Cheap Drugs - How to stay healthy without putting your Piggy Bank on life support.

Not too long ago I met a new patient who had come to me after her previous doctor had retired.  She was a very pleasant older woman who was retired herself and on a fixed income. She was relatively healthy but had a number of chronic medical conditions such as high blood pressure, high cholesterol, diabetes and an underactive thyroid that were well controlled with the use of six different medications which she took daily. During the visit she related that she did not always take her medications because the cost had gotten so high, amounting to more than $600 a month.
Modern medicine has worked miracles. People today can expect to live longer and better than ever before. We have drugs now that can cure infections that used to kill thousands, prevent hear attacks and strokes, cure cancer, and help diabetics live normal lives. But with all of this success and long life comes a cost. Medications can be expensive. The good news is that they don't always have to be. With a little planning a savvy consumer can often purchase the medicines they need for a fraction of the cost and stay healthy without hemorrhaging money.

So how can a smart consumer save money? There are a number of tools available to help us cut our medication bill down to size.

Generic Drugs

The first tool is no big secret. Its generic medications. Generic medicines have the identical active ingedient that the brand name has but often at a much lower price. The only difference between the two will be the shape and color of the pill and perhaps the binders that hold it together. Despite fears that generics will not work as well as the branded drug there is no scientific evidence to support this concern and in fact the FDA regulations require generics to have equivalent doses of the active ingredients. Some generic drugs are actually manufactured by the same company that makes the branded drug but they chaneg the look and repackage it without the brand name.

Use a Similar Drug if no generic drug is available

Even though some drugs may not be available in generic form they may be members of a class of very similar drugs and another member of that class may be available as a generic. "Statin" drugs are used to treat cholesterol. Most people are familiar with Crestor which is a statin. Crestor was not available in generic form a few years ago but several other members of that class such as Zocor, Lipitor, Mevacor, and Pravachol were and still are. With few exceptions, most patients can switch from one statin to another statin and do just as well. The same is true for many blood pressure medications and diabetes medications as well as medicines used for other conditions is a program available online that provides cheaper prices for nearly all generic drugs through your local pharmacies. No membership fee or other fees are required to use this service. You simply enter the drug, the number of pills, and you zip code. You then get a table showing how much the drug will cost at a number of pharmacies near your location. You can not use your insurance to pay when you use GoodRX. You just print the coupon and tell the pharmacist you will be using GoodRx instead of your insurance. In many cases this is cheaper than using your insurance and if you are uninsured it will be much cheaper than paying out of pocket on your own.

Another advantage using GoodRx is that you won't need to get an approval from your insurance company and you can get past the limits on the number of pills some companies allow.

Switch Pharmacies to one that has a low cost Generic Drug Plan

Neighborhood pharmacies are more convenient but they don't always have the best prices. Both Target and Walmart have generic drug programs that cover a long list of common drugs. These drugs can be purchased at very low cost. For most drugs on these lists a 30 day supply is only $4 and a 90 day supply is $10 even even with no insurance. If you do have insurance its important to tell the pharmacy you do not want to use your insurance for these prescriptions otherwise you may actually be charged a copay which could be higher than the cash price or you may be told that you can not get a 90 day supply through your insurance plan. Just tell them you will be paying cash out of pocket for your medications if the medicine is on their Generic Drug Formulary. Click on the links below to see if your medications are on these lists. Each pharmacy has a slightly different list so if you don't see your medication on one list check another. If your medication isn't on the list but a similar one is ask your doctor if it makes sense to switch medications.Local pharmacies like CVS and Rite Aid have similar plans although some of them require a small annual membership fee and have slightly higher prices.

These first three tools can result in significant savings. As an example, lets look at what happened with the woman I mentioned in the opening paragraph. We sat down and looked at the medicine bottles she had and I asked her if she would be willing to switch consider generic medications or switch to some similar medications if it would help her save some money. She happily agreed. As it turned out most of her medicines were brand name medicines for which generic equivalents were available. Two medications were not available as generics but there were alternatives that we could use which were just as good and they were available as a generic. In addition she was getting all of her medications through the local pharmacy at regular retail prices. By switching all of her medicines to generics or to similar medicines that had generic equivalents and transfering her prescriptions to a pharmacy with a generic drug plan we managed to get a 90 day supply of all 6 of her medicines for a grand total of $60. That was just $20 a month compared to the $600 monthly drug bill she had before. Her annual medication bill had been over $7,200. Now it was $240.  Even better was the fact that her chronic medical conditions eventually were under better control because she didn't have to skip her medications.
These aren't the only tools you can use to lower drug costs. A few more are ilsted below.

Splitting Pills

Its an odd quirk of drug pricing that doubling the dose does not double the price. In fact in many cases a 100mg pill of a drug costs exactly the same as a 50mg pill. This is often true whether we are talking about the generic or the brand form of a drug.  The cost for 30 pills of brand name Lipitor cholesterol medication at an one drug store at the time of this posting is $256 for the 20 mg pills. The same store charges the exact same price for the 40 mg pills. Buying the 40mg pill and cutting it in half would save a cash paying customer $1,536/year. Even if the patient has insurance and only pays a $30 copay they could save $180/year which isn't peanuts.

The generic version of the same drug is $15 for the 20mg pill, while the 40mg pill is only slighlty more expensive at $17. Buying the higher dose here woud bring the annual bill from $180 to $102. Not a lot but still $72 is enough to take a big bite out of the check at a nice restaurant. Better in your pocket than the pharmaceutical company.

While it is certainly a huge cost savings to split an expensive branded drug it will almost always save you money if you split pills. Most pharmacies sell pill cutters for just a couple dollars that make the job a snap.

One caution, capsules and time release medications can not be split. Check with the pharmacist to see if the drugs you are taking can but cut without changing their effectiveness.

OTC (Over The Counter) medications

Most people assume that getting medications through their drug plan is going to save them money but as I already mentioned above that is not always true. Sometimes co-pays can be more expensive than just paying for a drug out of pocket. This is also true of drugs that are available both with and without a prescription.

Common examples are antireflux drugs like Prilosec and Prevacid. These drugs are available in brand and generic form without prescription. It often pays to look at the non-prescription form on the shelves and compare it to the prescription price before purchasing. Sometimes the savings can be significant and it never hurts to ask if there is a similar drug that does not require  prescription. The added benefit of nonprescription drugs is that it does not require an office visit or a phone call to get a new supply of these medications, and if you forget your medicine when you travel you can easily pick up a new bottle at the local pharmacy. Always check with your doctor first though to see if the OTC version is acceptable for your condition.

Many allergy medications that used to require a prescription are also available over the counter now and can often be significantly cheaper if purchased OTC.

Note: I recently checked the price of Nexium ( a popular drug similar to Prevacid and Prilosec for refluc and acid conditions). The price for the precription drug was $500 for 60 pills. The price for the exact same medication OTC ( brand not generic) was about $50 !  It pays to check.

Canadian Pharmacies

The question of purchasing through a Canadian pharmacy does not seem to come up as often today as it did 5 or 10 years ago. Perhaps because ther are other options now. Still I do get occasional questions from patients about this option. There are concerns with this approach.

First it is illegal to import drugs from Canada. Doing so violates federal law and any company that is doing this is knowingly breaking the law. This alone has to make a consumer question the company's ethics and if they are willing to break the law in one circumstance they may be willing to do it in ways that may not benefit the consumer.

These pharmacies are not under the juristiction of any U.S governmental agency and therefor are not liable if there is a problem wth the product they sell to you. There have been incidents of counterfeit drugs being sold through Canadian pharmacies to American citizens. Since they have chosen to break the law by exporting drugs illegally it should not be surprising that some of these companies would have less than perfect ethics about what they are selling.

Since there are other alternatives I would avoid purchasing drugs from Canadian pharmacies.

The Elderly Pharmaceutical Insurance Coverage (EPIC) is a New York State program that is designed to help older New Yorkers afford their medications. There are several plans based on income which can pay part or all of the out of pocket expenses involved in the Medicare Part D drug coverage plan. There is a link down below if you would like more information about this program.

Useful Links

Michael Melgar

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