pharmacy mistakes, pharmacy checkout, pharmacists' attitudes, prior authorization

In one of the first scenes of the returning show, Roseanne, Roseanne is sitting at the kitchen table when her husband walks through the door, prescription bag in hand. “Oooh! My favorite! Drugs!” Roseanne exclaims. Dan replies, “Funny story – our insurance doesn’t cover what it used to, so I got half the drugs at twice the price.” Roseanne asks Dan what they are going to do. His reply? “Well, tradesies!”

They proceed to sit down at the table together, and Dan tells his wife, “I’ll trade you 5 of my statins for 5 of your anti-inflammatories and I’ll sweeten the pot by throwing in a couple of blood pressures.”

Although this scene was a humorous part of a show that is touted for addressing real world social issues, the issue of affording prescription drugs is all too real for many people.

Have You Had to Scrimp on Medicine?

A study published in January 2015 (https://www.cdc.gov/nchs/data/databriefs/db184.htm) showed that to save money, almost 8% of U.S. adults did not take their medication as prescribed, 15.1% asked a doctor for a lower-cost medication, 1.6% purchased prescription drugs from another country, and 4.2% used alternative therapies. The link above also shows interesting statistics on how people are skipping/delaying doses and taking less medication. Patients who were uninsured, compared to patients with insurance, struggled the most.

What can we do to save money on drugs? We don’t have to share our pills like Roseanne and Dan. (Not only because of money, but because sharing medications can be downright dangerous.)

Check Your Insurance Plan Before You Get to the Pharmacy Checkout:

If you have prescription insurance, be sure to read all the details of your coverage. Obtain a copy of your formulary by going on the website and printing one or by calling member services (the phone number should be on the back of your card) and ask them to mail you a formulary. Bring a copy of your formulary to all of your doctors (i.e. internal medicine or family physician and specialists).

Insurances vary greatly, so you really want to understand how your insurance works. Some insurances charge a copay for every prescription. For example, a generic drug may cost $10, while a brand drug may cost $25 (preferred) or $50 (non-preferred), depending on the tier the brand drug is placed in. Some drugs may not even be covered at all (excluded) or need a prior authorization (Doctor’s office must explain to the insurance company to provide information as to why the drug is needed) before the insurance will cover the drug.

Dealing with Deductibles:

Deductibles are becoming more and more common – you pay the full cost of prescriptions and medical services until you reach your limit.

Here is an example – I recently had a corneal abrasion. I have a high deductible plan. Since it was early in the year, I knew any prescription (as well as the doctor visit) would be full price.

(Insider tip – doctors very often do not know drug costs and whether drugs come in generic forms.)

The ophthalmologist prescribed a generic antibiotic eyedrop and said she wanted to give me another medication for the inflammation. When I asked which one, she had chosen to prescribe Prolensa. Offhand, from working in a pharmacy, I knew that medication (available in brand only) was a fortune and with my deductible, my out-of-pocket cost would easily be over $200. I asked for a generic alternative, and my cost was only about $30.

Most patients do not know drug costs offhand, which is why it’s great to have a formulary on hand to show your doctors. That way you don’t end up with a nasty surprise at the pharmacy checkout.

If you have a high deductible, it does help to ask for generics AND in certain cases you can even ask the doctor to write two prescriptions, one for the drug they want to prescribe, and a second one for an alternative if the first medication is not covered or is too expensive. Most of the time, doctors don’t mind doing this, especially since it may very well save a phone call later on.

Check for Coupons:

Another great tip is to check the manufacturer website for savings coupons – many manufacturers offer them, but you have to read the fine print to see if you can use it in conjunction with your insurance.

There are also prescription savings cards out there – some chains take them, many independents do not.

No Insurance? Don’t Despair!

What if you do not have insurance, and pay for everything out of pocket?

There are still many ways you can save money on your prescriptions.

You’ve Got to Shop Around:

Shop around for prices–with a caveat that it’s best to have all your prescriptions in one place. The reason? It’s easier (and safer for you!) for the pharmacist to check for drug interactions when all your medications are in one place. Chances are, if you find a pharmacy with great prices on one medication, they will be reasonably priced overall.

Many independents (aka mom and pop stores) often have lower prices on medications, especially generics, as well as exceptional personalized service, shorter wait times, often free delivery, and many other special services not found elsewhere.

Independent pharmacies often join buying groups and purchase drugs at low prices, and consequently they pass the savings on to their patients at the pharmacy checkout.

Not only can you get great prices on medications in general, but often the pharmacist can recommend (with approval from your doctor) a switch to an alternate medication that works just as well and is much less expensive.

Talk with Your Doctor:

Speaking of doctors, it is always good to let the doctor know of your situation when it comes to medications. A doctor would rather take some time to help you find an affordable therapy than to have you not take your medication because it was too costly. Example – Edarbi (azilsartan) is a blood pressure medication that currently comes in brand only. If you have great insurance, it may not matter, but those without insurance may be better off consulting with their doctor about taking a generic alternative in the same category of medication, such as losartan or valsartan. You just have to communicate with the doctor, as many doctors do not automatically think of these issues but are glad to work with you and the pharmacy to help get you on a more affordable regimen. A more affordable regimen leads to better adherence, which reduces the chance of a serious medical episode.

In fact, today we called a doctor for a patient who was prescribed generic Nexium (esomeprazole), and with the doctor’s approval, the patient was able to switch to generic Prilosec (omeprazole) and save a lot of money.

Ask the Pharmacist about Savings Programs:

Many pharmacies, such as Butt Drugs (it is not a joke, but watch this funny video commercial https://www.youtube.com/watch?v=oYYdF0zcuSI) have special programs,  where many generic drugs are offered at $20 for a four month supply. There are many pharmacies with programs like this; it just takes a little research to find a pharmacy in your area.

Check Facebook:

Another tip? Ask in your town’s Facebook group. There are always knowledgeable local folks that are more than happy to give others advice on saving money in your hometown. Everyone’s experience will differ, and what you read on the Internet is not always accurate, but fellow patients in your town can often point you in the right direction to a local pharmacy where you can speak directly with the pharmacist and discuss prices.

Your Pharmacist Can Help:

Don’t forget to ask for the pharmacist anytime – we are knowledgeable about all things drug-related and can often help patients save a great deal of money.

I hope some of these tips help you spend less at the pharmacy, so that you can take your medication as prescribed without playing “tradesies” or breaking the bank.

Karen Berger, PharmD, RPh, graduated from the University of Pittsburgh School of Pharmacy in 2001. She has worked in community pharmacies for 17 years, first, as a pharmacist/pharmacy manager for a large chain, and currently, as a pharmacist at an independent pharmacy in Northern New Jersey. Karen is excited to join The People’s Pharmacy as a contributing writer. She can be reached at karenmichelleberger@gmail.com

Karen Berger, PharmD, RPh

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  1. Mark
    Florida
    Reply

    Is it not illegal to charge a customer an Insurance price higher than the cash price?

  2. Patsy
    Reply

    Thank you for the response. Not having prescription coverage, I have tried to do a lot of homework, mostly about alternate methods and have read a good book written by a doctor who strongly recommends healing and preventive measures thru proper food choices, lifestyle, etc. Many friends are also fed up with overloads of prescription given. Six friends have read the book and are already making progress. Unfortunately, it’s an older publication so I have a long waiting list to get it back, ha! My problem now is how to deal with sleep apnia after almost suffocating with the latest mask. No refunds given when returned from provider. Have a good day.

  3. Patsy
    wi
    Reply

    I reently called to have a blood pressure pill filled, and when I came to pick it up questioned why it went from $28 to $128 and was told “price increase.” I was in a hurry, and when I got home looked in the bag, and it was for a prescription that my doctor cancelled and not my usual bp. I went back to the pharmacy and found out that they not only filled the wrong prescription for me but used a discount card that wasn’t the one I use. Had they used the right one even that prescription would have been much much lower. The manager said I should have checked the bag before you left. But it was their fault. When I got my printout at yr end I found out that the last presciptions filled were on the wrong card.

    Who can you trust? The pharmacies say they don’t always charge what the discount cards list on the internet. The other problem was that a supplier charged my insurance $500 for a CPAP mask when the company charges $150. Why do we and our insurance companies have to keep getting ripped off?

  4. Gin
    Reply

    My husband through his retirement has a good insurance plan with drugs included however, when our plan was renegotiated our co pay went from $5. To $10. Sounds reasonable? When he picked up his last 90 day generic maintenance Rx the copay was double to $30. Our daughter works in the pharmacy at Costco, when she checked the cash price (no insurance) 90 days would have cost him $13.65. Today i am filling 2 maintenance 90 name brand Rx, first with insurance copay $258. Cash price 119.75, second Rx for BP 90 days cash price $37.65. My advice ask both with copay and with cash. I would not have been the wiser without the daughter telling me. She also says in helping others they can check if there are manafacturer coupons available.

  5. Harry
    Kentucky
    Reply

    I have prescription coverage that I pay for every month. Recently I investigated GoodRX.com and found their coupons saved me more money than my prescription drug plan! They show you which pharmacies are the cheapest and have coupons you can print. There is no cost to use this website. I am not using my prescription plan insurance anymore because their coupons are cheaper! Just because one drug is cheaper at say Walgreen’s, does not mean they all are. I have prescriptions spread out over several pharmacies, depending on the price. None of them sell ALL drugs for the lowest price. They are not your friends. They are in it for profit so they have low price leader drugs and they have profit drugs. Buyer beware. Also many pharmacies have some drugs for free. You only have to ask which drugs they dispense are free.

  6. Mary
    Reply

    Last month when I went to see my physician to get my meds re-filled. He mentioned to me it was cheaper to order my meds by mail. I laughed at him. No, I said. I prefer to get my meds at the Pharmacy. I just do not trust getting my meds by mail. Before I retired 5 years ago, a number of my co-workers were not getting their meds by mail at all.

  7. Ken E.
    Massachusetts
    Reply

    Every time I go to a doctor, the staff pressure me to provide the name of a pharmacy so the doctor can order prescriptions “behind the scenes” without involving me. The staff is always shocked when I refuse saying I check the price every time. Depending on the drug and the pharmacy, the direct pay price can be less than the insurance co-pay. There’s considerable variation in price from pharmacy to pharmacy in my town. If everyone would ask the price and we could end the “list price game” on health care products and services, we could all save a huge amount of money.

  8. Tony
    Reply

    I only take one generic prescription drug for blood pressure..
    I went around and priced it at several of the pharmacy chains stores, and at several
    grocery store pharmacies. I was sure to ask who the manufacture was, so as to compare apples to apples, so to speak.

    Most all the prices that were quoted to me were in the $90-120 category for a 90 day supply. In frustration, I went to one of the leading Wholesale Membership Club pharmacies and was amazing surprised at the price they quoted me was only $25 ?????????
    I asked them straight out “How can you offer such a low price?” They told me that they only operate on a 3-4% profit margin.

    That not withstanding, I still think there is something wrong with the system.

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