Whether you need an antibiotic for your baby’s ear infection, an ointment to treat a rash or a medication to manage a mental health condition, you might be surprised at the cost when you fill a prescription.
By understanding your insurance coverage, knowing your options for prescriptions and doing a little bit of research, you may be able to lower the cost of your medication.
Jeff Millard, a pharmacist with Banner Health, helped us learn more about the strategies you can use to manage your prescription drug costs.
1. Understand your insurance
Different types of health insurance will cover prescription drugs in different ways. You may have:
- Employer-sponsored health insurance, which is where your employer provides your health insurance. It’s the most common type of health insurance.
- Individual health insurance, which is insurance that you purchase on your own.
- Medicare Part D, which is prescription drug coverage if you are enrolled in Medicare.
- Medicaid, which provides health insurance if your income is low.
- VA health care, which is insurance for veterans and their families.
You’ll want to know what kind of health insurance and prescription drug plan you have. When you know what drugs are covered, what your copays and deductibles are, and how your out-of-pocket costs are calculated, you can make better decisions about your prescription care.
Different drugs often are priced based on “tiers” in insurance plans. “Check your plan to see under which tier your medicine is listed. Your co-payment is based on this tier. Your health plan will also have a customer care line that can answer questions about medications,” Dr. Millard said.
2. Consider generic versions of medications
When a company creates a new drug, they get a patent, which means other companies can’t make versions of the same drug until the patent expires. When that happens, a generic version of the medication may hit the market.
According to the U.S. Food and Drug Administration (FDA), generic drugs must have the same active ingredient, dosage form, safety and strength as brand-name versions. “In most cases, generic medicines work just as well as branded drugs,” Dr. Millard said.
“You can ask your pharmacist if there’s a generic version of your drug. Generic drugs are often much less expensive than brand-name versions — up to 85% cheaper,” he said. That’s because generic manufacturers don’t have to invest in research and development.
“Most generic medications for chronic conditions like high blood pressure, diabetes and high cholesterol have $0 copays through health insurance,” he said. So switching to a generic statin, for example, could save you hundreds of dollars a year.
3. Comparison shop
Prescription drug prices can vary from pharmacy to pharmacy, so you can save a lot of money if you shop around. You can:
- Call pharmacies in your area to ask what they charge for your medications.
- Use online comparison tools like GoodRx, RxSaver and Blink Health to compare prices.
- Check with your insurance company to see if they have preferred pharmacies where you can get discounts on your prescriptions.
- Along with standalone retail pharmacies, check prices at warehouse stores like Costco and Sam's Club, big-box stores like Walmart and Target and grocery stores in your area.
4. Talk to your pharmacist
Your pharmacist knows a lot about prescription savings and can help you find cost-effective options. Your pharmacist may:
- Recommend generic alternatives for your brand-name prescriptions.
- Suggest lower-cost brands of the same medication.
- Recommend over-the-counter (OTC) medications that may be just as effective as prescription medications and may cost less.
- Help you understand your prescription drug coverage, including what drugs are covered, what your copays and deductibles are and how your out-of-pocket costs are calculated.
- Help you find prescription assistance programs (learn more below).
You should share a list of all of your medications with your pharmacist and be honest about your ability to pay. Be sure to ask any questions you have about your medications or your coverage.
5. Look into mail-order pharmacies
Mail-order pharmacies often have lower costs than retail pharmacies and they usually have a lot of different types of medication available. Plus they are convenient, since your medication comes right to your home. And they can refill your prescriptions automatically, so you don’t have to worry about remembering your refills.
“Some health insurance plans offer lower prices on certain medications if you use the plan’s mail-order pharmacy,” Dr. Millard said. You may also want to check an online pharmacy like HealthWarehouse.com.
Before you sign up for a mail-order pharmacy, compare prices with a website like GoodRx or RxSaver to make sure you’re getting the best deal. When you join:
- Sign up for automatic refills so you never run out of medication. You may be able to request a 30-day supply or a 90-day supply.
- Plan ahead. If you take multiple medications, order all of your refills at once (if possible) to save time and money on shipping.
- Use a single mail-order pharmacy so it’s easier to manage your prescriptions and keep track of your refills.
- Keep your contact information up to date so the pharmacy can reach you if there is a problem with your order.
6. Take your medication as directed
When you’re trying to save money on your prescriptions, you probably focus on the amount you’re paying. But the way you take your medication can also affect your costs.
If you don’t take the right dose at the right time or stop taking medication sooner than you should, your costs could go up. That’s because your symptoms could get worse, you could develop complications and you could even need to be hospitalized.
To take your medication properly, it can help to:
- Set reminders on your phone or alarm clock so you remember to take them.
- Take your medications with food or drink unless you’re instructed not to. This can help reduce side effects and make it easier to remember to take them.
- Keep your medications someplace where you will see them every day, such as on your nightstand or in your kitchen.
- Talk to your doctor or pharmacist if you are having trouble taking your medications as prescribed. They can help you find solutions.
7. Don’t overlook coupons and discounts
Coupons and discount programs are available for a lot of brand-name and generic medications, and they work at most pharmacies. To find coupons or discounts, check with drug companies or your insurance company. Look for information on their websites or call their customer service lines.
If you have a coupon or discount, give it to your pharmacist when you fill your prescription. You might be able to use more than one coupon or discount for the same prescription. Keep track of the expiration dates so you use them in time.
8. See if you qualify for prescription assistance programs
If you meet income requirements, you might be able to get help paying for prescriptions for yourself and your family.
Government programs include:
- Medicare Part D Extra Help, which can help pay for your monthly Part D premiums, copays and deductibles.
- Medicaid, which covers a wide range of health care services, including prescription drugs.
- Veterans Affairs (VA) Prescription Drug Program, which provides prescription drug coverage to veterans and their families.
- State pharmaceutical assistance programs (SPAPs), which are state-run programs that help people who cannot afford their prescription drugs. Each state has its own SPAP with its own eligibility requirements and benefits. To see what’s offered in your state, search online for “State Pharmaceutical Assistance Programs” and the name of your state.
There are also nonprofit prescription assistance programs. These programs include:
- NeedyMeds connects people who need help paying for medication with prescription drug assistance programs and other resources.
- RxAssist offers information on prescription drug assistance programs and other resources to people who have trouble paying for their medications.
To be eligible for most programs, you need to have low income and limited resources. Some programs also have restrictions based on your age or medical conditions.
To apply, you’ll usually need to share your income, assets, medical expenses and prescription drug coverage.
9. Talk to your provider about your cost concerns
Health care providers understand that it can be a struggle for people to meet the high costs of medications and they can help.
Your provider can work with you to help you save money on prescriptions. They may be able to prescribe generics or less-expensive alternatives, share coupons or discount cards or connect you with patient assistance programs.
The bottom line
Paying for prescription drugs can take a big bite out of your health care budget, but you have options that can help you save money. Comparison shopping, choosing generic drugs, buying your medication through mail-order pharmacies and checking for aid programs can make your medication more affordable.
To learn how to get the best prices on the medications you need to stay healthy, talk to your provider or a Banner Health expert. They can help you review your options and make the best choices.
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- 5 Medication Safety Tips All Parents Should Know
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