Can I Afford My Prescription Medication?
Talk to Your Doctor
As the cost of prescription drugs continue to rise, more and more patients, even those with health insurance, are neglecting to fill their prescriptions. Oftentimes, people don’t tell their doctors that the cost of their prescription drugs is high on their list of concerns. Perhaps even more troubling is that many people don’t tell their doctor they’re not taking the medication that was prescribed. Rather than seeking out a less expensive alternative to a pricey prescription drug, too many patients opt out of the medication therapy that they need.
Unless your doctor knows that your ability to follow through with your treatment plan is contingent on the affordability of a medication, they won’t be able to find less expensive treatment options. You should explain to your doctor that you can’t afford the medication. How will he/she know you can’t afford your medication if you don’t tell them? Your doctor will most likely have options available to prescribe something less expensive for you. Speak up and advocate for yourself. Don’t be embarrassed, prescription drugs are expensive!
If you’ve been prescribed a new medication and you’re wondering how much it’s going to cost you, give your pharmacy a call prior to submitting the prescription. If it’s a pharmacy that you’ve used before and they already have your insurance information on hand, they will be able to inform you of what your out-of-pocket expense will be. If the cost of a prescription is prohibitively high, talk to your doctor about less expensive alternatives. Shop around! You will find that different pharmacies can sometimes charge significantly different prices.
Find the Out-of-Pocket Cost
While the cost of many medications is outrageously high, others are more affordable than you realize. If you have an insurance plan with a copay for medications, you may assume that using your insurance will get you the best price on your medication. However, according to health economist Karen Van Nuys, this isn’t always the case. A study conducted by the University of Southern California Schaeffer Center for Health Policy & Economics, uncovered that consumers overpaid for their prescription drugs 23 percent of the time. The average overpayment on each transaction amounted to $7.69. Brand-name drugs are associated with an overpayment amount of over $13. Your health insurance agent is another great resource for information. Please do not hesitate to call us.
Stop! Ask Questions Before You Pay
How does it all work? If you have a fixed copay (versus a copay that is a percentage of the cost of the medication) and you’re purchasing a prescription, the pharmacist will likely charge you your copay. Copays are great because they are not mystery charges and are a fixed amount. You assume that your modest copay is cheaper than the cost of the medication, and you pay it without questioning. In most cases this is true, but if you paid out-of-pocket, you may have actually paid less.
For example, say that you’re filling a prescription for amoxicillin, you could pay your $10 copay, or you could forego using your insurance and pay the out-of-pocket amount, which can be four dollars, depending on where you have the prescription filled. Be careful here however, because the money you actually pay if you don’t use your insurance will not count towards your out-of-pocket costs on your insurance plan. In other words, you won’t get credit towards your out-of-pocket costs if you don’t use your insurance to buy your medications.
Simply asking your pharmacist what it would cost you to pay for the drug out-of-pocket can save you money. Please note, once again, the money you pay without using your insurance will not count towards your “Out of Pocket Maximum” and prescriptions that are run through your insurance DO count towards your “out of pocket maximum”.
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Your health insurance company’s formulary is a list of all the different drugs that their plans cover. Within the formulary, there are drug tiers. These tiers determine the level of coverage your prescription drug plan offers for a specific type of medication.
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Prescription Insurance vs. Discount Card vs. Coupons
Those who depend on prescription drugs have a couple of options that may make filling their prescriptions easier on their wallets. There are three options to receive discounts on prescription drugs.
- Coverage included with your medical insurance plan
- Prescription drug discount plan
- Using coupons and phone apps
While each of these plans can help you save you money, the way they work is quite different.
Prescription Drug Insurance
Prescription drug insurance is most likely integrated into your health insurance plan. Your personal individual and/or family health insurance plan will have a monthly premium that is paid by you, or you may have an employer provided health plan with prescription drug coverage integrated into the employer plan. When you fill a prescription, you will most likely pay a flat-rate copay, or you could pay a “deductible” first, depending on your health plan and the cost of the drug. Then the insurance company is billed for the rest.
When helping you select the right prescription drug insurance plan, one of our health insurance agents may ask you what medications you’re currently prescribed. Different insurers have different drug formulary’s (a lists of covered drugs). These preferred drugs may be both brand name and generic drugs, and they are chosen for their cost, effectiveness, and safety. Non-formulary drugs are not covered by the insurer, and the member will pay the entire cost. By verifying that the medications you’re currently taking are on an insurer’s formulary, your agent can ensure that you receive the medication for the best price.
Prescription Drug Discount Plans
While prescription drugs are covered with your health insurance plan by insurance companies, prescription drug discount plans are often provided by drug stores, drug manufacturers and membership organizations. Some discount plans are available for a monthly or annual fee, while others are free. The way they work is like a coupon. When you fill a prescription, you provide the pharmacy with your card, and you’ll receive a certain percentage off the cost of the prescription. This discount may vary from one drug to another, and different discounts may be applied to generic drugs and name brand drugs.
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Coupons for Discounted Prescriptions
One of the industry leaders for online discounts for many prescriptions is GoodRx.com. GoodRx is a company that operates a telemedicine platform, a free-to-use website, and a mobile app that tracks prescription drug prices in the United States. It also provides free drug coupons that offer deep discounts on medications. GoodRx offers savings of up to 80% on retail prescription drug prices and has helped Americans save over $35 billion on their healthcare to date.
The company gathers prices from more than 75,000 pharmacies across the U.S. to bring you up-to-date information about what discounts are available and how you can save. Their team of experts range from doctors and pharmacists to data scientists and economists. They scour the latest research and news from the FDA and other sources to bring you the latest insights about medications and your health.
More than 20 million Americans trust GoodRx to help them find better discounts and prices every month. Since opening in 2011, they’ve helped people save more than $35 billion in prescription drug expenses. The app is consistently ranked #1 in the medical category on Apple’s App Store and Google Play, and one-third of doctors recommend GoodRx to their patients. Nevada Insurance Enrollment also recommends this website and app; it’s free and can offer significant savings on your prescriptions. We’ve come to rely on their website for research and prices on a regular basis. Their online coupons can be significant!
This FREE Phone App Gives Huge Discounts on Prescription Drugs
Why pay full price? Prescription discounts from a FREE phone app. The app is easy to use and easy to understand. They also have a wide selection of available prescriptions.
A pharmacist told one of our clients to go to GoodRX.com to get discount coupons for her prescriptions. They paid $86 for Pulmicort/Budesonide and didn’t even use her insurance. Without insurance or without GoodRx the retail price was $436.
Go to goodrx.com. You can also visit the Google or Apple app store on your phone and download it directly.
Now for some legal stuff:
- We have NO affiliation with GoodRx
- Yes, this is legitimate and works very well
It’s important to note that prescription drug discount plans and online coupons (GoodRx) are not insurance plans. While the discounts they provide may be sufficient for some people, other people may end up paying significantly more money in the long run by choosing a discount plan instead of insurance coverage.
Why Are Drug Prices So High?
It’s not just your imagination; prescription drug prices in the United States are high. In fact, when you consider the world’s 20 most popular prescription drugs, those drugs cost three times more in the United States than they do in Great Britain, six times more than they do in Brazil, and 16 times more than they do in the country where they’re the most affordable.
What’s to Blame for High Drug Prices?
The high cost of prescription drugs in the United States can be blamed on the fact that our government grants protected monopolies to drug manufacturers, along with the requirement for coverage for government-funded drug benefits.
In Europe, drug costs are capped, and in some cases, costs are pushed down, meaning that drug companies have a reason to keep costs affordable. By contrast, the U.S. government doesn’t regulate prices the way that other countries’ governments do; in the United States, pricing is left entirely to market competition. On top of that, generics for popular drugs hit the U.S. market more slowly than they do in European markets. This means that when it comes to treating certain conditions, Americans simply have fewer prescription drug options.
Our Government has taken steps to reduce prescription drug costs by loosening the restrictions on what drugs Medicare Part D must cover, as well as speed up the process for bringing generic drugs to market. While there are some downsides to these measures, they may create more competition for drug companies and provide them with an incentive to lower prices. They also put an end to the gag clauses that kept pharmacists from telling a customer if they could pay less for a drug by simply paying for it out-of-pocket rather than using their health insurance prescription drug coverage.
Let Nevada Insurance Enrollment Help
As the cost of prescription drugs continues to climb, it’s important to educate yourself and keep your doctor in the loop to ensure that you receive a treatment plan that will work for you. Your health insurance agent can also help you review your coverage and make sure that it is a good fit, even as your needs change.
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What is Tier Pricing With Prescription Medications?
Your health insurance company’s formulary is a list of all the different drugs that their plans cover. Within the formulary, there are drug tiers. These tiers determine the level of coverage your prescription drug plan offers for a specific type of medication.
Health Insurance with a Preexisting Condition
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