It is becoming more and more expensive to follow doctor’s orders as the cost of medications continues to rise.
But the first price you see doesn’t have to be the price you pay.
There are many reasons why your medication costs may suddenly skyrocket. Your insurance company may pay less or no longer cover the cost of that particular medication. Or you may need to meet a deductible before your benefits take effect.
“This usually happens at the beginning of your plan year, whenever it means a fresh start for a lot of people – that’s January first,” said Lisa Gill of Consumer Reports. “You go to the pharmacy and suddenly the thing that you might have only paid a $10 co-pay for now costs $80, $90 or several hundred dollars or even more.”
Consumer Reports looked for ways to handle this element of surprise at the counter.
First, double-check that your pharmacy has the correct insurance information. If the cost is still high, ask your pharmacist for help finding the best possible price.
“Should I use any coupon? Or can your pharmacy help negotiate maybe a lower price outside of my insurance, or is there another way to do it through insurance that I’m just not thinking about?” Gill said. “Start asking them, ‘What’s best? What’s the best price you can find for me?’ and go from there.
If you’re getting your medications delivered, compare your online options. Amazon, Costco and HealthWarehouse.com All offer comprehensive pharmacy services. You may also be able to find common generic drugs at cheaper prices at Cost Plus Drugs or Script-co.
“If that doesn’t work, the next thing you should do is call the insurance company,” Gill said. “Well, you want to help and try to understand why this medication isn’t covered very well?”
You can appeal to have your insurance cover the medication or offer a better rate. Check your insurer’s patient portal for appeal instructions.
You may also be asked for prior authorization or proof that you have already tried other, less expensive medications.
Both require some paperwork, but your doctor and others can help you advocate for your health.
After discussing options with your pharmacist and insurance company, you can contact the manufacturer directly.
“If you have insurance and are taking a brand-name drug, the manufacturer typically offers a copay voucher program,” Gill explained.
Manufacturers may offer different copay or coupon programs. Details can usually be found on the manufacturer’s website or the nonprofit organization NeedyMeds.org.
If you have no insurance at all, many manufacturers offer patient assistance programs.
“It depends on your income. But the income level can often be quite high,” Gill said. “The cap is $100,000, maybe even higher.”
Not having insurance can sometimes be cheaper, especially for common generic drugs.
Compare shop prices using online tools such as Pharmacy Checker, IdMe or GoodRX.com. Your local mom and pop pharmacy might also be a good source.
“It’s the independent pharmacists, who typically own their own pharmacy, who are very willing to negotiate with you on price,” Gill said. “They often encounter or beat big, like really big, chain pharmacies or online pharmacies because they like your business and they want to help you.”
Sometimes it is enough to ask the manufacturer directly for an exception.
“Just call them, just explain the situation and say, ‘Can I get this medication for free or for very little?’ and describe your situation,” Gill explained.
“Even if the first customer service representative doesn’t help you, hang up and call again,” she added. “You get another one and just keep trying until you often find someone willing to help you.”
This tactic may not always work, but it’s worth asking about the medications you need.
Join us every weekday morning at 5 a.m. on Eyewitness News for our new ABC7 On Your Side segment. John Gregory offers money-saving tips, including tricks for saving on your bills, smart negotiation tactics, and tips on where to get free stuff!