“How can I save money while still treating/controlling my medical issues?”
This is a question that every pharmacist has encountered and almost every patient has pondered. Cost is not everything, but if patients can’t afford the medication, they won’t buy it. Price is always a factor to consider.
As a pharmacist, I review medication profiles frequently and have been trained to quickly see where I could suggest changes to impact patient costs. In this three part series I will discuss several paths to medication savings. Part 1 will focus on what the patients can do themselves to alleviate large medication costs. Part 2 will highlight the various discount card and patient assistance programs. Part 3 will concentrate on the pharmacist’s role in getting the best bang for your buck.
Today, I’ll be discussing the two major ways you, as the patient, can start saving immediately: discounted medication lists and price matching
Discounted Medication Lists
Pharmacies such as Kroger, Wal-Mart, K-Mart, Target, Rite-Aid, etc offer a large variety of medications on a discounted list. These medications are generally generics and are inexpensive for the pharmacies to purchase. The medications range from cholesterol and blood pressure medications to antidepressants and birth control.
Here’s what to keep in mind:
- Pricing is not static. A medication, a formulation such as tablets or capsules, or just a specific strength can be removed from the list at any time. For instance, a recent national back order of Doxycycline caused this particular antibiotic to be pulled from these lists.
- You will not be able to specify the manufacturer. These discounted prices are based on negotiations between a pharmacy and a specific manufacturer. Therefore, while several pharmacies may list 30 capsules of generic Prozac, the generics will not all be provided from the same manufacturer. This may be a problem for allergy sufferers; as I discussed in a few of my “Pharmacy Basics” posts, different manufacturers may contain different inactive ingredients. Do your homework.
How can you best use this information?
My suggestion is that you print a few of these lists and take them to the doctor at your next appointment. I have provided links to several national chains at the end of this post. The prescriber can then evaluate if any of the cost saving options are appropriate. The pharmacy, however, will help you with the specific selections and potential allergens.
Bear in mind that the trade-off for best pricing is often convenience. Making the decision to go with the best priced medication may mean taking more tablets and/or taking the tablets more frequently. This is a serious issue to consider. The medication won’t help if you don’t remember to take it.
Once the doctor prescribes the medication, you can go to the pharmacy with the best price or you can utilize the next tip.
Large retail pharmacies often price match within their immediate area (which does not include pharmacies three hours away or mail order, unfortunately). The price match is matching the “cash” price or the price of the medication without any insurance or discount cards.
Pharmacies typically require confirmation of the price/quantity/strength/NDC; this will need to happen often (if not every time), per corporate policy, if the price match continues. Medication costs change frequently and therefore the pharmacy’s cost to purchase medications changes as well. Some pharmacies even match the “club” prices of competing chains without the patient actually having to shell out the “club” membership dues or prove membership.
But, as the Genie, said, “There are a few, uh, provisos. Ah, a couple of quid pro quo.”
- Not all medications are subject to price matching; some retail stores exclude controlled substances from price matching, others allow the pharmacist to use professional discretion.
- While most insurance plans have a standard copay for the medication regardless of which pharmacy you use, some companies mandate the use of specific retail pharmacies or mail order pharmacies in order to get the best pricing. These details will be listed in the informational packets provided by your insurance company.
- Percentage Based Copays
If you have copays based on a percentage of the cash price; price matching will not work. You must have your medication filled at the least expensive location to get the best pricing. There is no way for the local pharmacy staff to match a cash price and bill the insurance for the cheaper price–the pharmacy computer system will not allow it. So in these percentage based copay plans, the best bang for your buck is at the cheapest pharmacy–the pharmacy with the least expensive cash price.
This type of copay system is problematic in that it encourages pharmacy hopping (when a patient goes from pharmacy to pharmacy instead of sticking with one location); in my opinion, this is a patient safety hazard and can be downright dangerous. I will discuss this more in Part 3. Once you find a pharmacist that understands your unique needs as a food allergic individual, my advice is that you stay put (if at all possible). Educating pharmacists and pharmacy techs about the food allergens in medications is a work in progress. Locating a heath care professional that “gets it” is priceless.
As always, please comment with specific questions or further resources. Stay tuned for Parts 2 and 3, coming soon!