A pharmacist tells how to manage out of pocket drug costs
As a practicing pharmacist, I see a lot of surprised faces when patients' prescription drug charges are totaled. Many have sticker shock. Others are surprised by how affordable their medication is because they hear so much in the media about high drug costs and how senior citizens have to choose between food and medication. To get the best possible deal on medication, here's what I recommend:
Use the formulary
The formulary is a list of drugs-brand name and generic that are covered at the maximum level. The purpose of the formulary is to give members broad access to drugs and supplies at a reasonable overall cost. A committee of doctors and pharmacists determines what drugs are on the formulary. The committee considers safety, effectiveness, uniqueness and market factors. Your health plan may still provide some coverage for non-formulary drugs, but you will end up paying more out-of-pocket.
Using a generic drug is the No. 1 thing you can do to reduce your prescription drug costs. The average brand-name drug claim is more than $175, which is seven times more than the average generic claim of about $25. Generics have the same active ingredients, work the same way and have the same risks and benefits as the brand-name versions. If a chemical copy of your medication is not available, another generic that treats your condition may be available. Simvastatin, for example, is a chemical copy of the cholesterol-lowering drug Zocor. If you take Lipitor or another brand-name cholesterol-lowering drug, simvastatin would be an appropriate alternative. Currently, about one in every 30 BCBSND members who has a prescription takes Lipitor. In 2003, Lipitor was prescribed to one in 15 people; however, its price and utilization combined still make it the most expensive drug. Good news for consumers is that Lipitor will be available as a generic called atorvastatin in November 2011.
This tool, www.MyPrime.com, can help you manage your prescription drug benefit. One feature allows you to enter the name of a drug and view a list of generic and brand name alternatives. The list also shows prices for a 90-day PrimeMail or a 30-day retail supply. PrimeMail is a mail order drug program. If you take a brand-name prescription drug, PrimeMail may generate savings. It isn't always cheaper than your retail pharmacy, but it's worth checking. MyPrime.com also allows you to see your prescription drug claim history and find a pharmacy based on the zip code you enter.
Use over-the-counter products when possible
Over-the-counter medications are usually less expensive than even a prescription generic drug. Prescription pain relievers really aren't necessary if there is an over-the-counter product available. Heartburn medications Prevacid and Prilosec and allergy medications Claritin and Zyrtec were once available only as prescriptions, but are now available over-the-counter. If you have any issues with medication, whether it is cost, side effects or something else, I encourage you to talk with your doctor or pharmacist. They may be able to help you find solutions.
When you shop for over-the-counter medications, do you go for the store brand or do you stick with brand names? Why?