Families often budget for basics such as housing, transportation, food, and clothing. However, sometimes life gets in the way of maintaining a strict personal budget, and the high cost of prescription drugs for an unexpected medical condition must be accounted for.
All too often, the one-time cost of an expensive drug or the ongoing expense of monthly prescriptions end up devastating a bank account. Thankfully, you do have options to help reduce the cost of prescription drugs for both acute and chronic conditions.
How to Save Money on Prescriptions
1. Request Generic or Low-Cost Drugs
Physicians don’t always consider your bottom line when signing their prescription pads. Generic drugs aren’t always available, but it’s important to stress to your physician that the cost of medication is important to you and you need the lowest cost drug available.
According to the Mayo Clinic, generic drugs may have different fillers than their name-brand counterparts, but the FDA requires they meet the same standards of quality, strength, and purity as name-brand drugs. There’s no need to fear that the generic version won’t work as well.
Also, if your prescribed drug doesn’t have a generic equivalent, talk to your doctor about using a different drug altogether. Sometimes doctors choose a name-brand drug that requires fewer follow-up appointments than other drugs, but ultimately, it’s up to you to decide how to address your condition.
For example, some doctors may choose to prescribe the new name-brand anticoagulation drug, Xarelto, versus the older drug, Coumadin. Both drugs address the same condition, but Coumadin requires regular blood draws and follow-up appointments, while Xarelto does not. That said, Xarelto costs roughly $10 per pill while Coumadin costs only $4 per month. If you want to treat your condition with a $4-per-month generic rather than a $10-per-pill name-brand, voice your concern to your doctor.
2. Access a Mail-Order Pharmacy
When you pick up your monthly prescriptions from a pharmacy, the pharmacy’s overhead expenses are passed on to you. Mail-order pharmacies save you money by reducing overhead expenses, making it possible to reduce the cost of prescriptions. They’re also a convenient solution if you grow weary of trekking back-and-forth to a local pharmacy.
To use a mail-order service, go online and find a licensed pharmacy that delivers to your area. Some prescription insurance providers only allow you to use certain mail order pharmacies (such as the Express Scripts mail-order pharmacy for Express Scripts users), so call your insurance provider and check requirements before signing up.
- Practice and hold licensure in the United States
- Hold a Verified Pharmacy Practice Site (VIPPS) certification
- Require a prescription to fill your drugs
- Employ real people and a real pharmacist you can speak with on the phone
If you want to look into licensed mail-order pharmacies, check out Pharmacy Checker. This site helps consumers search for specific drugs offered at the lowest prices at licensed mail-order pharmacies across the United States.
3. Find a Prescription Assistance Program
Many pharmaceutical companies have prescription assistance programs (PAPs). These programs come in handy for uninsured or under-insured consumers. The prescription drugs qualifying for PAPs are usually very high-cost, so pharmaceutical companies use PAPs to make their products available to the public.
Of course, finding a PAP for your prescriptions can be challenging – you may not know which pharmaceutical company manufactures your medicine, and searching the Internet can be overwhelming. Thankfully, NeedyMeds exists to collate and categorize PAPs by drug type. Simply visit the site and input the name of your medication. If a PAP is available, NeedyMeds will tell you about eligibility requirements and how to apply.
For example, doctors sometimes prescribe an antibiotic called Zyvox to patients who have a serious infection. Usually, doctors prescribe this antibiotic only after several other versions have been tried and failed. Patients without health insurance or prescription drug coverage could end up paying more than $2,000 for Zyvox; however, a consumer who goes to NeedyMeds can apply for the Zyvox PAP and, if eligible, reduce out-of-pocket costs to zero.
4. Use a Flexible Spending Account or Health Savings Account
As healthcare reform ripples across America, many employers are offering flexible spending accounts (FSAs) or health spending accounts (HSAs) to employees. The benefit of both FSAs and HSAs is they allow consumers to pay for medical expenses, including prescriptions, with pre-tax earnings. Depending on your marginal tax rate, savings can be sizable.
It’s important to note that while FSAs and HSAs provide the same opportunities to save money on prescriptions and medical care, their rules differ slightly. Consumers can fund FSAs and HSAs, and employers often contribute to both types of funds. However, unlike HSAs, FSAs don’t roll over at the end of the year, so if you don’t use your money, you lose it.
5. Obtain a NACo Card
The NACo card is a free prescription discount service available to anyone living in participating U.S. counties. If you’re uninsured, don’t have prescription coverage, or don’t have prescription coverage for the drug you need, the NACo card saves you an average of 24% at checkout.
To enroll, visit the NACo website and fill out the online submission form. Enter your zip code to see if the program is available in your area, and if it is, NACo will send the savings card to your home free of charge.
6. Qualify for Medicare Extra Help
Consumers using Medicare Part D (Medicare’s prescription drug plan) can receive price breaks on prescriptions if they meet the Extra Help program eligibility requirements. Eligible participants pay no more than $2.65 for generic drugs and $6.60 for name-brand drugs.
You or a family member may qualify for Extra Help if you receive at least one of the following:
- A notice from Medicare stating you automatically qualify
- An Extra Help automatic enrollment notice from Medicare
- Supplemental Security Income and/or Medicaid assistance
- An Extra Help “Notice of Award” from Social Security
Most of the time, you’re automatically notified of Extra Help eligibility if your income falls below the designated level. If you have questions or want to find out more, call Medicare directly at 1-800-MEDICARE.
If you do not qualify for Extra Help, there are ways to find a Medicare Part D program to meet your needs for prescription coverage. The Medicare Plan Finder enables consumers to compare the cost of prescription drug programs and co-pays.
7. Apply for a State Pharmaceutical Assistance Program
Even with the availability of pharmaceutical discount programs and Medicare programs, some people still fall through the cracks. State pharmaceutical assistance programs (SPAPs) help catch these individuals, particularly the uninsured or under-insured who cannot access pharmaceutical company PAPs, earn too much money for Medicaid, or don’t qualify for Medicare Extra Help.
State pharmaceutical assistance programs are not available in every state, and they don’t cover every condition and every drug. Each program has specific and variable eligibility requirements, generally tailored to low-income individuals managing chronic and costly illnesses.
For instance, the State of Texas has only two SPAPs, and program participants must have End Stage Renal Disease or HIV. Therefore, many people who want to utilize SPAP benefits simply aren’t eligible. But, for those who are, SPAPs provide an important lifeline to additional prescription coverage.
To find out if you’re eligible for your state’s SPAPs, go to Medicare’s SPAP website.
8. Seek Out Local Programs
It would be remiss not to mention the many local programs available to consumers in need. Many counties in large urban areas have county hospitals funded by tax dollars to help individuals without insurance. These county hospitals enroll eligible participants in their programs and usually offer price breaks on prescriptions. Furthermore, many charitable organizations offer clinic medical care for uninsured or under-insured individuals. These clinics are savvy about prescribing the least costly drugs, occasionally offering vouchers for those in need.
Of course, it’s extremely challenging for consumers to know where to look for these local programs. American social service agencies are often a hodgepodge of different clinics and programs, often causing confusion for individuals dealing with a medical or financial crisis. Unfortunately, doctors and pharmacies may not be aware of the programs that exist for people in need.
If you’re not sure where to start, first visit the NeedyMeds website. The site has a listing of local clinics by zip code, and the staff at these clinics can provide further information about enrollment to obtain the services you need. You can also call your local hospital and ask to speak with a social worker. Medical social workers have up-to-date listings of local clinics and programs available in the immediate area, and they’re usually glad to help those who don’t know where to start.
The financial stress of acute and ongoing prescriptions can ruin a budget, but you don’t have to simply accept the high cost of prescription drugs. As a consumer, you have the right to speak with your doctor about reducing costs, and you also have the right to shop around for the best price. If the cost of your prescriptions is still too high, alternative assistance programs exist to help safeguard your health.
How does your family reduce the cost of prescriptions? Have you ever experienced sticker shock when you take your prescription to the pharmacy?