Pricey Prescriptions: There Are Ways to Cut Your Costs
By Emily Hagedorn, The Bakersfield Californian
Mar. 20–The pill bottles on Joaquin Cruz’s bedside table hold medicine that could save him — or at least make his treatment easier to bear.
But they also might be depleting funds for his retirement and wedding because that’s what they cost him.
Cruz, 65, was recently diagnosed with pancreatic cancer and one of his chemotherapy medicines, Tarceva, carried substantial sticker shock: $3,800 a month.
“We said, ‘No, no, no. We have Blue Cross and Medicare,’” said fiance Diane Chacon. “It wasn’t on the approved list of medications.”
Even with health insurance, paying for prescriptions can be daunting.
In 2007, the average annual increase in manufacturer prices for 220 brand name prescription drugs was more than 21â„2 times the inflation rate, according to a report released this month from the AARP Public Policy Institute.
But there are ways to cut some prescription costs and find programs that help pay the tab. Places to start include the doctor’s office, pharmacy and Internet, local experts say.
Bakersfield’s Comprehensive Blood and Cancer Center, where Cruz is being treated, is trying to get him into a program offered by Tarceva’s manufacturer.
“You just got to dig and dig,” Cruz said. “Don’t give up.”
IN THE DOCTOR’S OFFICE
“If they know you’re having trouble, we find that more often than not, doctors will stop and give you a hand,” said Yolanda Prado, program manager for Kern County’s Health Insurance Counseling and Advocacy Program. “And if you have someone that’s not going to help you out, go find another one.”
Don’t go after the flashiest new drug being advertised, she said. Try a generic.
Generics, which have the same active ingredients as their brand-name counterparts, have been in the market longer, said Evelyn Elliott, Kern Medical Center’s pharmacy director.
Don’t assume a physician will prescribe a generic first, Elliott said. Tell him or her you want to save money, and ask for a cheaper drug.
Bring your formulary — a list of approved drugs — from your insurance plan to the doctor’s office, said Shannon Hernandez, a social worker with the Comprehensive Blood and Cancer Center. If a certain drug isn’t approved, perhaps a similar one is.
Here are some other questions to ask your physician:
–Is there an alternative to a prescription, such as changing diet and exercise?
–Would an over-the-counter medicine work just as well?
–Do you know of programs that could help me get this cheaper?
–How much will I be taking and how many times a day? How long do I need to take this?
–If I feel better before the end of the regimen, do I need to finish it?
Prado also recommends asking for free samples.
“If you have a sample and it doesn’t work, you don’t have to spend the money,” she said.
Samples are best for short-term conditions, Elliott said. Samples for chronic conditions may seem frugal at the beginning but can lock you into paying more over the long-term considering the medications are often expensive to purchase.
“The drug companies don’t give you samples of generics,” she said.
IN THE PHARMACY
It pays to comparison shop, especially if the medication isn’t covered by insurance, Prado said. Wal-Mart and Target sell some generics for $4.
Elliott’s sister takes several diabetes medicines. By getting her physician to change her prescriptions to the generics on Wal-Mart’s list, the family is now saving thousands of dollars a year, Elliott said.
But by having all your prescriptions at one pharmacy, a pharmacist is more likely to spot any dangerous interactions, she said. So carry a list of medications with you to show each pharmacist,
Mail-order and online pharmacies can also be a source for savings, Elliott said.
These are good for drugs for long-term conditions, Prado said. Don’t go online for something you need immediately, like an antibiotic.
Legitimate online pharmacies are often approved by Verified Internet Pharmacy Practice Sites and the Better Business Bureau.
Hernandez is leery of discount card programs that some pharmacies offer.
Ask how much a drug is with and without the card, she said. Sometimes, the card doesn’t garner the savings you expect for the fee you pay.
“If a pharmacy doesn’t have the time to deal with you, look to see who can help you,” Prado said.
OUTSIDE THE PHARMACY
If a prescription sounds too expensive to be true, it might be.
Don’t pay it, and ask the pharmacy and your doctor’s office if there are any programs that could help out, Hernandez said.
One avenue for help is co-pay assistance programs, which are usually run by charities and offer help to people with certain conditions.
The Leukemia and Lymphoma Society, Chronic Disease Fund and National Organization for Rare Disorders are just a few.
Hernandez has had good luck getting people who make less than $100,000 annually on these programs, she said.
Patients with limited income could also get free or reduced-cost medicine in a prescription assistance program through the drug’s manufacturer. Applying requires lots of paperwork, Elliott said. But savings can be substantial.
There are also a few Web sites, such as Partnership for Prescription Assistance at www.pparx.org, that search all prescription assistance programs at once.
Prado knows people who have gone to Canada or Mexico for cheaper medications, despite the illegality. It’s risky, experts say.
“Are you sure where the medicine has come from?” Elliott asked. “You really don’t.”
“You don’t know how long they were holding that drug. It might not even be good anymore,” Hernandez said. “You could be getting sugar pills for all you know.”
WHAT THE GOVERNMENT OFFERS
If you are over 65 or disabled, you are eligible for the prescription benefit Medicare Part D.
For most people, monthly premiums run between roughly $14 and $103 locally.
For a basic Part D plan, you pay a $275 deductible and then 25 percent of the next $2,235.
After this you fall into “the doughnut hole,” the coverage gap where you pay 100 percent of the next $3,216.25. After that, your plan picks up 95 percent of the tab.
There are 56 plans available in the Bakersfield area, so most people can find one that works for them, Prado said. But it does take time to research.
Prado’s office, which is run by the state Department of Aging, can help seniors navigate the benefits.
And unless you also have Medi-Cal or turn 65 in the middle of the year, you have to wait until the open enrollment period at the end of the year to sign up.
If you are low-income, you may be eligible for “extra help,” which could cover up to $3,600 of your prescription costs. You can apply for this through the Social Security Administration.
Prado had some tips for people who have Part D:
–Before committing to any insurance plan, make sure it covers the medicine you need. Ask the plan for a copy of its formulary.
–If your plan doesn’t cover the medicine you need, you can try some of the other cost-saving measures mentioned. Also, talk to your doctor. There may be something else that can be prescribed, or the doctor can appeal to get it covered.
–Check to see if your plan carries restrictions. These can include prior authorization from your doctor, quantity limits or step therapy, in which you have to try the cheaper generic drugs first.
–Make sure you’re refilling when your plan allows you to. Some will charge more if you get a refill even a day or two early.
–Make sure you’re going to the pharmacy approved by your plan.
–Plans can change their prices and formularies anytime during the year. Read the backside of your monthly statement to see any pending changes.
“You may think it’s going to cover everything,” said Dr. Ravi Patel, oncologist and founder of the Comprehensive Blood and Cancer Center. “Read between the fine print.”
—–
To see more of The Bakersfield Californian, or to subscribe to the newspaper, go to http://www.bakersfield.com.
Copyright (c) 2008, The Bakersfield Californian
Distributed by McClatchy-Tribune Information Services.
For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
NYSE:WMT, NYSE:TGT,