Posted tagged ‘pharmacy’

Preventing prescription pitfalls – How to save money and hassle at the pharmacy

September 17, 2018

The Pediatric Insider

© 2018 Roy Benaroch, MD

Doc writes prescription, pharmacist fills prescription, insurance covers prescription. Simple, right? But that’s not the way it works anymore.

Some changes are good. Gone are the cryptic abbreviations and illegible handwriting–replaced by computer printed scripts, or better yet scripts magically transmitted via the ether. But along with fewer errors there’s even less transparency on pricing and coverage. Patients, who haven’t been to pharmacy school and couldn’t possibly decode the pages of exclusions and conditions in their insurance contract, get hosed. And doctors and pharmacists get blamed.

Remember this, if nothing else: it’s all gamed by the payer. Insurance company tricks are there to prevent them from spending money on your health care, while making your doctor and pharmacist look bad. Inscos are often abetted by Pharmacy Benefit Managers (PBMs) – middlemen who skim even more health care dollars off the top, adding another layer of screwage.

But you can fight back. Here are some tips to help you get the medications you need, affordably.

Ask for generics (from your doc and pharmacist). There are often generics available, though these days they’re not always cheaper than the brands. Ask anyway. Remember that newer, brand-only drugs are not more likely to be better or safer. Go with an older, established medication if you can.

Don’t assume your “insurance price” is the best price. You might think your insurance-negotiated rate is better than what you can get without insurance. That’s not necessarily so. Those PBMs mark up everything, and often drive the price of very inexpensive drugs higher for those with insurance. Ask for the retail price to compare. And check out pricing sites, too.

Visit NeedyMeds.org for drug-discount programs and other information. This is a great non-profit, non-commercial site that pulls together just about all of the information you need to save money on prescriptions. There’s a price look-up, lists of industry- and private-sponsored assistance programs, and tons more.

Try out other “pricing sites” to help compare. Two simple ones that work well are Goodrx.com and WellRx.com. They don’t have the depth of info that NeedyMeds offers, but they’re simple to use to find prices in your area. You’ll enter the name of your medication and your zip code, and get back the price (to the penny) available at local chains. This assumes you don’t use your insurance – so keep in mind buying meds this way won’t count against your deductible.

Look into “90 day” supplies of medications. If you’re on a stable dose, your doc may be happy to write for 90 days instead of 30. That often saves $$. But you won’t be able to refill your next supply until that 90 days is almost up, so pay attention to the calendar. If your doc sends the prescription in too soon, the pharmacist will hold it until your insco deems it time for you to be able to refill it. Not doc’s fault, not pharmacist’s fault.

Don’t assume mail-order pharmacies are cheaper than filling locally. This happened to me – the Aetna mail order 90 day supply price was twice what it cost to fill the same medication for 90 days at my local pharmacy. Unexpected. But I’ll take the less-expensive, less-hassle option of a local pharmacy for sure.

Not-in-stock doesn’t mean never-in-stock. If your medication is out of stock at your favorite pharmacy, they can usually order it in just a few days – just ask them, if you’re not in a huge hurry to get the meds. If you are in a hurry, call around to different chains (not just different locations of the same chain, which probably use the same warehouse to resupply them shelves.)

Avoid “prior authorization” medications when possible. A prior auth is a nightmare, designed to prevent you from getting medicine while making it look like your doctor’s fault. “Just tell them to do a prior auth,” you’ll be told – but doing a prior auth typically takes a tremendous amount of time and frustration, and unless you’ve met the “secret criteria” it’s not going to work.

If you do need a prior auth, figure out the “secret rules” first. As with any game, you won’t win if you don’t know the rules. If your insurance insists on a prior authorization, call them and get them to tell you exactly what is needed to happen for the prior auth to be approved. Do you need to try one or more medications first? Which medications? What are the criteria that they use to make their determination of coverage? If you can find that out and tell your doctor, it will save everyone a lot of hassle – and you might just get your meds covered.

Consider OTCs over prescriptions. There’s a mystique to prescription medications, and that makes it seem like they’re more powerful or more-likely to work. That’s just not true. For conditions like allergies and acne, OTC meds or combinations of OTCs and prescriptions are often just as effective, safer, and cheaper than prescriptions.

The deck may seem stacked against you – the insurance company has the resources, and they make the rules. But you’ve got your doctors, nurses, and pharmacists on your side. Work together to get the meds you need at a price you can afford.

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How to save money on prescriptions

November 28, 2008

Costs of prescription medications are heading up. Health insurance pharmacy benefits—if you have any—are heading down. Copays and deducibles? Up. Extra income? Down. It’s a tough time for many families who need prescription medicines.

There are many good ways to minimize your prescription expenses. Feel free to add your own in the comments section, below!

Always ask if a generic is available! Older medications often have a generic version at a much lower cost, and generic products are perfectly fine. There are many docs and many people who believe that brand-name products are superior, but in almost all cases it’s just a matter of marketing and packaging. The drug companies want you to believe only the newest, fanciest, and most-expensive medicines are for you. Don’t believe it!

Buying generic is safer, too. Generic medicines have been on the market longer, and are much less likely to have some kind of surprise side effect that hasn’t been noticed yet. It is very rare that a new medicine has any real advantages over the older products.

If a pharmacist tells you that a prescribed medication is expensive, ask if there are similar therapeutic substitutions. These won’t be exactly the same, but will be very similar. You’ll want the pharmacist to be in touch with your doctor before switching a medicine, but often there are cheaper choices available on your formulary. Don’t assume that your doctor knows what medicines are in the lower tiers for your plan.

Ask for samples: but watch out. Samples will always be for the new, expensive medicines—so once the samples run out, you’ll want to switch to a generic. Samples might get you “hooked” on an expensive medicine that you’ll stay on for a while, which is exactly why the drug companies give samples to the doctors to distribute.

For long term medicines, you may be able to order a larger quantity through a mail-order service. Ask your insurance company if you have a mail-order pharmacy benefit. It’s a hassle, but it can save money.

Sometimes, a larger quantity can be prescribed for the same copay. This won’t work for pills taken every day—the pharmacist won’t give you > 30 days on the same copay—but for prescription skin creams or medicines taken “as needed”, your doctor could prescribe a larger amount at once.

Many drug manufacturers offer “patient assistance programs” to help low-income families afford medications. An excellent web site with clear instructions for finding and using these programs is www.needymeds.org. It’s a non-profit, and they don’t collect any personal information. Go there to look up by medication what sorts of programs might be available for your family.

Info in this post was adapted from the chapter “Choosing insurance and paying bills” in A Guide to Getting the Best Health Care for Your Child, by me. Makes a great holiday gift!