco membership to buy there, but a Costco membership may confer additional discounts. Their prescription pricing page is here. Other big retailers may also have pricing on their sites.

You may not need any GoodRx discount coupon to obtain the lowest price — so be sure to ask: “What is the price with the GoodRx coupon? What’s the price without a coupon? What’s the price with a Costco membership?”

Blink Health lets you buy meds through them, by paying online, and then you get a coupon or voucher to take to a local store to pick up your prescription. It’s largely for generics, at least right now. The New York Times wrote about them: “The listed price for a 30-day supply of the generic version of Lipitor, for example, is $196 at Kmart, according to GoodRx, and $61 at Kroger. With a coupon obtained through GoodRx, the drug is about $12. Blink Health is offering Lipitor for $9.94.”

We don’t know where GoodRx gets the “listed price,” which it puts on its site next to the lower prices it offers — but that “listed price” is the one that drives you to believe that anything below that listed price is an improvement. That may be, but $9.94 is still better than $12.

Other sites pop up intermittently promising discounts;  again the caveat applies about coupons.

So it’s a subscription, for $4 a month; with this information, the site suggests, you can shop around wisely. The site says it was launched in 2013, by a South Carolina pharmacist named Steve Patton.

Does that discount prescription card really give a discount?

Maybe not. We mentioned this in No. 6 above, but want to amplify: We have seen and heard of dozens of such cards, issued by businesses, by trade groups, by on-line suppliers of cards, even by my local county government.

But be careful: Pharmacies do not universally take these cards. And even if they do, the discount card may not give a discount that’s deeper than a cash price. We have done spot checks of these cards and don’t have a universal assessment of them, other than to say: Do your homework. Ask the questions above.

Ask “How much is it with this discount card? How much is it with cash?” Ask this for every medication, and for every purchase: It might be better for one medication at one pharmacy, and much worse at another.

Other workarounds

One friend told us: “One other question I started to ask is whether there’s a rebate (as well as coupon) and if it can be applied immediately. Not sure of other pharmacies’ policies, but the CVS near me was great about digging up any and applying them to the price I paid. I ended up saving a considerable amount on one medication.

“Asking about discounts for buying in bulk (e.g. 90-day supply) or by mail order can also net some savings.”

Another friend told us what worked for here in the New York area when her CVS told her that the medicine she’d been getting for years for $5 was going up to $385.

“My doctor called the RX into Central Pharmacy in Brooklyn (and sister pharmacy Pro Pharmacy in Queens). They partner with Zero Co-Pay Program on a number of meds. Bottom line: I now get my RX for free — and they deliver, also for free. I know this sounds too good to be true.”

I wrote about it here.

Another friend wrote: “I used Jeanne’s tip about GoodRX a couple years back and found that by getting my husband’s prescription at the supermarket instead of Walgreen’s, we could save $75ish/month. Thousands of dollars later, I remain a Jeanne Pinder superfan.”

Paying cash — that’s right, cash

Your medications could easily be cheaper if you pay cash, without your insurance card. That’s right: cheaper without insurance. There are a number of reasons for this, and it’s not always true, but we have been told time and again that buying on cash, depending on the medication and the pharmacy, can be cheaper.

Here’s an investigative report about the topic from Lee Zurik, an investigative reporter and anchor at WVUE/Fox8Live in New Orleans.

Always ask: How much will this cost? How much will this cost me? What’s the cash price?.

Ever wonder how much the drugstore paid for that pill? Here’s a post containing price lists compiled for the government.

Are generics always cheaper? No. Listen to our friend Leslie Ramirez from leslieslist.org.

Do you expect your co-pay to be the same every time? Well, stop it. Listen to Charles Ornstein as he tries to figure out a co-pay for a prescription.

The insurance company coverage is often governed by a formulary, or list of approved medications. Those formularies can change, and so one should always check with the insurance company or pharmacy benefits manager on coverage.

Here’s a nationwide formulary resource that we have not completely vetted, but at a glance it looks to be valuable (in my quick test it was 50 percent right). It’s free, and it lets you search any plan in any state. But! As with any information you find on the web, always check.

Are those drug discount cards really a bargain? Maybe not. Listen to Richard J. Sagall, M.D., who wrote this post for costsofcare.org.

Are manufacturers coupons a bargain? Also maybe not. Joseph S. Ross, M.D., and Aaron S. Kesselheim, M.D., J.D., M.P.H. explain in the New England Journal of Medicine.

Efforts to limit copay cards and coupons are on the rise, as Lisa Schencker of The Chicago Tribune writes in this piece. “Typically, patients with individual and employer-based plans can use the cards or coupons to save money on their insurance copays for certain prescription medications at the pharmacy,” she writes. “While a coupon can reduce all or part of a patient’s copay, the insurance company still has to pay its full portion for what might be a high-priced drug — a cost that opponents of the discounts say is ultimately passed on to all consumers in the form of higher insurance premiums.”

if you have big prescription costs, or if you’re very organized, take a look at this guest post that we ran from a woman who is extremely smart about all this. She has advice not only about shopping for the drugs she and her family use, but also medications for pets. She has a binder with printed lists, and every time she goes to the doctor, she has a conversation about medications. It’s a great example.

Thinking about buying prescriptions online? Here is a blog post about resources for checking up on whether that pharmacy’s legit.

Buying overseas

We hear not frequently that people travel abroad expressly to buy medications. Recently some Americans made headlines by driving to Canada to buy insulin because insulin prices are so high here.

This Philadelphia man travels to buy his son’s prescriptions.

This practice is particularly common for U.S. citizens who live close to the Canadian or Mexican borders. Others find the prices cheap enough to fly from their U.S. cities to Canada or Mexico, buy prescriptions and fly back. Still others buy while they’re on vacation, or visiting relatives in other countries.

This particularly came across our radar recently in an online conversation about fertility medications, which can be extremely expensive — women talked about buying medications overseas, which the fertility clinics frown on.

We do not make medical recommendations here, so we’re not recommending any of these courses. But if you do decide to try to buy abroad, make sure you know if you need a prescription, and what import restrictions there might be. Here’s a page from the U.S. Food and Drug Administration website referring to the current state of affairs. Here’s a page from the U.S. Customs and Border Protection agency on the same topic. On the state level, several states are seeking to import drugs directly. But as it stands right now, anyone planning to import drugs from overseas, either by traveling abroad and bringing them back or by ordering online should know that there may be legal issues involved.

The same import restrictions apparently apply to buying from online pharmacies, including the Canadian online pharmacies that advertise so heavily. In addition to import restrictions, you should attempt to establish if the online pharmacy is legit. Here are some resources.

Patient assistance programs

You might also be interested in NeedyMeds, a nonprofit helping people in need find medications. They have information about patient assistance programs, which typically help people with expensive medications.

Those patient assistance programs are offered by drug companies with differing rules, some of them through foundations and some directly through the companies. Such programs may provide meds directly to patients at little or no cost, or they might offer help with co-payments, the patient’s out-of-pocket expenses.

Quite often, this drug company assistance is either directed through a foundation, or used as a tax writeoff or something similar. Here’s a Los Angeles Times story exploring some of these issues.

This blog post links to a site that gives the average price that pharmacies are paying for every drug in every size in the U.S. — it’s a great resource.

We also love our legacy project, a crowdsourced PriceOfBC map of people’s contributions on the price of their birth-control pills. It was an early experiment (from 2011), and we are still very fond of it.

Beyond that, here are a few posts from the blog.

Buying prescriptions online? Check these resources to see if the site’s legit.

Big-box generic drug plans: Good even for the insured?

More generics mean cheaper drugs. What if you need the brand-name pill?

Generics will make drugs cheaper–but are they safe?

Generics will make drugs cheaper: What does that mean for consumers?

Generic birth-control pills: $4 or $10? Or $9? Or $50?

Birth Control Abroad: Buying Cheap Ortho Overseas

Yaz, Yasmine and Beyaz: The price of birth control

The price of birth control: How much do those pills cost?

Birth control pills: How do you choose?

Pharmacy Discount Plans–A Good Option?