How to pay less for your prescription drugs, legally


by Susan Scutti

Source: CNN

Even a not-so-pricey drug can add up to a nightmare expense when it needs to be refilled every month.

The $600 price tag on EpiPens, $1,000-per-pill hepatitis C drug Sovaldi and the $750-per-pill price increase on the AIDS drug Daraprim have spurred outrage over pharmaceutical drug costs. To get prescription medicines for less, many people try these six tricks.

Free samples

Some patients request free samples from their doctors to help reduce drug costs, according to the Food and Drug Administration website. From the physician's perspective, this is an easy way to ease a patient's concerns. After all, pharmaceutical companies give free samples of brand-name drugs -- usually the new, expensive ones -- to doctors as a promotional tool, so those doctors usually have no problem passing them on to their patients.

However, free samples are intended to allow patients to evaluate the side effects of a new drug for a couple of weeks before actually buying it, according to the FDA. So samples, by definition, provide only a temporary fix.

Generic drugs           

Many people ask either their doctors or their pharmacists to swap out a brand prescription for a cheaper generic alternative. Generics are variations on the expensive name-brand drugs that have lost patent protection.

"Whereas the average cost of a name-brand prescription was $268 in 2011, it was only about $33 for a generic drug," noted the National Center for Policy Analysis (PDF), a nonprofit, nonpartisan public policy research organization.

Naturally, many people make good use of these lower prices. According Holly Campbell, a spokeswoman for PhRMA, an industry representative for drug makers, "generic utilization rates are nearly 90%."

Getting the best price on a drug may require an extra step beyond simply asking. Often, pharmacies offer discounts on generics for those who buy in bulk, such as when you purchase a three-month supply of your medication all at once. You may also need to explain any special circumstances, such as being a student or a senior, and it helps to simply request the lowest price possible.

The major chain pharmacies also offer discount generic-drug programs, which you usually pay a small fee to join. You also need to provide them with personal information (that may be sold to marketing companies). If you have a chronic illness and know that many refills are down the road, the fee and divulged data may be worth it to you.

Though generic drugs may appear to be more cost-efficient, they may not be as low-cost as consumers anticipate. For instance, the National Center for Policy Analysis found that half of all generic drugs increased in price over a one-year period ending in July 2014, with some rising in price dramatically: Eighteen percent of generic drugs rose in price by 25% or more, while some increased by more than 100%.

Another potential downside with generics is a slight difference in formulation, which may equal a big difference in side effects. Though the brand name is easy to tolerate, you might get a headache, say, when taking the generic. However, in some cases, the reverse is true, and some patients tolerate the generic better than the brand-name.

Prescription drug coupons  

These coupons market discounts and rebates on out-of-pocket expenses or co-pays directly to the consumer. They are available from various sources, including doctors' offices, marketing pamphlets and online. Typically, consumers sign up online for virtual drug discount cards and then do a web search and print out an eCoupon to be used at a pharmacy.

Non-manufacturer websites actively promote eCoupons and drug discount card services using Facebook promotional pages, Twitter and even YouTube videos.

The free app and website GoodRx allows consumers to search, shop for and download coupons from their own cell phone or computer. Basically, you print out a card or coupon, go to the pharmacy and present it for either a reduced cost or reimbursement.

What may be misleading about coupons is that you may end up paying more or being reimbursed less than you expected, said Timothy K. Mackey, director of the Global Health Policy Institute at the University of California, San Diego School of Medicine.

As Mackey explained, zero-pay coupons may seem generous on the part of pharmaceutical companies, but ultimately, insurers end up paying what you do not. To offset costs, insurers eventually change their coverage limits or raise the co-pay on certain drugs in order to pass the costs back to consumers.

Even more, whenever you apply online for a discount card or coupon, what is written into the terms and conditions is data collection: The pharmaceutical company is gathering marketing data on what you think and your demographics, which can be used or sold.

While most of us perceive these subsidized consumer copays as a discount, they're really a whole ecosystem of brand recognition, brand loyalty and data generation for marketing, said Mackey. Consumers need to be careful when using coupons, keeping abreast of any changes in terms and prices. Though at first a coupon supplies a discount, a generic may come on market some time later, so you may continue buying the discounted brand when a much cheaper generic is available.

A recent behind-the-curtain program was launched by Physicians Interactive: eCoupon automatically searches for and delivers any applicable prescription drug coupons for you directly to your pharmacy. That may sound wonderful, but according to Mackey, it's just another direct-to-consumer advertising scheme.

Essentially, the system checks coupon availability for any medication prescribed by your doctor, checks your personal eligibility and then automatically sends a coupon for you directly to your pharmacy. Leveraging and linking your electronic health records to prescribing systems, this smart system "target markets" you at the point of sale.

Patient assistance programs

Commonly referred to as PAPs, these pharmaceutical drug company programs offer free or reduced-cost medications to low-income, underinsured or uninsured individuals.

Because each medication may have its own PAP and eligibility requirements, signing up for these programs is "onerous," according to Mackey.

"Every company has its own eligibility criteria for PAPs, and, in most cases, US citizenship and some proof of income, such as tax records or a record of social security benefits, are required," according to the FDA. PAP forms also require a doctor's signature.

PatientAssistance.com, a nonprofit organization founded in 2008, provides consumers with a searchable database of thousands of PAPs, allowing you to browse by brand name, generic drug name or pharmaceutical company name. There's also the Partnership for Prescription Assistance, a website that provides access to more than 275 public and private PAPs, including more than 150 programs offered by drug companies. It also shows people how to contact Medicare and other government programs.

"We in the research community don't see them as terribly effective, but we don't have data on this," Mackey added. "We don't know the impact they have."

Comparison shopping

Prescription drug prices are not set in stone and can vary greatly among pharmacies and retail stores. The indie drugstore may offer a better price than the big chain. Prices can even vary between locations of the same chain.

To help you find the best price, there are a variety of websites and apps. One website, BlinkHealth, offers online prices with the security of brick-and-mortar oversight; with this site, you can search for drugs and pay cut-rate prices online and then pick up your prescription at a nearby pharmacy.

LowestMed, a freebie, helps you compare prescription drug prices at local stores. Type in the name of your drug, and this app, which claims it will find discounts as high as 85%, will compare prices in your area. Prescription Saver, another free app, performs nearly the same service, with the added benefit of giving directions to the nearest cost-saving pharmacy.

The OTC Plus, designed by board-certified doctors, is essentially a matchmaking app joining an over-the-counter medication to a list of your particular symptoms. This free app also shows you how to read medicine labels and sends coupons to your cell phone.

Finally, the big-time players such as Walgreens, CVS and Rite Aid each have free apps for customers. These help customers fill and refill prescriptions and show weekly discounts on pharmaceutical prices.

Online pharmacies

"In January 1999, Soma.com became the first pharmacy to operate via the Internet and sell medicines directly to the consumer," Mackey noted in a paper published this year. Today, an estimated 35,000 online pharmacies operate globally.

Digital drugstores may work to your benefit ... or deliver death directly to your door via UPS.

"If you go to online pharmacies, there's a host of drugs they sell," said Mackey, who noted among the plethora of available options are "products you shouldn't be able to get," such as drugs in critical shortage, vaccines and controlled substances.

Make no mistake that excellent online pharmacies exist, selling FDA-approved medications to people with prescriptions. To verify a website, the FDA recommends looking for the National Association of Boards of Pharmacy's Verified Internet Pharmacy Practice Sites Seal and then visiting the website to confirm.

Mackey suggests Legitscript, an internet security company that uses computational methods to determine whether a particular site is complying with laws and regulations.

In the virtual world, you cannot trust that an online pharmacy with an address in Saskatchewan, Canada, is real. You need to check a pharmacy's legitimacy; otherwise, you may unknowingly purchase counterfeit drugs or real drugs that have expired.

"You're taking a risk," said Mackey, "Expired or counterfeit, the drug's not going to be effective when you use it." For a drug intended to be life-saving -- such as an EpiPen -- unless it's the real deal, you could die.

"The reason online pharmacies exist is because there's a demand," Mackey said.

Original Article