Part three of the series will focus on how the pharmacy can help you navigate and negotiate the best medication price and situation for you.
Some manufacturers/pharmacies have medications for one set price regardless of strength. Thirty of the 50 mg tablets may cost the same as thirty of the 100 mg tablet. This may be beneficial to you. Depending on the release mechanism, certain medications can be cut in half. Not all medications. Please do not just assume that a medication can be safely cut–always speak with your pharmacist first.
The pharmacist can process the scenarios to see which option would be the most beneficial. This may take a while. Ask the pharmacy staff to run the numbers and call you at a later time. You don’t want to rush him/her because options may be missed plus it’s just rude. Please remember that the pharmacist may have several people asking for this service, in addition to doctor’s offices holding to give new prescriptions, vaccines to administer, interactions to call on, patients to counsel at pick up, a sick child’s medication waiting to be filled, the list goes on and on.
If you are using insurance, then this process becomes a bit more tricky. You will need to call the customer service number on the back of your card. Customer service will be able to provide you with a copy of your plan’s formulary (the list of medications covered and how much they cost). The formulary is the best way to evaluate medication coverage and cost when dealing with an insurance company. The plan formulary should be taken to each doctor appointment; this one step could save the doctor, the pharmacist, and ultimately you a lot of time and frustration (as in the case of prior authorizations, non-formulary and therefore higher priced meds, or medications that are just simply not covered at all).
Some medications are offered singularly and also in combination; examples include lisinopril/hydrochlorothiazide, metformin/glyburide, and Janumet (Januvia/metformin). There are many reasons to take combination products such as ease of use, decreasing number of tablets taken per day, adherence (which is just a fancy word people in medicine use for saying that a person takes the medication every day as directed), and price.
Sometimes the price is a positive aspect of a combination product and sometimes it is a negative; for the purpose of this post I will only focus on price.
Knowing the right questions to ask will come in handy:
1. Do these individual medications come in a combination product? Conversely, does this combination product come as individual medications? If you have insurance, I would first look at the formulary for pricing, if not, ask the pharmacy staff to price out the individual medications and the combination.
2. Could I have a higher strength and cut it in half? What would be the cost?
3. Is there another product in the same category of medication that costs less? For example beta-blockers are a type of medication often used for blood pressure and heart rate control. There are several medications within this category: metoprolol, propranolol, nadolol, atenolol, etc. Additionally, metoprolol is found in an extended release version and an immediate release version. Extended release is more expensive but may only need to be taken once per day. Immediate release is less expensive and often taken multiple times per day. The choice becomes one of price vs convienence.
**Please take into consideration that not all medications within the same category will work for all people. Even though medication A may be the least expensive, some patients may need Medication B for a variety of reasons including effectiveness, side effects, lack of an appropriate choice for allergens, or drug interactions. Your pharmacist and prescriber can weigh the pros and cons of one form or another and discuss which would be the most appropriate choice for your particular circumstance.
Why you should NOT Coupon Shop
First and foremost, in my opinion, hopping from pharmacy to pharmacy for $25 here and there is NOT SAFE. Large retail pharmacy chains often offer a cash incentive for transferring prescriptions but (and this is a huge BUT), pharmacists are unable to see your entire medication list when some are filled at Kroger, some at Rite Aid, and others at CVS, Walgreens, or the local independent. What this means is that interactions may and WILL be missed.
Another reason to find the pharmacy and pharmacist best for you and stick with him/her is due to allergy or intolerance issues. Pharmacy data bases are not currently equipped to handle these issues and the pharmacist must manually check the package inserts and potentially call the manufacturer to make sure that each medication is safe for the allergic patient.
Having a pharmacist that knows your special circumstances and goes above and beyond to ensure your or your child’s safety is invaluable.