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HealthHints

Saving Money on Medication:
Where to look to start cutting costs

November 2008 – Vol. 12, No. 11

Editors: Janet M. Pollard, MPH; and Carol A. Rice, Ph.D., R.N.

“Over 40 million Americans have no health insurance, and millions more have limited coverage.”¹ “If you think your prescription drugs seem to cost you more each year, you are right.”²

“On average, prices charged by drug manufacturers to wholesalers for widely used brand name prescription drugs in 2003 increased three times the rate of inflation.”²
From the years 2000–2003, an average cumulative price increase of over 25 percent occurred.²
Some widely used brand name drugs even doubled in price from 2000–2003.²
From September 2003 to September 2004, manufacturers’ prices on brand name drugs most commonly used by older Americans were reported to have increased 7.4 percent on average.³

For a typical older American (who takes three drugs), these increases likely translate to large spending increases if these price increases are passed on to the consumer.² For families with multiple members who need medications periodically and for individuals who use medications for chronic conditions regularly, these costs add up as well. In fact, “many Americans just can’t afford health care, and, if they can, they don’t have the money to buy their medications.”¹

So, this leaves us with the question “what can we do to reduce the costs of our medications?” I wish I could tell you the answer was simple or that if you just followed a three-step process you would come to the perfect solution for your health-care spending. Unfortunately, this is not the case. Each person’s health needs are different. Because different people use different medications produced by different manufacturers, the answer may be different for each of you.

There are many avenues for saving health care dollars, but it will not be without some research on your part. Still, there are some simple things you can do in an effort to reduce your spending on medications. We hope this issue of HealthHints will make your search for ways to cut your drug prices a little easier by giving you a guide to many of the resources available to you. So, let’s begin our journey to find the answer that is right for you.

Information, Information,…Knowing about your medications

Information, information, information… Though we are seeking information to cut our costs, we won’t get very far in our journey if we don’t have our own information correct. The first thing to do is to make an accurate list of your medications—both prescription and over-the-counter. Here are some things to denote in your list:

Brand name (e.g., Tylenol),
Medical/technical name (e.g., acetaminophen),
Dosage (e.g., 500 mg),
Form (e.g., liquid, tablet, capsule; children’s or adult’s formula), and
Amount needed (e.g., 30-count bottle of pills or 150 count).

Also, be sure to include in your list any vitamins and herbal supplements you are taking since these can interact with any drugs your doctor might prescribe. You should be able to find all the necessary information on the package label. If you don’t have the information you need, call your doctor or pharmacist for more information.

Ask Your Doctor & Pharmacist: Communicate for cost savings

Once you have your list of medications, vitamins, and any other supplements, you are ready to take action. One of the first things you can do to cut drug costs is talk with your doctor. In fact, it can be helpful to tell the person scheduling your next doctor’s visit that you need time for a drug consultation, or schedule a consultation-only appointment to discuss your treatment and your medications. If you have more than one doctor prescribing medication to you, schedule the consultation with your primary care physician. Let your doctors know that cost is a concern. Before your appointment, get prepared.

Have your list of medications and supplements ready.
Start keeping a prescription drug record all of the time, adding new prescriptions and taking off old ones, as well as noting when dosages are changed. (Note: When a doctor is giving you a new prescription or changing dosages, let him/her know that cost is a concern at that time, in case there are less costly options.)
Write down the questions you want to ask the doctor, and take the list with you.⁴

Here are some questions that can help start the conversation with your doctor:

Are there medications available that work the same but cost less?
Is there more than one drug that can be used to treat my condition?
Are there generic drugs that will work the same as my brand name drugs? (Generic drugs often cost less and work as effectively.)
How do other prescription drugs compare in price? (Note: Sometimes the most expensive drug is not the most effective drug.)
If lower cost medications are available, how do they compare in safety and effectiveness?
Are free samples available?
Is there an older version of this drug that would be just as effective but is less expensive?
Is pill splitting an option? (See “Is Pill Splitting Safe & Cost Effective?” for more details.)
What is this medication? (Make sure you know what medication you are taking for what condition. Ask the doctor to write it down, or take notes so you can remember accurately. Having this information will allow you to consult with your pharmacist and other doctors in an easier manner. It can also help you in researching other ways to reduce drug prices.)^4,5

Your pharmacist is also a part of your health care team and a good source of information on prescription drugs and prices in your area. It can be helpful to discuss your medications with your pharmacist, especially if you are seeing more than one doctor. Here are some suggestions for talking with your pharmacist.

Make an annual appointment with your pharmacist, and take in all your medications (including over-the-counter and supplements) once a year for a review. Ask about prices.⁴
Ask if any new generic drugs have become available.⁴
Ask if any of your prescription drugs have become available over-the-counter.
Ask if there are any special manufacturer coupons that may save you money.
Ask if buying in larger quantities will save you money, such as buying a 90-day supply rather than a 30-day supply.
Be sure to compare prescription drug prices at several different pharmacies.

Is Pill Splitting Safe & Cost Effective?

Splitting pills in half can sometimes give you two pills for the price of one. That’s because many popular drugs are sold for about the same price regardless of the strength (e.g., a 20 mg pill may be sold for the same amount as a 40 mg pill in the same quantity bottle).^6,7

Pills are sometimes split because they are only available in higher strengths or because whole and half tablets must be combined for the exact dosage. So, to help patients save money, sometimes doctors can prescribe pills at twice the required dosage and instruct the patient to cut them in half, effectively cutting costs in half as well.⁷ (Note: Pill splitting never implies changing the dosage recommended by your doctor.) The following are some tips from the American Association for Retired Persons (AARP) on splitting pills safely and effectively:

Ask your doctor if any of your medications are candidates for splitting. Some medications are not meant to be cut or broken in half, such as time-release tablets or those formulated with special coatings that contribute to the absorption rate of the medication. Pills that aren’t scored or notched can produce fragmented or crumbled pieces, which can result in altered dosages when attempting to split. Some medications are simply not available in dosages that would allow for splitting.
If your doctor says your medication is a candidate for splitting, shop around for the best price at double the dose. Keep in mind, in some cases pill splitting will not produce any cost savings.
Check with your health insurer or pharmacy assistance program to make sure changing your prescription for this purpose is permitted.
Buy a good quality plastic pill splitter. They are available for about $3–6. Even if you have a notched pill and sharp knife, a pill splitter is worth the investment to ensure that you get the right dose. If you ask, your pharmacist may split your pills for you.
When you get your prescription, split the pills right away to make sure you don’t accidentally take the wrong dose.^6,7

Medicare Assistance: The prescription drug benefit

Medicare is the federally funded health insurance program for those over age 65 and certain disabled individuals. As a part of a major restructuring of the Medicare system, Medicare began offering widespread coverage for medications to beneficiaries beginning January 1, 2006. To help you make an informed decision about whether or not new Medicare services will be able to help you to better afford your prescription drugs see our handout, “Medicare Part D: The Prescription Drug Benefit.” (PDF)

Fraud Alert: Tips for avoiding prescription drug scams

Unfortunately, as you continue your journey to find low-cost medications, you must also be on the lookout for fraud. You should beware of anyone calling you soliciting medications or personal information. When purchasing on-line, you must also take special precautions to avoid scams and potential health risks. The following are tips and warnings provided by the U.S. Federal Drug Administration (FDA) regarding buying medication and medical products on-line:¹⁵

Check with the National Association of Boards of Pharmacy ([847] 698-6227) to determine whether a website is a licensed pharmacy in good standing.
Don’t buy from websites that offer to prescribe a prescription drug for the first time without a physical exam, sell a prescription drug without a prescription, or sell drugs not approved by FDA.
Don’t do business with websites that have no access to a registered pharmacist to answer questions.
Avoid websites that do not identify with whom you are dealing and do not provide a U.S. address and phone number to contact if there’s a problem.
Look for easy-to-find and understand privacy and security policies. Don’t provide any personally identifiable information (Social Security number, credit card number, or health history) unless you are confident that the site will protect them. Make sure the site does not share your information with others without your permission.
FDA recommends you don’t purchase from foreign websites at this time because, generally, it will be illegal to import the drugs bought from these sites, the risks are greater, and there is very little the U.S. government can do if you get ripped off.
Beware of websites that advertise a “new cure” for a serious disorder or a quick cure-all for a wide range of ailments.
Be careful of websites that use impressive-sounding terminology to disguise a lack of good science or those that claim the government, the medical profession, or research scientists have conspired to suppress a product.
Steer clear of websites that include undocumented case histories claiming “amazing” results.
Talk to your health-care professional before using any medications for the first time.

Consumers who suspect that a website is illegal can report it to FDA at 1-888-INFO-FDA (1-888-463-6332). Remember, fraudulent companies can put you at potential risk. Be aware of the following dangers when dealing with on-line purchases:

Purchasing a medication from an illegal website puts you at risk. You may receive a contaminated or counterfeit product, the wrong product, an incorrect dose, or no product at all.
Taking an unsafe or inappropriate medication puts you at risk for dangerous drug interactions and other serious health consequences.
Getting a prescription drug by filling out a questionnaire, without seeing a doctor, poses serious health risks. A questionnaire does not provide sufficient information for a health-care professional to determine if that drug is for you or safe to use, if another treatment is more appropriate, or if you have an underlying medical condition where using that drug may be harmful. The American Medical Association has determined that this practice is generally substandard medical care. FDA agrees.¹⁵

See the FDA’s “Buying Prescription Medicines Online: Consumer Safety Guide” online fact sheet for more information.

In addition to avoiding fraudulent scams on-line, you must also be aware of fraudulent practices that come right to your door or phone, particularly those regarding Medicare and drug discount card scams. Medicare beneficiaries with drug discount cards are fast becoming a target of con-artists. According to the Texas Department of Aging and Disability Services, “those behind the scams offer to enroll people [in Medicare-Approved Drug Discount Cards] in exchange for their bank information, Social Security number, or credit card number. In some cases, callers seem to already have obtained personal information and use that to try to collect additional information.”¹⁶

The Texas Department of Aging and Disability Services offers the following tips for avoiding fraudulent scams:

Be on guard against phone or personal solicitations. Medicare contacts people only by mail. Medicare will never phone or knock on a person’s door to enroll them in a program.
Do NOT give out personal or financial information to people you don’t know.
Medicare-Approved Drug Discount Cards will carry a Medicare-Approved Seal.
If you suspect fraudulent practices, call the Medicare Fraud Hotline at 1-800-447- 8477.¹⁶

Resource Extra

See U.S. Pharmacopeia’s fact sheet,“…A Dozen Questions to Help You Understand Your Medicines,” (PDF) for more information.

Resource Guide: Finding your way to the right information

The next step in our journey to reduce drug costs will require your input into the research. The Resource Guide handout (PDF) can help you find your way amidst the different options available. These options will usually require an application, information about your specific medications, and/or financial and health status information. Note: Be wary of anyone who solicits this information from you. Rather, initiate the research and make the appropriate contacts yourself. See the section on “Fraud Alert” for more information.

This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.

References:

Sagall, R.J. (2004). Pharmaceutical companies helping people get their medicines. Retrieved January 5, 2005. From http://www.needymeds.com/indices/article.shtml.
American Association for Retired Persons (2005). Growth in prescription drug prices dramatically outpaced inflation 2000-2003. Retrieved January 14, 2005. From http://www.aarp.org/legislative/prescriptiondrugs/rxprices/
Articles/a2004-05-24-drugprices.html.
American Association for Retired Persons (2004). AARP study finds prescription drug cost increases continuing to outpace inflation. Retrieved January 14, 2005. From http://www.aarp.org/research/press/presscurrentnews/
Articles/a2004-12-03-drugs.html.
American Association for Retired Persons (2005). Ask your physician and pharmacist eight questions to lower Rx costs. Retrieved January 14, 2005. From http://www.aarp.org/or/Articles/a2004-06-29-or-
questions.html.
American Association for Retired Persons (2003). Seven ways to cut Rx drug costs. Retrieved January 14, 2005. From http://www.aarp.org/bulletin/
prescription/Articles/a2003-09-30-cut_rxdrugs.html.
Gollub, G. (2003). Do’s and don’ts of splitting pills. AARP Bulletin Online. Retrieved January 14, 2005. From http://www.aarp.org/bulletin/prescription/Articles/
a2003-09-30-splitting_pills.html.
Pennsylvania Medical Society (2002). Pill splitting cuts Rx costs but can pose medical risks. Retrieved January 5, 2005. From http://www.pamedsoc.org/Content/ContentGroups/
Patient_Health_Index/Consumer_Health_Issues/Insurance_and_
Prescription_Drugs/Pill_Splitting_Cuts_RX_Costs_but_can_Pose_
Medical_Risks.htm.
Texas Department of Aging and Disability Services (2004). Helpful links. Retrieved February 1, 2005. From http://www.dads.state.tx.us/services/txcares/HelpfulLinks.html.
Texas Department of Aging and Disability Services (2004). Manufacturer-sponsored assistance. Retrieved February 1, 2005. From http://www.dads.state.tx.us/services/txcares/
manufacturer-sponsored.html.
TexCare (2005). Medicaid for children. Retrieved February 4, 2005. From http://texcarepartnership.com/CHIP-Medicaid-Page.htm.
United States Department of Health and Human Services (2005). Your child may be eligible for free or low-cost health insurance. Retrieved February 4, 2005. From http://www.insurekidsnow.gov/.
TexCare (2005). TexCare children’s medicaid: Children’s health insurance program. Retrieved February 4, 2005. From http://www.texcarepartnership.com/CHIP-CHIP-page.htm.
Texas Health and Human Services Commission (2004). Proposed CHIP rule changes. Retrieved February 4, 2005. From http://www.hhsc.state.tx.us/chip/reports/
1204_RuleChanges.html.
Employees Retirement System of Texas (2005). State kids insurance program (SKIP). Retrieved February 4, 2005. From http://www.ers.state.tx.us/Insurance/Publications/
skipbrochure.html.
United States Food and Drug Administration (2005). Buying medicines and medical products online. Retrieved January 5, 2005. From http://www.fda.gov/oc/buyonline/default.htm.
Texas Department of Aging and Disability Services (2004). Fraud alert: Warning about drug discount card scams. Retrieved February 1, 2005. From http://www.dads.state.tx.us/services/txcares/FraudAlert.html.

Saving Money on Medication: Where to look to start cutting costs