Recently, a lady was waiting in line at a pharmacy while the person in front of me picked up her prescription. Matter-of-factly, the pharmacist stated, "That'll be $850." Her only response was, "Really?" Telling the pharmacist she would have to call her doctor about a less expensive option, she left without her prescription.
Many of us regularly get sticker shock when we see how much drugs cost. More and more dramatic examples imply that there is no end to it. Let's discuss how to reduce our spending on prescription drugs, how we got to the point where some medications cost a million dollars or more per dose, and what needs to be changed in our exorbitant medication-industrial complex.
7 strategies to cut back on prescription medication costs
Take a look at these seven tactics to cut prescription costs. Savings will differ based on cost-sharing, deductibles, insurance, and donut holes.
Three questions to pose to your healthcare provider are: Are all of the medications you take really necessary? Can you safely cut back on the dosage of any medications you take? Could a generic or less expensive medication be used instead?
Take a look at these seven tactics to cut prescription costs. Savings will differ based on cost-sharing, deductibles, insurance, and donut holes.
Three questions to pose to your healthcare provider are: Are all of the medications you take really necessary? Can you safely cut back on the dosage of any medications you take? Could a generic or less expensive medication be used instead?
Check your health insurance plan's preferred medication list, or formulary, as these typically have lower costs than other comparable medications.
Split pills: If each pill contains more than the recommended dosage and can be divided, in certain circumstances, the cost of a prescription will be lower. For instance, if you typically take a 25-mg pill, splitting a 50-mg pill in half could result in lower copays and medication expenses. If the math doesn't add up for you, ask your pharmacist.
Find out if copays would be lower with a 90-day supply as opposed to a 30-day supply.
Look for prescription drug discount plans that provide savings. There are limitations and regional variations in availability. It's not always less expensive to use discount programs because payments made through them might not be deducted from your maximum out-of-pocket expenses or insurance deductible.
Evaluate your options with a pharmacist and compare costs at several pharmacies. There are instances when not using your insurance results in a lower cost.
Think about ordering online from a mail-order company (like Blink Health or Cost Plus Drug Company). Spending made via these websites, though, might not be deducted from your insurance deductible. Furthermore, online prices aren't always cheaper.
Why do drugs cost so much in the United States?
These are my top five candidates:
The financial motivation of drug manufacturers. Pharmaceutical companies dismiss this notion regularly. They claim that creating new medications and carrying out the necessary clinical trials to demonstrate their efficacy and safety are costly. Drug approval by the FDA is a challenging and expensive process, and many promising drugs end up failing.
However, a recent study that was published in JAMA Network Open discovered no link between the amount of money a pharmaceutical company spends on R&D and the cost of the drug. The majority of the top 30 pharmaceutical companies generate billions of dollars in profit, even after deducting R&D expenses. Furthermore, the very same medications produced by the same companies for the same health issues usually cost far less in Europe than in the US because drug prices are negotiated there.
PBMs, or pharmacy benefit managers, manage prescription benefits for Medicare, commercial insurance, and large employers. PBMs bargain with pharmacies and health insurers to lower costs. They play a role in determining patient costs and which medications to cover. Their fees and incentives, which are frequently a portion of the entire amount spent on medications and may encourage the approval of more expensive drugs, add to the final costs that health consumers bear. A plethora of state and federal laws aim to restrict PBMs' capabilities and the degree of transparency in their business practices.
Cost-sharing. Through increased copays, deductibles, and premiums, insurers have progressively transferred costs to patients in recent years. Occasionally, this is justified by the idea that it encourages patients to seek medical attention only when absolutely necessary; naturally, this could also deter people from seeking care even when it is appropriate.
Legal maneuvers. To prolong their time with a monopoly on a specific drug, many pharmaceutical companies sue prospective competitors and file multiple patents (see example). Alternatively, they modify already-approved medications to produce "me-too" drugs that they can patent as novel drugs. Certain pharmaceutical companies purchase the rights to older medications and subsequently raise the price. Others have avoided price competition by purchasing another drugmaker or merging with them.
Advertising directed at the consumer. Pharmaceutical companies invest billions in advertising (almost $8.1 billion in 2022). Drug prices are increased by marketing expenses, which also increase demand for more recent, highly marketed medications. Compared to older drugs, advertised drugs are typically much more expensive (and not always better). This may explain why such advertising is prohibited in the majority of other countries.
What could prevent drug prices from rising?Prescription drug costs are probably going to stay high for some time to come, but three developments may be able to moderate price increases in the coming years:
The US government may now bargain for Medicare drug prices thanks to the Inflation Reduction Act of 2022, which should result in cheaper prescription costs. In 2026, the first ten medications that are price-protected will go into effect. These medications include the diabetes medication sitagliptin (Januvia) and the blood thinner apixaban (Eliquis). Every year, more medications will be added to this list. It could have a significant effect if you take any of these medications. It's not a solution that will benefit everyone, though, as there are currently over 20,000 approved medications available.
Along with other proposed federal and state laws meant to shield people from exorbitant prescription drug costs, the FDA recently approved Florida's importation of drugs from Canada.
Legislators seem more interested than ever in supporting organizations like AARP, Consumers Union, and Patients for Affordable Drugs that work to bring down the cost of prescription drugs.
In summary, let's be honest: the people who create and distribute medications are encouraged to set their prices far above what many people can afford in our complex, dysfunctional healthcare system. Furthermore, there's a limit to how much you can accomplish alone. An overhaul is actually necessary to cut out intermediaries, who raise costs without always providing value.
Do what you can, even if it has a minimal effect, until we arrive. Making every effort to maintain your health may be the most important thing that you do. Ultimately, the most effective approach to reducing the amount of money you spend on prescription medications is to not need them.
