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Katrina H. Miller, PhD
In the United States, the cost of medication is higher than anywhere else in the world. Prices of medications that are patented (known as brand-name medications) are deliberately kept on the high side, in order to encourage “innovation”. While this is good news for pharmaceutical executives; is not so good news for average Americans who must often make the choice between buying medication or food. This seven-page report will provide you with the information you need to get your medications at the best possible price. Over a dozen strategies to get low cost or free medication are presented, as well as a real-life example of how these strategies were used to make medication affordable for a patient. Almost anyone reading this report will find one or more ways to make the cost of medication more affordable.
Strategy 1: Increase Your Chances of Getting Effective Medication
1. The best drug purchase for you is a drug that is effective, affordable, and will not cause you more problems. A quick source of educating yourself about effective medication is found at www.consumerreports.org/health/best-buydrugs/index.htm. 2. For your safety, every doctor you see needs to know each medication and supplement you are taking. Put all the medications and supplements you are using in a brown bag and carry it with you to every doctor visit.
Strategy 2: Know How to Use Your Insurance
1. Know how to use your insurance company’s formulary. The formulary is the key to understanding how much your copayment will be. It is a list of medications that your insurance company will pay for, and how much the copayment will be. a. Some insurance companies arrange medications into steps (sometimes called “tiers”). The copayment varies according to the step.
Afford Medications Miller, Page 2 b. The formulary should accompany you to each doctor visit. Tell your doctor that you need to use medication on your formulary’s first tier as much as possible. c. If the medication your doctor prescribes is not on the first step of your formulary, it may be possible for your doctor to ask your insurance company for an “exception”, which would reduce your copayment to the next lower step. d. You can obtain a copy of your formulary from your insurance company’s website. Alternately, you can contact customer service (the phone number on the front of your insurance card) and ask for a copy of the formulary. 2. For medications you renew every month, it is more cost effective to use your insurance plan’s mail order pharmacy. Medications obtained through mail order cost about half of what medications cost in local pharmacies. The medication comes right to your door.
Strategy 3: Check Eligibility for Government Assistance
1. Even though you have private insurance coverage, you or other members of your family may be eligible for government assistance. The quickest and easiest way to find out what benefits can provide a safety net for you and your family, go to www.benefitscheck.org. You will find information regarding your eligibility for Federal and State programs and local and private programs that help pay for prescription drugs. Additionally, you will find information about assistance with utility bills, health care, meals, and other needs. 2. The American Association of Retired Persons (AARP) offers a four page brochure delineating the state and federal benefits available in your state. You can order the brochure from AARP or download and print it. To access this site, go to www.giclocalsupport.org/bop statefactsheets/statefactsheets.html or call AARP at 1-888-OUR-AARP.
Strategy 4: Purchase Your Medication at a Bargain Rate
Many superstores have prescription drug plans offering medications for bargain prices, often starting at $ 4.00 for a 30-day supply. To see if there is such deal near you, visit www.medtipster.com and enter your zip code and the name of the medication you want to buy.
To see a list of medications covered by some of these plans:
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a. Walmart: i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf
Costco: www.envisionrx.com/pdfs/CMPPDrugList.pdf Target: sites.target.com/site/en/spot/page.jsp?title=pharmacy_generic_drugs _alphabeticalhttp:// Discount drug cards that can be used in addition to your insurance coverage can be found at www.pparx.org/en/prescription_assistance_programs/discount_cards.
Strategy 5: Use Generics When Possible
1. Generics usually cost less money because more than one pharmaceutical company produces the medications. Generic medications usually slash between 50% and 80% off the brand-name price. 2. As a less expensive alternative, generics are more likely to be used as the basis of any cost saving medication plan, including your insurance’s formulary and superstore bargain plans. 3. Knowing the generic name of a medication can help you locate bargains at internet pharmacies (especially if the generic is not available in the United States but is available in Canada or some other safe overseas location). You can find the generic name of brand-name drugs at www.genericdrugfinder.com.
Strategy 6: Use a Legitimate Internet Pharmacy
1. If the medication you need does not yet have a generic, or is not discounted at the bargain rate, the next less expensive alternative is probably to check a legitimate internet pharmacy. Legitimate pharmacies have been reviewed and certified as having practices conducive to drug safety. a. The National Association of Boards of Pharmacy (NABP) sponsors the Verified Internet Pharmacy Practice Sites (VIPPS) program. To be VIPPS accredited, a pharmacy must comply with the safety requirements most consumers expect. To check if the internet pharmacy you wish to use is VIPPS accredited, you can enter the web site of that pharmacy on vipps.nabp.net/verify.asp.
Afford Medications Miller, Page 4 b. Consumer Reports, the American Association of Retired Persons, and Smart Money Magazine recommend the site pharmacychecker.com to identify legitimate internet pharmacies. Many of these sites are offshore. You will often find generic brands that are not yet marketed in the United States. Many of the sites listed are offshore or in Canada. Canada’s patent laws are not as generous to the pharmaceutical company as are the United States. Many medications that are only marketed “brand-name” in the United States are sold as generics in Canada. Any of the pharmacies listed on pharmacychecker.com have been verified for safety. Note: There are laws against consumers importing drugs from overseas. These laws are meant to protect the profits of the pharmaceutical industry rather than the consumer. The laws do not involve safety concern of drugs imported from Canada. The United States is currently not enforcing laws restricting imports of medications from Canada.
Strategy 7: Cut Higher-Dosage Pills in Half
1. To double your savings, ask the doctor if it is possible to order a pill with twice the milligrams and “cut” it. Both tablets and capsules can be cut. Do not cut extended release type of tablets or capsules. a. To cut tablets, break in half at the scored line. If there is no scored line, use a pill cutter. Tablets that break into fragments should not be cut. b. There are two ways to “cut” capsules. The easiest way is to empty the content of the entire capsule into a glass of juice and water. You then drink half the glass for the first dose, and the other half for the second dose. To get greater precision, you might empty the contents on a plate and shape the particles into a thin line. You could then divide the line in half. The unused half could be left on the plate until the next dosage, or you could put it in an unused gelatin capsule.
Strategy 8: Call “211” Information and Referral
1. You can dial “Information and Referral”, and United Way initiative, to find local programs available to help fund medication by dialing “211” from any phone with the area code of your locale. If you do not have a phone with your area code on it, you can find it by using your zip code at www.211.org.
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Strategy 9: Apply to a Patient Assistance Program
If you cannot afford copayments. It may be possible to get on a Patient Assistance Program sponsored by a pharmaceutical company. The quickest way of coordinating with your physician, determining if you are eligible, and submitting your application to the pharmaceutical company is found at rx.hope.com.
Each drug company that you have a prescription from will need a separate form. If it is difficult for you to keep track of what medications need refilling and when, and also to handle paperwork such as appeals, there are two services available on line to help. Each of these services costs a small fee.
a. The Select Care Benefits Network (SCBN) Prescription Advocacy Program (phone 888- 331-1002; www.myrxadvocate.com. b. The RX Foundation (phone 888-793-6863; www.rxfoundation.com).
Strategy 10: Find a Disease-Based Assistance Programs
1. If you or a member of your family has a chronic illness, you may be eligible to have your pharmaceutical and other medical expenses subsidized. There are two portals where you can locate your condition and find a program that may assist you with out-of-pocket expenses. a. Www. needymeds.org has a link for disease-based patient assistant programs. b. Www.panfoundation.org has specific diseases and specific medications that they will pay for.
Strategy 11: Use Drug Coupons
Drug coupons are like vouchers enabling you to get a prescription free or at a discounted rate. There are many coupons available for prescription and nonprescription medication available on two portals: 1. Www. needymeds.org has a link to “drug coupons”.
2. Www.medtipster.com is a search engine that identifies if there is a superstore discount plan in your locale and if a coupon is available for the drug you need.
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Strategy 12: Apply for a Grant
1. Healthwell is a charity that offers help paying for copayments, deductibles, and even premiums. To find out if you are eligible, check out their site at healthwellfoundation.org/what-we-do.html.
Strategy 13: Try this Copayment Waived Pharmacy
1. Managed Rx Plans, Inc. is a pharmacy that accepts the payment your insurance company pays for your medication as full payment towards your prescription, as long as your insurance company pays at least 70% of the cost of your medication. Shipping is free. Their site is found at managedrxplans.com. To find out if you are eligible for their program, call them at 1-800-799-8765.
Example of How Using These Sources Will Save You Money
A 60-year-old woman returned to the hospital monthly with psychosis. She stated she could not afford the steep copayment for her medication, so she only took her medication while she was in the hospital. For example, her monthly copayment for Zyprexa, 10 mg, was $375. Her copayment for Celexa was $125. Her problems with memory were an additional barrier to adhering to a medication regimen, and when she was able to afford meds, she was unable to keep them coming to her home consistently. She had prescription coverage from a large national insurer. Her husband asked to help them find an affordable of getting the medication. I recognized that Zyprexa has a generic, olanzepine, which was not available in the United States in 2009 (but was available in Canada). To get a basis of comparison, I wanted to know how much her insurance company payment was to her pharmacy for Zyprexa. I called her pharmacy benefits manager and was told that while she paid $375 for her Zyprexa copayment, the insurance company paid about $1300. At pharmacychecker.com, I found that she could purchase a 100 day supply of olanzapine 20 mgs for $56.00. Additionally, there would be a $5.00 shipping fee, to make the final damages $61.00. Zyprexa would come in tablet form, easily cut to the 10 mg my patient uses. The supply then would last 6 months, averaging the monthly amount to about $10.00. Zyprexa, on insurance company dollars, cost
Afford Medications Miller, Page 7 around $1675 a month, $375 of which the patient needed to pay. On her own dollar, the patient could fund the entire amount for $10.00 a month by purchasing the generic and cutting the pill in half. I also recognized that Celexa has a generic equivalent that is available at most discount drug stores for around $4.00 for a thirty-day supply. I found citalopram in both 20 mg and 40 mg tablets available at Walmart for $10.00 for a three-month supply (i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf ). She needed 20 mg daily, and if she cut the 40 mg tablet, she would have a six month supply. Her monthly cost for citalopram would average $2.50. Monthly out-of-pocket expenditures for her prescriptions if she used her insurance: $500. Without insurance—using the generic versions, internet pharmacy, and pillcutting: $12.50. BUT WAIT—WE DID EVEN BETTER! In working with her insurance company, I learned that she paid $375 of a total $1675 monthly amount for Zyprexa. Her insurance did pay 70% or more of the cost of her medications. She would be eligible for Managed RX Plans (managedrxplans.com). I contacted them and got her enrolled on their program. Her monthly copayments with this pharmacy were $0.00. In addition to relieving her financial burden, they also sent her prescriptions automatically, so that she did not have to remember to call them to refill her prescription. This eliminated the problem caused by her difficulty with maintaining her prescriptions. After getting access to the medication she needed and automatic refills, she stopped getting psychotic and was able to function in her home and in her other relationships.
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