Paying for Prescription Drugs, Part II: Pharmacy Prescriptions

Health
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By Martine Brousse

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Pharmacies, once reserved for oral drugs, have seen an influx of infused or injected drugs in recent years. Due to a shift made by private insurers from Medical benefits to Pharmacy benefits (which benefits their pocketbook), the average patient’s share of cost has climbed accordingly.

But all is not lost, as several ways exist to reduce one’s liability in addition to the options that were discussed in Part I.

1. Be savvy

Few people pay full price when they know a good sale is happening elsewhere for the same item. Consider your prescription in the same way. Your local pharmacy may not be the cheapest, as your insurance-contracted rates and policy are inflexible in determining pricing.

Ask about cash prices, which may be lower. Call Costco, Wal-Mart and Target. Their prices are usually better, and Costco even offers $5 brand-name prescriptions. A membership is not required; by law the pharmacy service is available to all.

Check www.needymeds.org for direct links to coupons, rebates, assistance programs and discount cards.

2. Inspect your prescription

Do you really need a 90-day supply? Could you safely replace the more pricey prescription strength with two (or more) over-the-counter alternatives? Is there a generic equivalent? Can leftover pills you did not use up for a similar condition be taken instead?

Be aware of potential waste: Can you start with a smaller amount, and get a refill once effectiveness has been established or allergic reactions ruled out?

A little research may save you a trip to the pharmacy… and a bit of change.

3. Communicate with your physician/office

Your physician is unlikely to know your financial situation unless you bring it up. Ask for samples, or for less costly generic options. Ask if a manufacturer’s drug rep can be contacted to bring in samples or help with an assistance application.

Explain that a high price may force you to skip on doses, stretch the supply by taking less than prescribed, or forgo getting a refill until your next paycheck. The physician should work with you to find a satisfactory solution. Seeing a treatment through to the prescribed end is a struggle for many Americans: More than half never finish a treatment, mostly due to financial concerns. If your treatment must be altered or adjusted due to circumstances, your physician is the best one to determine how.

Inquire if the office supports a patient donation program. In my oncology practice, patients donated expensive growth factor drugs (in pre-filled syringes) they had purchased and were not going to use to other patients who were in need.

Work with the billing department to see if a prescribed oral treatment may be cheaper if given as an infusion in the office. This is the case for quite a few chemo drugs, for example. Whereas the oral form is brand name, the infused product may be generic, potentially saving you thousands of dollars. If your policy does not force you to use one form over the other, your (financial) wishes should be their command.

4. Check federal and state benefits

Patients with Part D have access to federal and state programs to help them cover the cost of prescriptions. For info on the Extra Help Program, PACE program or MTM program, call the Medicare Helpline at 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.

All patients can determine whether they are eligible for benefits by visiting www.benefits.gov.

5. Use your HSA or FSA account

The IRS allows a number of prescriptions and over-the-counter medications to be paid for with your health savings account or flexible spending account. The money in your FSA will be lost to you if not used in full by the end of the year, so make good use of it at your pharmacy.

For more information, visit www.irs.gov/publications/p969/ar02.html or consult a tax professional.

Prescription drugs are expensive, and finding a fair price may require time and research… on an ongoing basis. Trusting your local pharmacy for any and all your prescriptions may be a thing of the past, replaced by the type of shopping around we do for so many other items and aspects of our daily life.