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Saving Money on Medication

Where to Look to Start Cutting Costs

Volume 9, Number 1 – January/February 2005 (updated August 2006)

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Andrew B. Crocker, MS, Extension Program Specialist-Gerontology Health

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Inside HealthHints....

• Saving Money on Medication
• Information, Information, …
• Ask Your Doctor and Pharmacist
• Is Pill Splitting Safe and Cost Effective?
• Resource Guide
  • Patient Assistance Programs
  • Pharmaceutical Company Assistance
  • Rx Discount Cards
  • Veteran and Military Benefits
  • Disability Assistance Programs
  • Assistance for Children
  • Discount Mail Order Programs
  • Medicare Assistance
• Medicare Changes: Part D
• Fraud Alert
• Other Helpful Links
• References

Saving Money on Medication: Where to Look to Start Cutting Costs

“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 to 2003.²
• From September 2003 to September 2004, manufacturer’s 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 that 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., 500mg)
• Form (e.g., liquid, tablet, capsule; children’s or adult’s formula)
• 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 and 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 the of time—adding new prescriptions and taking off old ones, as well as noting when doses 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?” in this issue of HealthHints 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

Resource Extra
“...A Dozen Questions to Help You Understand Your Medicines” see the fact sheet at http://www.usp.org/pdf/EN/patientSafety/justAskDozenQs.pdf for more information.

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 and take in all your medications (including over-the-counter and supplements) once a year for a review. Ask about prices.⁴
• Ask your pharmacist if any new generic drugs have become available.⁴
• Ask if any of your prescription drugs have become available over-the-counter.
• Ask your pharmacist 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.

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 following is a resource guide to help you find your way amidst the different options available to you. These options will usually require an application, information about your specific medications, and/or financial and health status information.

Patient Assistance Programs

Federal and state governmental agencies, private foundations, and pharmaceutical companies offer assistance programs to individuals who meet certain levels of need.

For more information, see the following websites compiled by the Texas Department of Aging and Disability Services:⁸

• Partnership for Prescription Assistance
  • Website: https://www.pparx.org/Intro.php
  • A database of research-based pharmaceutical companies that provide prescription medicines free of charge to physicians whose patients might not otherwise have access to necessary medicines.
• Benefits CheckUp
  • Website: http://www.benefitscheckup.org/
  • A free, easy-to-use service that identifies federal and state assistance programs for older Americans.
• Access To Benefits Coalition
  • Website: http://www.accesstobenefits.org/
  • A public-private partnership dedicated to ensuring that low-income Medicare beneficiaries know about and can make optimal use of new Medicare prescription drug benefits and all available resources for saving money on prescription drugs.

Pharmaceutical Company Assistance

Many drug makers offer free supplies of their own products to persons who do not have prescription drug coverage. Sadly, with the inception of Medicare Part “D,” many of these programs for eligible Medicare beneficiaries have been limited due to the availability of prescription drug coverage. While coverage under Part “D” may be a limiting factor, it certainly does not exclude older adults from qualifying for prescription drug assistance programs. For a free directory, call (800) 762-4636 or go to https://www.pparx.org/Intro.php.⁵

Rx Discount Cards

Prescription discount programs may be available through many drug companies as well as private entities, such as foundations. These programs typically allow eligible individuals to purchase a 30-day supply of certain prescription drugs at a discount or specified co-payment. To be eligible, however, participants must meet income criteria and have no other form of prescription drug coverage, in most cases.⁹ For specific information about qualifications, check with the particular program.

For help in this area, see the following charts and information, which compare drug discount cards and supplies; the names of several companies offering these services along with their phone numbers, websites, and common discounts; and examples of products that are discounted. These discount cards may be offered by for-profit or non-profit entities or pharmaceutical manufacturers that have made arrangements with pharmacies to discount certain drugs. Note that cards other than those offered by the pharmaceutical manufacturer may have an annual or monthly fee.

• Drug discount cards and pharmaceutical manufacturer drug discount cards
  • http://www.rxassist.org/faqs/drug-discount-cards.cfm

Additionally, ask your pharmacist about discounts available or search the website at http://www.rxassist.org/ for more information.

Additional resources for prescription drug assistance may be found by searching the following websites:⁸

• Pfizer Helpful Answers
  • Website: http://www.pfizerhelpfulanswers.com/
  • Program offered by Pfizer to low-income individuals who do not currently have prescription drug coverage.
• Together Rx
  • Website: http://www.togetherrxaccess.com/home.html
  • Prescription drug savings program that provides savings to eligible enrollees on more than 150 widely prescribed medicines.
• NeedyMeds.com
  • Website: http://www.needymeds.com/
  • This site offers information about many different prescription assistance programs offered by various groups.

Veteran and Military Benefits

Veterans and military personnel, retirees, spouses, widows, and dependents may qualify for health benefits, including reduced or no-cost prescription drugs. To find out about the benefits available to you if you are a veteran call (877) 222-8387, or go to the Veteran’s Administration website at http://www1.va.gov/health_benefits/. If you are a military retiree, spouse, widow, or dependent call (800) 538-9552 or go to http://www.tricare.osd.mil/.

Disability Assistance Programs

People with disabilities can seek help through Medicare Programs. Medicare program benefits are for people with disabilities regardless of age. Go to the Medicare website at http://www.medicare.gov/ for eligibility. See further in this issue of HealthHints for the specific Medicare benefits available regarding drug cost savings.

Assistance for Children

There are several important programs that can help pay for health premiums, prescription drugs, and other health services for children and their families who qualify.

Medicaid

Medicaid health insurance is provided at no cost to qualifying children. Children’s health care benefits under Medicaid are extensive and often are better than benefits packages offered by private employers. Medicaid emphasizes preventive health so that children’s health problems can be caught early or prevented altogether.

Once qualified for Medicaid, the child continues to receive coverage until a change occurs in the child’s or the family’s situation that would cause disqualification. The child’s situation is checked periodically, usually once every six months, possibly more often, to determine if the child still qualifies for Medicaid coverage.

Income and asset requirements are considered for qualification to Medicaid for children. Use TexCare’s Medicaid for Children website at http://texcarepartnership.com/CHIP-Medicaid-Page.htm as a starting point for gaining further information,¹⁰ or contact them at 1-800-647-6558.

CHIP

The Children’s Health Insurance Program (CHIP) is available to help with the insurance cost problem that is faced by many Texas families. This insurance is available to children in working families, including families that include individuals with a variety of immigration statuses (see http://www.insurekidsnow.gov/ for more information).¹¹ In CHIP, higher-income families may pay monthly premiums, which cover all children in the family. Most families also will have co-payments for doctor visits, prescription drugs, and emergency care.

CHIP is offered by private health plans. CHIP covers services such as prescription drugs, as well as hospital care, surgery, x-rays, physical/speech/occupational therapies, emergency services, transplants, and regular health check-ups and immunizations.

For a complete list of benefits offered through CHIP, call TexCare at 1-800-647-6558. You can also check for recent updates to CHIP and Medicaid that may impact your family by going to the TexCare Children’s Medicaid website at http://www.texcarepartnership.com/CHIP-CHIP-Page.htm.¹²

A number of changes are being made to further align CHIP eligibility rules with Children’s Medicaid eligibility rules. Be sure to check their website for any changes that may effect your family.¹³

SKIP

The State Kids Insurance Program (SKIP) is another program that can help cover children’s health premiums. If you do not qualify for Medicaid and meet the other socioeconomic eligibility requirements, this may be a cost saving possibility as well. For requirements see their website at http://www.ers.state.tx.us/Insurance/SKIP.htm or contact TexCare at 1-800-647-6558.¹⁴

Discount Mail Order Programs

Discount mail order programs both in and out of the United States can offer cost savings on prescriptions. A key element in mail order is quality control of your drugs (e.g., making sure temperature-sensitive drugs are not harmed) and avoiding fraud. There are many mail order options, but here is a list recommended by the American Association for Retired Persons:⁵

• AARP program at (800) 289-8849 or http://www.aarppharmacy.com/
• Medco Health at (877) 733-6765 or http://www.yourxplan.com/
• DestinationRX (for price comparison among plans) at http://destinationrx.com/
• Minnesota Senior Federation (for help filling prescriptions from licensed Canadian pharmacies) at (877) 645-0261, ext. 124
• United Health Alliance (for help filling prescriptions from licensed Canadian pharmacies) at (866) 633-7483

Note: The U.S. Food and Drug Administration (FDA) does not recommend mail order outside of the United States for safety reasons. If you decide to use mail order from outside the U.S., be sure to use one of the reputable services, such as those listed above, and be sure you understand the risks (see the “Fraud Alert” section in this issue of HealthHints).

Medicare Assistance

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. The following section provides information on this program

Medicare Changes: Part D – The prescription drug benefit

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, Andrew B. Crocker, MS, Extension Program Specialist–Gerontology Health has provided the following information for your use.

Medicare Part D

Medicare began providing prescription drug coverage through Medicare Part “D” on January 1, 2006. Enrollment in Medicare Part “D” is completely optional, but you may pay an additional premium if you do not enroll in the program within a certain time period after becoming eligible. Private companies, contracted by Medicare, offer the Part “D” benefit, but there is no separate application process—application is made directly through Medicare.

Medicare will help you decide which plan is best for you and process your enrollment in it. Medicare is basing its coverage formulary on the formulary that is used for the Medicaid program, the health insurance program for low-income individuals that is federally and state funded and administered by the state. Over-the-counter medications are not covered by the Part “D” benefit—only prescription medications.

In 2006, the monthly fee averaged $35 ($420 annually), which is deducted from your Social Security benefit check. Most plans have a $250 deductible. Thus, the plan basically costs $670 a year.

Here’s an example of how to figure your expenses based on year 2006 figures. Assuming that your prescription drug expenses are more than $670 annually, Medicare has established a formulary to calculate your benefits. After you have met the deductible of $250, Medicare will pay:

• 75 percent of costs between $250 – $2,250; you are responsible for the other 25 percent;
• nothing between $2,250 – $3,600; you are responsible for 100 percent of the cost of your prescription drugs between $2,250 – $3,600;
• 95 percent of costs over $3,600; you are responsible for the other 5 percent.

Formulary defined…
A formulary is a list of preferred, prescription drugs that a health plan approves for use by its doctors based on safety, effectiveness, and affordability. Typically, health plans only pay for medications on this “approved” list. Ask your doctor if he/she is prescribing your medications from the formulary list. If he/she needs to prescribe a non-formulary drug, ask if prior authorization can be sought for the health plan to cover payment of this medication.

Certain low-income Medicare beneficiaries may be able to receive additional help under Medicare Part “D.” For 2006, if you are single and have annual income of less than $12,123 or married and have annual income of less than $16,362, you may qualify for further benefits; Medicare will waive both your monthly premium and your deductible—saving you $670 per year. Until your annual prescription drug cost exceeds $3,600, you will be responsible for a $2 to $5 co-payment for each prescription. Once your annual cost goes above $3,600, you will not have to pay any co-payment to receive your prescription drugs.

If you are single and have an annual income of less than $13,471 or married and have an annual income of less than $18,180, you may qualify for further benefits, as well. Medicare will reduce your deductible to $50 per year. Your monthly premium will be fixed to a sliding scale that varies depending on the value of your assets: house, car, savings accounts, and other items of value you may own. For our purposes, we will assume that the 12 monthly premiums will still total about $420.00. You will still save a minimum of $200 per year. Until your annual prescription drug cost exceeds $3,600, you will be responsible for a 15 percent co-payment for each prescription. Once your annual cost goes above $3,600, you will be responsible for a $2 – $5 co-payment for each prescription.

Medicare uses the Federal Poverty Level (FPL) to compute which beneficiaries may be eligible for extra assistance. The FPL changes from year-to-year, and these figures will change beginning in 2007 and each year after that.

As with most Medicare programs, the fee structure increases yearly on a percentage basis. This means that the guidelines for Medicare Part “D” will change for 2007. The new copy of Medicare and You 2007, which comes in the mail in October 2006, will have the set rates for 2007. Be sure to review these changes carefully as you will need to make an informed decision about changes you might want to make to your existing plan or enrollment in a new plan. These changes may only be made once per year: November 15 through December 31.

As always, the most current information on this and all other Medicare programs may be accessed through Medicare—either by phone at 1-(800) MEDICARE (1-800-633-4227) or via the Internet: http://www.medicare.gov/.

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 [http://www.nabp.net/, (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 FDA’s “Buying Prescription Medicines Online: Consumer Safety Guide” at http://www.fda.gov/cder/consumerinfo/buyOnlineGuide.htm for more information or as a resource to distribute or discuss.

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, please call the Medicare Fraud Hotline at: 1-800- 447-8477.¹⁶

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References

1. Sagall, R.J. (2004). Pharmaceutical companies helping people get their medicines. Retrieved January
   5, 2005. From http://www.needymeds.com/indices/article.shtml.
2. 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.
3. 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.
4. 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-orquestions.
   html.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. TexCare (2005). Medicaid for children. Retrieved February 4, 2005. From http://
    texcarepartnership.com/CHIP-Medicaid-Page.htm.
11. 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/.
12. TexCare (2005). TexCare children’s medicaid: Children’s health insurance program. Retrieved February
    4, 2005. From http://www.texcarepartnership.com/CHIP-CHIP-page.htm.
13. 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.
14. 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.
15. 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.
16. 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.

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