Life with Chronic Disease: How to Avoid Prescription Sticker Shock

Recently,  a friend who has spent her career in a health related field, posted the following to her Facebook page, "Prescription drug 90 day supply same drug : Aetna Medicare Part D Mail order preferred Plan $140, Wegman’s Pharmacy $48, Used Good Rx coupon on my phone at Wegman’s and paid $15.27."  As it turned out, there was more to this post.  This was a new script that the doctor electronically submitted to my Medicare Part D Preferred Mail Order Pharmacy so I did pay $140 for the first 90 day supply, sticker shock, so I went shopping.

My friend’s experience is all too common and many are finding prescription plans aren't actually saving them money. Medicare is supposed to make your prescription drugs affordable. But, as many are learning that’s not the case due to the infamous "donut hole" and the fact that some drugs aren’t covered.

Regardless of your age, condition or insurance status, paying for prescription medications can be a real challenge.

How to Prevent Rx Sticker Shock

When your medical provider says you need a prescription, ask the following questions:

• What is the name of the medication and what is it being prescribed for?

• What happens if I don’t take it?

• Are there side effects?

• Is there a comparable generic?

• Can lifestyle changes be implemented in place of the medication?

• How much does the drug cost?

• Are there similar medications but less costly?

• Does your provider offer samples and/or drug coupons?

Note that some of these questions you may need to discuss with your pharmacist.

If this is a drug you know you’ll need to take, review your insurance plan. Plans differ so it’s important to know how much they’ll pay for the medication, recognizing certain medications may not be covered. Have this information with you when you go for medical appointments in order to help them select the best medication that is affordable to you.

Check for manufacturer coupons: Brand name drugs will often have websites where discounts are offered. Note that there may be a time or refill limit for these programs. Also be sure to read the fine print, as some types of coverage such as Medicare, Medicaid, Tricare, or other federal or state government-funded programs will not allow use of coupons.

Comparison shop: Prices for prescriptions can vary significantly from one pharmacy to another. In addition, while a pharmacy may be the cheapest for one medication, it may be considerably higher for another. If you are using different pharmacies, in order to get the best prices for your meds, please inform all pharmacists of the medications you may be taking. Use the GoodRx comparison shopping feature.

Utilize Patient Assistance Programs

• Medicine Assistance Tool: PhRMA’s Medicine Assistance Tool (MAT) is a search engine designed to help patients, caregivers and health care providers learn more about the resources available through the various biopharmaceutical industry programs. MAT is not its own patient assistance program, but rather a search engine for many of the patient assistance resources that the biopharmaceutical industry offers.

• Rx Assist: Patient assistance programs are run by pharmaceutical companies to provide free medications to people who cannot afford to buy their medicine. RxAssist offers a comprehensive database of these patient assistance programs, as well as practical tools, news, and articles so that health care professionals and patients can find the information they need. All in one place.

• GoodRx:  Compare prices for every FDA approved drug at over 70,000 US pharmacies, including the pharmacy nearest to you.. Print free coupons or send them to e-mail or text message. Show them to your pharmacy and save. You can download their app to your phone or tablet and show it to your pharmacist. You can get the app for free at their website. You can also order a free discount card from the website.  GoodRx also has a program to help with pet medications.

• Community Cares Rx: Receive up to 20% off on brands and 70% off on generics with this card.

• Script Save WellRx

• RxOutreach:  For generic medications, RXOutreach.com is a respectable, non-profit, mail-order pharmacy that offers generic medications at a discounted rate to qualifying patients with a household income at or below 300 percent of the federal poverty level. You may qualify for their services, even if you already have a prescription drug plan (including the federal plans), and may find the medications are even less expensive than using your insurance.

• Check out store prescription plans: Many of the chain drug stores, pharmacies at grocery stores, and big box discount stores may offer savings on a select number of prescription medications through drug-savings programs that you can join for free or at a small cost.

• Local chapters of condition specific organizations (e.g. American Parkinson Disease Association), hospitals and health care centers will sometimes have coupons to distribute. Definitely inquire and be sure to visit the vendor displays at condition specific conferences you might attend.

If it’s a new medication, try a smaller quantity to make sure you aren’t allergic to it.

Talk to your pharmacist: Your pharmacist can often make suggestions for other options if you let them know you can’t afford a prescription. Often times there is more than one medication option to treat a condition. By working with both the pharmacist and your provider can help you find the most affordable option.