Even if you have great health insurance you may not be protected from high drug prices. For one thing, there is the deadly co-pay problem. For another, insurance companies may not be willing to pay for the latest and greatest medicine your doctor has prescribed. If it’s not on the formulary, you may have to accept a different (cheaper) medicine. California has attempted to control drug prices by passing Senate Bill 17 (SB17). Now PhRMA is fighting back!
The California Revolt:
Most people grumble about the high costs of medicine. Legislators in California actually did something about them. Although the law won’t take effect until January 1, 2019, the lobbying group for the pharmaceutical industry is fighting back with a lawsuit. What’s got drug companies so excited?
Drug pricing is super secret. Companies have all sorts of ways of obscuring costs. Rebates and discounts are classic ways the industry has made it hard to track actual pricing.
California has tried to cut through the cotton curtain surrounding drug pricing policies. SB 17 forces drug manufacturers to inform the government and insurance companies 60 days before they raise prices over 16 percent. That’s not 16 percent in one year, but spread over two years. The companies would have to explain the reasons for the price hike.
Drug Companies Sue:
That may not sound radical to you, but the pharmaceutical industry is not at all happy about this bill. The trade group, PhRMA, has filed a lawsuit to prevent its implementation.
PhRMA has also sued the state of Nevada. In June, Nevada lawmakers enacted a bill that requires the makers of diabetes medications to disclose profits if they raise list prices too steeply.
The outcome of this litigation is unclear. We suspect that the deep pockets of the pharmaceutical industry are likely to slow down any state attempts to control drug prices. What can you do in the meantime?
How You Can Control Drug Prices:
We have been writing about out-of-control drug prices for decades. We used to think that generic drugs were the answer but there’s a problem, Houston:
1. Some generic drug prices have skyrocketed
2. We have come to doubt the FDA’s ability to approve and monitor generic drugs in a safe manner. You can read about our concerns in this regard at these links:
What can you personally do to control drug prices? In our Guide to Saving Money on Medicine we offer lots of detailed suggestions. Here is is just a sample:
10 TIPS FOR SAVING MONEY ON MEDICINE
1. Whenever you can, make changes to your lifestyle that may help reduce the number of prescription drugs you need to take. Exercise, weight loss, real food and relaxation techniques are all very effective for helping to reduce blood pressure, cholesterol, anxiety, depression, and insomnia.
2. Consider non-drug alternatives such as home remedies and dietary supplements. You may find that vinegar and Listerine soaks or topical Vicks VapoRub are as good for fighting toenail fungus as prescription Jublia, with the added virtue of being much cheaper. Coconut water, almonds, chewing gum, fennel, yellow mustard or DGL (deglycyrrhizinated licorice) may ease heartburn without the cost or side effects of PPI drugs.
3. Talk to your doctor and pharmacist about over-the-counter drugs, which are often far less expensive than prescription medications, and frequently equally as effective. For example, there are now many effective OTC allergy medicines available.
4. Discuss your cost concerns with your doctor, and ask her to consider prescribing the most cost-effective medication for your condition. There may be several options available to you. Also talk to your doctor and pharmacist about whether or not it is safe for you to split your pills. Sometimes the difference in price between 5-milligram, 10-milligram, and 20-milligram tablets is negligible, and simply buying larger doses and splitting them at home can help save money. But not all pills can be split safely.
5. Find out if you qualify for free medicine. The pharmaceutical industry has a program for helping those in serious financial need get their prescription medications. To see if you’re eligible, visit www.helpingpatients.org or call 888-477-2669.
6. Shop around! Prices vary between pharmacies and online services. Secret shoppers for Consumer Reports surveyed over 200 pharmacies around the country. What they found was shocking: “In short, prices can vary widely from retailer to retailer, even within the same ZIP code. Drugs could cost as much as 10 times more at one retailer vs. another.”
7. Haggle! Americans negotiate the price of a new or used car. What they don’t realize is that it is also possible to negotiate with a pharmacist about the price of medicine. Consumer Reports suggests asking, “Is this your lowest price?” This is especially true if you pay out of pocket. Do not rule out independent pharmacies. They may beat the chains and are more likely to negotiate.
8. If your insurance company requires that you take a generic drug, ask your pharmacist to seek out the authorized generic, which should be identical to the brand name. It may even be made on the same production line. Though it might be a bit pricier than other generics, it will be far less than the brand name. Authorized generics are especially important if your medicine has a narrow therapeutic index (see page 11). When taking a generic drug always monitor your reactions (both lab records and subjective responses).
9. Control your quantity. See if you can try a free sample when you start a new drug to make sure that you can tolerate it and that it works for you. If you can’t get a sample, ask your pharmacist to dispense a trial dose. If you decide to go ahead with the prescription, you might save money by buying in bulk from big-box pharmacies like Costco. Consumer Reports found that Costco offered great prices and you don’t have to be a member to buy Rx drugs there. During the open enrollment time period of your insurance plan make sure your medications are covered. Plans change drug coverage from year to year.
10. Shop online. Consumer Reports suggests GoodRx.com to “learn a drug’s ‘fair price.’” Visit PharmacyChecker.com and CIPA.com to find verified Canadian pharmacies (see page 16 of this guide). This may be especially important if you need to take a brand name medicine that is prohibitively expensive in the U.S. and is a narrow therapeutic index drug.
To get much more information about how to control your personal drug costs, check out our Guide to Saving Money on Medicine. You will learn about authorized generics and much more information about Canadian pharmacies. Here is a link to the Guide.