Save at The Pharmacy

A Practical Guide to Reduce Medication Costs

By Donald Levasseur PharmD
www.PharmerDon.com

© 2009 PharmerDon, Inc., All Rights Reserved

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Disclaimer, Copyright and Legal Notices
This e-book is protected under international copyright law, and is Copyright © 2009 by PharmerDon, Inc. All trademarked terms are the property of their respective holders. This e-book is provided for informational purposes only. We make no claims or guarantees, and assume none of the risk inherent in your using this information. We make no promises that you’ll save a certain amount from using the information in this e-book. By continuing to read this e-book you acknowledge that you assume all responsibility. It is possible to accidentally increase your cost if you switch to a lower cost medication. This can happen if there are unintentional side effects or drug interactions after the change. There can also be other unforeseen circumstances that may increase cost or cause harm. These are risks you assume when using this information. Every attempt has been made to provide accurate and reliable information. Notwithstanding this fact, the publisher does not warrant or represent at any time that the contents within are accurate due to the rapidly changing nature of healthcare and the pharmaceutical industry. The publisher assumes no responsibility for errors, omissions, or contrary interpretation of the subject matter herein. Any perceived slights of specific persons, peoples, or organizations are unintentional.

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Table of Contents

Introduction .......................................................................... Do You Really Need the Medication? .................................. Is There a Generic Equivalent? ........................................... Is There an Alternative? ......................................................

4 6 9 11

Combination Products ......................................................... 13 Free Samples ...................................................................... 15 Understanding Insurance Copays ...................................... 17 Manufacturer Programs ...................................................... 20 Mail Order ........................................................................... 21 Prescription Discount Cards .............................................. 23 Store Programs ................................................................... 25 Import from another Country ............................................... 27 Save on Over the Counter Medications .............................. 29 Other Resources and Tips .................................................. 31 Conclusion .......................................................................... 38

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Introduction

Treating medical conditions with pharmaceuticals is a fairly new phenomenon. Bayer did not start distributing aspirin until 1899, and this was in powder form only. Penicillin was discovered in 1928 and Insulin was discovered in 1922. Since these early beginnings, scientists have developed a large array of medications to treat conditions that were previously untreatable. These medications have improved the quality of life for millions of people worldwide and have saved countless lives. Unfortunately many of these medications can be very expensive and many people are struggling to pay for these life sustaining treatments. I want to take a moment to thank the pharmaceutical industry in their efforts to develop new medications that save lives. It is estimated that it costs between 500 million to 2 billion dollars to develop and market a new drug. Furthermore, only 1 in 3 drugs marketed make a profit for the manufacturer. You can see with numbers like these, drug manufactures have a lot to overcome to develop a successful new medication. It is understandable that medication prices are on the rise. Not only are drug costs on the rise but doctors are more commonly using multiple prescriptions to treat a single medical condition. For example, it is not uncommon to see a person with diabetes or high blood pressure being treated with 2, 3 or 4 medications. Also, if a person has more than one condition, the number of medications prescribed can easily get into the double digits. As these trends continue, it is becoming
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more important for people to find ways to save money without compromising their health. The intent of this book is not to support the high prices, nor to criticize them. It is also not the intent to criticize any person, company, industry or country for their pricing policies on medications. The sole purpose of this book is to help the individual lower their overall medication costs by understanding and utilizing the information provided. Finally, it is important to communicate with your doctor and pharmacist. They cannot help you save money if you don't tell them your goals. Many doctors don't routinely take the price of medications into consideration when writing a prescription. Don't be afraid to speak up and ask for a generic medication or a less expensive brand. The doctor will usually try to accommodate you once you have stated your case.

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Do You Really Need The Medication?

The first question that should come to mind anytime a medication is prescribed is “Do I really need this medication?” Many people walk into the doctor's office with the belief or expectation that a medication will be needed to treat the condition. There are countless examples of medications prescribed when an alternative therapy or no therapy would be effective. This does not mean avoid taking a medication when prescribed appropriately, just discuss the need and alternatives with your doctor. Here are just a few cases where medications have a legitimate need and use but may also be over prescribed.

Attention Deficit Hyperactive Disorder (ADD/ADHD)
There are many times medications are needed to treat this condition. That being stated, the DEA reports from 1990 to 1996 there was an increase in prescriptions for methylphenidate by 500% and an increase in amphetamines by 400%. The DEA states “…there is also strong evidence that the drugs have been greatly over-prescribed in some parts of the country as a panacea for behavior problems.” 1 The cause for these increases is not totally clear, but before starting therapy it is a good idea to discuss your options with the doctor.

Sinus Infections
A sinus infection can be the result of a viral infection or a bacterial

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infection. An antibiotic is frequently prescribed for sinus infections but antibiotics are not effective in treating a viral infection, and there is evidence that about 50% of bacterial sinus infections will resolve without antibiotics.2 Furthermore, there is evidence nasal steroids show no benefits over doing nothing. 3

High Cholesterol
Depending on your cholesterol level and risk factors, the National Cholesterol Education Program guidelines state the first step to treatment is lifestyle changes including diet, exercise and weight management.4 In fact, lifestyle changes could be as effective as medication therapy if the individual is motivated to make the effort required. This person may eventually need to be treated with medications but effective lifestyle changes could postpone beginning medications and avoid this cost.

You Have More Than One Doctor
When someone has more than one doctor, it is possible for one doctor to prescribe a similar medication to one already prescribed by a previous doctor. It is important to have a complete list of medications you are taking with you at all times. Show this list to all your doctors so they know about every medication you are taking. This is an effective way to prevent overlapping therapy and unnecessary costs.

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Treating Side Effects with another Drug
Many times a medication can cause a side effect (unwanted or unintended effect). The symptoms are often treatable with another medication, and this is commonly done by doctors. Switching the original therapy to an alternative one may be just as effective without the unwanted side effect, and this will eliminate the need for the second medication. A good example of this is a class of drugs known as ACE inhibitors such as lisinopril. This class of drugs is known to cause a cough in some people. A doctor may prescribe a cough suppressant to treat this side effect. Now the person is on two drugs. Switching to another class of medication will solve the problem, eliminate the need for a second medication and keep costs down. Whenever the doctor prescribes a new medication ask these questions.
1. 2. 3.

Is there something else I can do besides taking a medication? What is the evidence this drug will help my condition? If I take this medication, is there another medication I can stop taking?

1. DEA Report on Ritalin http://www.add-adhd.org/ritalin.html accessed 1/25/2009 2. 3. 4.

http://sinusinfocenter.com/treatment_antibiotics.html accessed 1/25/2009 JAMA. 2007;298(21):2487-2496. http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm accessed 1/26/2009

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Is There a Generic Version?

Using a generic version of the medication is an often overlooked cost savings approach. Many medications are available in two different versions. These are brand name and generic. The brand name is the first one on the market. The manufacturer of the brand name has invested millions of dollars to prove safety and efficacy. As a result they are given exclusive marketing rights for 5 years after it has been approved by the U.S. Food and Drug Administration (FDA). Also, a new drug is given a patent for 20 years which protects the original manufacturer from competition.1 This time frame is essential for a manufacturer to recoup the investment they have in research and development. When the manufacturer no longer has patent and exclusive marketing rights, then another manufacturer can market the same chemical (drug). So, a generic drug is the same chemical manufactured and marketed by a different company than the original company. The generic manufacturer does not have to invest millions to prove a drug is safe and effective. This has already been done by the brand name manufacturer. They simply have to prove it is bioequivalent (it performs in the same manner as the original drug).1 Because the generic manufacturer has a lower initial cost, they can sell the drug at a much lower price. The cost savings for generic drugs is so substantial that hospitals often stock just the generic version of drugs when they become available.
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When a patient in the hospital has been issued an order for a brand name medication, they will be given the generic version if there is one on the market. To take advantage of this potential cost savings, ask the doctor to give you a medication that has a generic version whenever possible. There are many times when a doctor is faced with multiple choices for medications to treat a condition. If you initially indicate you would like a generic, they are more likely to give you one. When they have given you the prescription verify they have signed the line that says "substitution permitted" or any similar statement. When getting the prescription filled, request the pharmacy fill it generically. Using a generic instead of a brand can save you 80% or more when you don't have insurance. You generally will have a lower co pay with the generic when insurance is involved.

1, http://www.fda.gov/cder/ob/faqs.htm#How%20many%20years%20is%20a%20patent%20granted %20for?

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Is There an Alternative?

Many conditions can be effectively treated with several different medications. Some of these have been around for years, and some are newer. The older medications are more likely to have a generic version than the newer ones. Also the older ones are more likely to be less expensive. This is not to say that the newer medications are better or the older and less expensive ones are inferior. In fact, the less expensive older ones often have a proven track record for safety and effectiveness. A good example of an alternative medication is in lowering cholesterol. The primary category of drugs used to lower cholesterol is the HMG-CoA reductase inhibitors also known as “statins”. The available drugs in this category are lovastatin (Mevacor®), simvastatin (Zocor®), rosuvastatin (Crestor®), pravastatin (Pravachol®), atorvastatin (Lipitor®), and fluvastatin (Lescol®). All of these medications reduce cholesterol by the same mechanism. As of this writing, Crestor and Lipitor have no generic equivalent available. A month's supply of Lipitor 20mg or Crestor 10mg costs about $125.00. However, if you ask the doctor if you could use Zocor 40mg instead, the generic version of this drug would cost about $28.00 per month.1 The above example describes using a different medication in the same class because they work by the same mechanism. It is possible to find
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similar savings by looking outside the class for drugs that work by a different mechanism. Often using a different class of drugs will provide the same desired results. A good example of finding an alternative medication in a different class is the Angiotensin II receptor blockers. These medications are for lowering blood pressure and include irbesartan (Avapro®), candesartan (Atacand®), olmesartan (Benicar®), telmisartan (Micardis®), valasartan (Diovan®) and losartan (Cozaar®). None of these medications has a generic and can be expensive, costing $50.00 a month or more. An alternative class of drug which would work just as well for many people is the ACE inhibitors. In this class, lisinopril or enalapril would cost around $12.00 per month.1 Talk to your doctor to see if this type of change would work for you. Find lower cost alternatives at PharmerDon.com/save/lower-costalternatives

1. Prices from Drugstore.com 1/29/2009

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Combination Products

Drug manufacturers frequently produce drugs that are a combination of two active ingredients. They are doing this for many different reasons including product line expansion, patient convenience and patent extensions. Sometimes the combination product includes two drugs with the same indication. Examples of this type of combination include Zestoretic® (the two blood pressure medications lisinopril and hydrochlorothiazide), Vytorin® (ezetimibe and simvastatin to lower cholesterol) and Avandamet® (rosiglitazone and metformin to treat diabetes). Many more examples like these exist. Other times the two drugs which are combined have different indications. There are fewer of this type of combination because the manufacturer relies on patients who have two different needs. One example of this type of combination is Caduet® (amlodipine to lower blood pressure and atorvastatin to lower cholesterol).

Combine Ingredients
If you are on more than one medication, check to see if the medications are available in a combination product. Sometimes the combination product will cost less than the two individual medications. For example, if you are on Zetia® 10mg and simvastatin 40mg each once daily, a month's supply of Zetia® is about $107.00, and simvastatin
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is about $28.00. If you switch to Vytorin 10/40, which is a combination product with these two ingredients, a month's supply costs about $108.00 a savings of about $27.00 per month ($324.00 per year).1

Separate Ingredients
Sometimes it is more cost effective to purchase the two ingredients in a combination product separately than as a single product. For example Lotrel 5/20 generic (amlodipine and benazepril) cost about $196.00 for 90 capsules. If you switch to amlodipine 5mg ($23.00 for 90) and benazepril 20mg ($69.00 for 90), you will spend about $92.00 for a three month's supply, saving you about $104.00 per 90 days or about $416.00 per year.1

1. Prices from Drugstore.com 03/04/2009

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Free Samples

Manufacturers of prescription medications often distribute small packages of medications to doctor's offices and clinics to be given to patients for free. These are known as “free samples”. The manufacturers use these to promote their medications. Doctors often give free samples to patients to help with medication costs. To help reduce your costs, you can ask your doctor if they have any samples for the medications you are taking.

The Free Sample Trap
Beware of the free sample trap. The manufacturer's intent when providing free samples is to get you started on a medication so that you will continue with it after the free samples run out. If you do this, your costs will actually go up in the long run. This is especially true because free samples are more commonly distributed for brand name medications that have no generic available. The other problem with free samples is they could be a health risk because of the possibility of drug interactions. When you get a prescription filled at the pharmacy, it is common for the pharmacist (actually the pharmacy computer) to check for drug interactions. Free samples bypass this important safety step, which could result in an increase in costs due to these possible interactions. Drug interactions can result in hospitalizations, the use of more medications to treat
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problems or side effects and sometimes death. Always have your free samples screened for interactions. The best way to utilize free samples to reduce costs is when all of these statements are true.
1.

You are on a brand name drug that has no generic equivalent available.

2. 3. 4.

The doctor feels this is the best medication for you. The doctor does not want you to switch drugs. There are samples available for it.

In this case, every time you get samples from your doctor you are saving.

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Understand Insurance Co-Pays

To get the biggest advantage from your insurance plan, it is important to understand the benefits provided including the co-payments for various medications you may use. Often this is easier said than done, but one thing that can help here is to review the information the insurance company sends after enrollment. Another possible resource is the insurance company's website. You want to look for a few key pieces of information. 1. What is the co-pay for each tier, and where do your medications

fall. Generally medications are divided into 2 to 5 categories by the insurance company. Each category will be assigned a co-payment amount. These are called tiers. A four tier plan is fairly common and usually looks like this:
   

Tier 1 – Generics – Lowest co-pay Tier 2 – Brands – Higher co-pay Tier 3 – Non-Preferred Brands – Even higher co-pay Tier 4 – Specialty Drugs – Highest co-pay or even percentage of cost.

You want to know which tier your medications are in. If you are using medications in the upper tiers, you may want to check with your doctor to see if you can switch to medications in the lower tiers. Get a copy of your insurance plan's formulary, and bring this with you to the doctor's
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office. This will give the doctor the ability to choose a medication from the lowest tier whenever possible. 2. What is the maximum day’s supply you can have for your co-pay?

This is very important. Some insurance companies will consider a month's supply to be 30 days and some say 31 days, while others say 34 days. If your doctor gives you 30 tabs with 11 refills and your co-pay is $10.00, you will pay $120.00 for a year (actually 360 days) of medication. However, if your insurance company allows you to get 34 days for the same $10.00 co-pay, after 8 fills of 34 you will have an extra 32 tablets. This is basically a free month's supply of medication. Do not miss out on this opportunity. If you are on several medications, this can really add up. For the plans that allow a 31 days supply, you will have an extra 12 doses at the end of 12 months, compared to purchasing 30 each time. If your insurance plan allows you to get a three month's supply, make sure you clarify this. This could mean 90 days, 91days or 93 days depending on the insurance company. Get the most doses your plan will allow for at each fill. 3. Does your insurance company give you a price break if you get a

three month supply of medication? Some plans will charge two and a half co-pays when you purchase a three month supply. For example: a one month supply of a generic is $10.00, but if you get three months worth, you pay only $25.00 ($10.00 for months one and two, and $5.00 for month three).

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4.

Is it cheaper to pay cash? If you are on a medication long term, it

may be cheaper to buy a year's supply and pay cash at the pharmacy than it is to use your insurance plan and pay the monthly co-pay for a year. Ask the pharmacy for the price before you fill it with your insurance plan. Let’s say your insurance co-pay for a generic medication is $10.00 for a month's supply. If you are taking atenolol 100 mg daily, then 30 (or 31 or 34 depending on your plan) tabs would be $10.00 ($120.00 per year). If you purchase 180 tabs at drugstore.com, it would cost about $24.00 ($48.00 per year). In this case, it is more cost effective to pay cash than to use your insurance. 5. Do you get a price break on your prescription if you use the

company’s designated pharmacy or a mail order pharmacy? Sometimes the company has a contract with a specific pharmacy. Some of the major insurers are: Aetna - www.aetna.com - 860-273-0123 Blue Cross Blue Shield - www.bcbs.com Cigna - www.cigna.com – 800-CIGNA24 (800-244-6334) Humana - www.humana.com – 800-4-HUMANA (800-448-6262) United HealthCare - www.uhc.com - 888-545-5205 Go to their websites or call to find out what you will pay for a specific medication. Some have online tools to help you to save money.

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Manufacturer Programs
Pharmaceutical Assistance Program
Many pharmaceutical manufacturers understand that not everyone can afford expensive medications. They have received lots of negative press due to high drug prices. Due in part to this fact and in part because of a genuine desire to help people, many of these manufacturers have established assistance programs for some of their medications. There are usually forms to fill out and specific requirements to meet, but it is worth looking into if paying for your medications has become a burden. Here is a list set up by the government. http://www.medicare.gov/pap/index.asp You can also call the individual manufacturers directly. Here is a list of phone numbers for most pharmaceutical manufacturers. http://www.drugs.com/manufacturers.html

Discount Coupons
Also known as discount cards, loyalty coupons or loyalty cards. Many brand name medications have these cards available to help lower the cost of the medications. These cards are often available at the doctor's office. If your doctor does not have a card for your medication, you can search for one on the internet. Start your search here http://www.PharmerDon.com/save/discount-cards

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Mail Order

Before you consider mail order, make sure you can tolerate the medication and the doctor wants you to be on it long term. It will cost you more if you are switched to a different drug soon after you purchase a large supply of your medication from a mail order pharmacy. Using a mail order pharmacy may help with cost savings in many ways. I generally am not an advocate of mail order, but from a strictly cost savings perspective, it is difficult to ignore the benefits. Mail order pharmacies fill a large number of prescriptions. As a result, they generally have a lot of buying power and can negotiate lower prices with the manufacturers. This cost savings is often passed on to the consumer. Mail order pharmacies often contract with insurance companies to provide cost savings. They also give an incentive to their customers to switch to mail order by offering reduced co-pays. For example: a one month supply of a generic is $10.00, but if you get 3 months through mail order, you pay only $25.00 ($10.00 for months one and two, and $5.00 for month three). This ability to purchase a three month's supply is often restricted to the mail order pharmacies and not available at the retail level. By using mail order, you not only save on the medications, but you also save on gas and time. You do not have to go to the pharmacy to pick up the medication. It is delivered to your door.
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If you do choose to go with mail order, be prepared to wait. Some of the mail order programs advertise that it could take up to 14 days to get your medications.1, 2 Because of the possible delay in receiving your medication in the mail, you want to initiate your refill early enough for the mail order pharmacy to process your request and get it to you before your supply runs out.

1. Blue shield of eastern New York web site. Accessed 2/21/09 2. Military Tricare website. Accessed 2/21/09

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Prescription Discount Cards

Believe it or not, you may already have access to a valuable prescription discount program. Many companies provide prescription discount cards as an added bonus to doing business with them. These discount cards are often free of charge and provided when you first sign up. Other times, you have to ask for your prescription discount cards. These cards are not insurance. What they are is a discount off the cash price of medication. They can not be used in combination with actual insurance and they cannot be used in combination with each other. If you do not have prescription insurance coverage, this can be a helpful and easy way to get a discount on your medications. A discount card can also be helpful even if you have insurance. Sometimes insurance will not pay for certain medications. When this happens, you can then use the discount card to save money instead of having to pay full price. These cards can save you time in addition to money. The reason they save time is because most pharmacies will honor the discount cards. The resulting discounted price will often be about the same or a little cheaper than the lowest price of a medication if you were to shop around for the best price. Companies who provide these discount cards include;

AARP - http://www.aarphealthcare.com/Products/RxDiscounts/

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AAA - http://www.aaacarolinas.com/Savings/Health/index

You can also sign up for a free discount card at http://www.PharmerDon.com There is no charge for this card, and it can be used at over 40 thousand pharmacies nationwide.

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Store Programs

Many retail chains have their own discount programs. These can sometimes change, so here are some that are currently in place.

Walmart
This is probably the most publicized program around. Walmart generated a huge buzz when it announced it was going to offer a month's supply of over 300 generic medications for only $4.00. Most of the medications on this list have been around for quite a while and are very inexpensive, but they are still beneficial. More recently, Walmart expanded the program to include a 90 days supply for only $10.00. Here is a link to the $4.00 generic list. www.walmart.com/pharmacy

Kmart
Similar to the Walmart $4.00 generics program, Kmart has $5.00 generics for a 30 days supply or $15.00 for a 90 days supply. The list differs slightly from Walmart's and requires enrollment. You can find their list at www.Kmart.com. In addition to this program, Kmart has a promotion offering the ability to purchase an over the counter medication for $1.00 with any prescription purchase. You must be over 60, and there is a small selection of products to choose from, but it is an added benefit.

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Target
Also similar to the Walmart $4.00 list, Target offers many generic medications for $4.00 for a 30 days supply, and you can get a 90 days supply for $10.00. Their list can be found at www.Target.com. In addition to this, Target offers what they call Pharmacy Rewards which will give you a 10% off shopping day when you have filled 10 prescriptions with your red card.

Walgreens Their program requires enrollment also. They have a list of over 400 medications you can get for $12.00 for a 90 days supply. Go to www.Walgreens.com to see their list.

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Import From Another Country

Before considering importing your medication form another country, you need to know it is illegal to do so. Even though it is illegal, the authorities tend to look the other way when importation is for personal use. The United States is one of the few countries where there are no price caps on medications. As a result, much of the world's new drug research is possible due to profits manufacturers make by marketing drugs in the United States. Because of the caps on medication prices in foreign countries, there are some great bargains to be had by shopping abroad. Unfortunately, there are many barriers to purchasing medications in foreign countries. Some of the problems are that there are medications whose names are different in other countries or the same name is a different chemical (drug) in another country. Another major problem with importing from other countries is the issue with counterfeit medications. There are many cases in which medications purchased from foreign pharmacies have turned out to be fake. If you are considering getting your medications abroad, then you should look at Canadian pharmacies. There seems to be fewer problems with Canadian pharmacies because they have been more closely watched both here and in Canada. Minnesota, New Hampshire, Washington and
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Wisconsin have programs to help employees and residents import medications from Canada. Before you use a foreign pharmacy, make sure you do your homework. Start your search at http://www.pharmacychecker.com/OnlinePharmacyRatings.asp. This site has a list of pharmacy ratings and profiles. They also have a lot of information about online pharmacies and the ability to do price comparisons. Here are a couple links www.CanadaDrugs.com, and www.CanDrugstore.com

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Save On Over the Counter Medications

Compelling marketing has led consumers to believe we need a vast array of over the counter medications in our medicine cabinet. In fact there are just a few hundred medications contained in the over 100 000 products marketed in the United States. Most of the medications are available in a generic product at a fraction of the price of medications heavily promoted. Many pharmacies will have store brand medications on the shelf right next to the more expensive brand name medication. These items will frequently sell at a discount to the brand name product. Read the labels of the medications you have at home. Many times the ingredients are the same or overlap with each other. For example, many people have Tylenol for headaches, Tylenol PM to help them sleep and Benadryl to treat allergies. If you read the ingredients in these products, you will find Tylenol contains acetaminofen, Benadryl contains diphenhydramine, and Tylenol PM contains acetaminophen and dyphenhydramine. Do you really need three bottles that contain only two medications? To further elaborate on this, you could purchase generic acetaminophen and generic diphenhydramine at a fraction of the brand name prices. You could actually pay less for both generics than the brand of one of the above items. Another little known fact is the cheapest product is not usually available
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on the shelf. You usually have to ask the pharmacist for it. Here is just one example. Chlor-Trimeton is a common allergy medication. It sells for about $6.00 for 24 tablets. There is a bottle of 100 chlorpheniriamine (the active ingredient in Chlor-Trimeton) available if you ask the pharmacist that retails for under $3.00. This is just one of several examples. Another money saver is Walmart's new over the counter $4.00 program. They have made many over the counter medications available for $4.00 to compliment the $4.00 generic prescription program (page 16). Finally, talk to the pharmacist before you purchase over the counter medications. There is a lot of misuse and overuse of these medications. Use the pharmacist to help you choose the most cost effective medication for your situation. Don't forget to let them know which medications you already have at home. You might not need to purchase anything.

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Other Resources and Tips

First Time on a Medication
The first time you fill a prescription, purchase a small quantity of the medication such as a 1 to 2 weeks supply. You want to make sure the medication works and you can tolerate it before you purchase a large supply.

A Long Term Medication
If you are on a medication long term, you may want to by in bulk. A three month's supply often costs less than three 1 month's supplies.

Tablet Splitting
Sometimes tablet splitting is an option. Check with your pharmacist or doctor if the medication you take can be cut in half. Many drugs are extended release, meaning the medication is released out of the pill slowly over time. These usually cannot be split or cut, but there are many drugs which are perfectly safe to cut. In this case, ask the doctor for the higher strength tablet, and take a half tablet. Here is a good example, Zoloft 100 mg tablets are scored and are easily cut in half. If you are on 50mg daily of Zoloft, the doctor could order Zoloft 100 tablets with the instructions to take one-half tablet daily. Here is a list of medications that definitely should not be split or crushed. http://www.ismp.org/Tools/DoNotCrush.pdf
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Comparison Shop
Prescription drug prices can vary substantially from one pharmacy to another. If your medication costs are troublesome, call around to several pharmacies to get prices on the medications you use. You may save a substantial amount by taking a few minutes to do this. When you do call around, make sure you call several of the local independents. The large chains have developed the illusion of being inexpensive. The real values and bargains will often be found at the independent pharmacy. For a pharmacy price comparison tool visit pharmerdon.com/save/pharmacy-price-comparison

www.pharmacychecker.com
This website will help you find the best price on medications, as well as give you pharmacy ratings and verify online pharmacies.

If You Have Medicare Part D
Use your drug card for every prescription. Your drug plan card provides a discount on your medications, even through the coverage gap (donut hole). Using the card ensures you get the lowest price on medications at all times. Some people pay cash for inexpensive medications to try to avoid the coverage gap. This technique costs more in the long run. Here is how it works. Drug A costs $5.00 with the card but $15.00 without. The difference is $10.00. However, the insurance plan may

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have paid the pharmacy only $2.00 for their portion of this medication. The extra $10.00 paid only saves $2.00 towards the prescription benefit, not $10.00 like you would expect. The bottom line here is, use your Medicare Part D prescription card every single time to make your money go further. When it comes time to sign up for a new Medicare part D plan make sure you compare all available options. Start your search at www.pharmerdon.com/save/medicare-plan-comparison

Together RX Access
This is a prescription savings card put together by a group of drug manufacturers to help people save money on more than 300 prescription drugs. Cardholders can save 25% to 40 % on brand name drugs. There are savings available on generics also. 1-800-444-4106 http://www.togetherrxaccess.com

Partnership for Prescription Assistance
This is a great resource for people with limited income. The organization will match patients who qualify with a prescription assistance program. Those who qualify will get free or nearly free medications. https://www.pparx.org 1-800-4ppa-now (1-800-477-2669)

Social Security
If you have limited income and are on Medicare, you could be eligible for extra help paying for prescription drugs. Visit the Social Security website at www.socialsecurity.gov or call 800-772-1213.
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Military and ex-Military
If you are or were a member of the American Military you should look into Tricare. They provide a full range of health benefits to all branches of uniformed service. To see if you are eligible, go to www.tricare.mil or call 800-538-9552.

Generic Alternatives
This is a good source of information to find an alternative to a brand name only medication. It has been compiled by the state of Minnesota. If your doctor has given you a prescription for an expensive brand name drug, you can look here to see if there is an alternative that would have a generic and may be less expensive. http://www.state.mn.us/mn/externalDocs/
Rx/Generic_alternatives_list_PDF_061207031315_Generics.pdf

Another resource for this type of information is PharmerDon.com/save/lowercost-alternatives.

Consumer Reports Best Buy DrugsTM
This website is packed with information. Consumer Reports is dedicated to providing useful and unbiased information to the consumer. They have compiled a lot of information to help you find the most cost effective and safe therapy. www.crbestbuydrugs.org

Benefits Check Up
This is a service of the National Council on Aging. They help seniors with limited income and resources. They will help people find the right
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program for prescription drugs, health care, nutrition (including food stamps), energy, transportation, housing and much more. http://www.benefitscheckup.org/

Medicare's website
This site allows you to compare insurance plans available to you in your area. Here is a link to the Medicare Prescription Drug Plan Finder www.medicare.gov/MPDPF/Home.asp. You can also check if there is a patient assistance program provided by your medication's manufacturer by visiting the Pharmaceutical Assistance Program link www.medicare.gov/pap/index.asp. Medicare also maintains a list of states that will assist people to pay for medications. Here is the link to the State Pharmaceutical Assistance Program www.medicare.gov/spap.asp. All of this information is available from the Medicare website http://www.medicare.gov/ or call 1-800-MEDICARE (1-800-633-4227).

Price Comparison Websites
There are some websites that allow you to compare drug prices at local pharmacies and or find lower cost alternatives to the medications you are taking. Here are two sites to explore www.destinationrx.com and www.pillbot.com

Price Matching
Many retail pharmacies will match a competitor's price. This is
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frequently not advertised, but if you ask, you may get a lower price. In order to do this, you must have already checked around for the competition's prices. Once you have found the lowest price, you can check with your current pharmacy and see if they will match their price. Do not ask your pharmacy to call around for the lowest price. It is unlikely they will do more than call to verify the price you have found.

Gift Cards
Watch the local pharmacies' ads. They will often offer a gift card with a new or transferred prescription. This can range from $10.00 to $25.00. The pharmacy hopes to keep you as a customer after this promotion and is willing to lose money on your prescription in anticipation you will stay with them. This type of promotion has been decreasing in popularity with the pharmacies and is becoming less frequent. However, if you watch carefully, you can still come across these offers. Unfortunately these offers cannot be used if your medications are paid for with government funds including Medicare, Medicaid and Tricare.

Flexible Spending Accounts
This type of plan allows you to set aside a portion of your paycheck into a tax free account. The money can then be used to purchase qualified expenses (usually medical). If you are spending a lot on medical expenses and prescription medications, this could save you quite a bit because you are using money before payroll taxes are taken out.

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Internet Pharmacies
It is sometimes possible to save money buy using an internet pharmacy. You can often check the price of your medication right on their website and the prescription is delivered to your home saving you a trip to the local pharmacy. Be aware there are many rogue pharmacies on the internet. When selecting an internet pharmacy make sure you check that it is accredited by the National Association of Boards of Pharmacy and it carries the Verified Internet Pharmacy Practice Sites (VIPPS) seal.

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Conclusion

Many hours of work and research have gone into creating this book. I trust you will find the information here to be useful, and you now have all the tools you need to help you reduce your medication costs. Make sure to involve your doctor and pharmacist in all changes to your medications. They will usually help you with lower cost options if you just ask them. If you have found the information here to be beneficial, please provide feedback. We want to hear your success stories. Don't forget to get your free retail pharmacy prescription discount card at Pharmerdon.com.

Editing Services Provided by: Sally A. Buckner edenscaper@aol.com 757 286-5513

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Notes

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Notes

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