If you’ve been to the pharmacy recently, you may have noticed the rising out-of-pocket cost of prescriptions. As medication costs have increased, the share of the burden borne by patients has also gone up. In 2015, U.S. consumers spent an estimated $46 billion on out-of-pocket prescription costs.
Unfortunately, that means even patients with “good” insurance coverage may find that costs can be a barrier to getting necessary treatment. Patients sometimes forgo treatment altogether, or they are forced to prioritize their medications and buy only those that seem most essential.
Our doctors do consider less expensive non-prescription alternatives when they are supported by research (for example, over-the-counter treatments, vitamins, supplements, and dietary/lifestyle changes). However, many times a prescription medication is the best treatment option.
At the time the prescription is written, we don’t know your cost for a given medication. That’s because a patient’s cost varies widely based on his or her specific insurance plan, pharmacy and discount program. A drug that costs one person hundreds of dollars may have virtually no out-of-pocket cost for someone else. Additionally, the landscape is constantly changing. So you may find that a prescription that was affordable becomes much more expensive when it’s refilled a few months later.
Additionally, in recent years many so-called generic drugs have become more expensive. Gone are the days when “substitute generic” meant the prescription would be a bargain. In fact, the generics now sometimes cost even more than branded drugs. In addition, many manufacturers get around the “substitute generic” notation by making slightly different sizes or formulations, which means the pharmacy cannot automatically substitute (since the branded and the generic aren’t an exact match).
Although each case is different, at U.S. Dermatology Partners we’ve found there are several strategies that can help to make prescriptions more accessible and help our customers save money on prescriptions.
Prescription Cost Basics
Prescriptions are non-returnable. If you have doubts about a prescription (for example, the stated cost is high, or a prescription rebate card isn’t working), you should call us before you pay for it at the pharmacy. Often there are equivalent drugs that may be less under your particular insurance plan. But in most cases, once you pick it up and pay for it at the pharmacy, the cost cannot be refunded.
Prices vary by pharmacy. It can pay to shop around, especially if you are uninsured or have a deductible to meet. Patients don’t always realize how much the prices can vary from one pharmacy to another. For example, even non-members are able to use the pharmacy services at Costco and Sam’s Club (just let them know at the door that you are there for the pharmacy). Additionally, many pharmacies offer inexpensive $4 drugs. Mail-order pharmacies can also offer savings, particularly for very high-cost drugs such as the biologic therapies used for psoriasis.
Manufacturer coupons can be helpful (but not always). The coupons and rebates can provide great discounts. However, these coupons are generally issued for expensive drugs, and they come with a lot of limitations and fine print. For example, if you are uninsured or if your insurance excludes a particular medication, the coupons often don’t work. And patients with government-issued insurance (Medicare, Medicaid and Tricare) are typically excluded. If we give you a coupon, but the pharmacy is unable to run it or the cost is higher than you expect, it’s worth checking to see if there is a cheaper alternative.
The cost is more than just what you pay at the pharmacy. The hidden sources of expense are prescriptions that don’t get used or doctor’s visits that result in a prescription that is never successfully filled. In addition, when insurance companies require appeals to get medications approved, there can be a substantial cost associated with the frustration and delay in obtaining treatment. If you’re not able to get your prescription for whatever reason, we would always want you to call us.
At U.S. Dermatology Partners, we have a long-standing policy of not allowing drug companies to bring food or gifts for the staff or doctors. We feel prescriptions are already expensive enough without these additional marketing costs, and this is a small thing we can do to help. Of course we do accept samples and coupons since we feel those benefit our patients.
We shouldn’t lose sight of the fact that we’re very fortunate to live in a time with great medical advances. Today there are very effective medications for conditions that were virtually untreatable only decades ago. Although managing the cost is an ongoing challenge, one of the best tools we have is open communication between doctors and patients. An inexpensive option may not always be available, but we are always willing to advocate for our patients so they can access needed medication.