I will speaking tomorrow at a community event on how seniors can save money on prescriptions.  With Americans spending approximately $1,200 a year on prescription medications, it’s no wonder this is such a concern for many of our seniors, who tend to be on more medicines than most.  A recent study by the Kaiser Family Foundation showed that nearly one-third of patients say they’re skipping prescription medicines prescribed to them because of the cost concerns.  Trying to keep costs under control can be a challenge, especially since neither the patient nor the prescriber typically do not know what the patient will actually pay for their medications until the pharmacist checks the patient’s coverage.  This is even more tricky since drug prices can vary widely from pharmacy to pharmacy, even if you have insurance.

Here are a few things I recommend to consider in trying to cut your out of pocket costs for prescription medications.

• Do you really need the medicine in the first place?  When I get a new patient, especially for seniors, they often have a lot of specialists, but no primary care physician that is trying to coordinate.  This can cause duplicate and unnecessary medications.  In addition, especially when multiple doctors are involved, patients will sometimes be on one medication that treats a side effect of another medicine.  This is generally not good practice. Another reason for excess medications is that patients will often go to the hospital, and be discharged on the medicines that they were getting in the hospital, with no one really adjusting these medications for back home.  There are multiple medications that hospital patients take that no longer need to be taken once out of the hospital.  multiple doctors/duplicate medicine. Finally, there are some medications that patients take that are really no longer recommended.  For example, niacin and fibrates for heart disease or taking osteoporis medicines like Fosamax for more than 5 years.
• Are you taking branded medicines, or worse non-preferred branded medicines? In general, generic medications are just as good as branded medications.  Fortunately about 87% of medicines prescribed are generic.  By taking a generic, you will save a lot of money.  Unfortunately, there are times when patients need medicines that aren’t available in generic, especially for diabetes and respiratory diseases.  In these cases, you want to make sure that you are using the preferred branded medication, since there is usually more than one.  In general, there isn’t much difference between medicines in the same class, or at least enough of a difference that it is worth paying a lot extra.
• Are you using all available discounts? The pricing on pharmaceuticals is a huge challenge. It might surprise you that even with insurance, for some generic medications, it would be cheaper to pay out of pocket (no insurance) than to pay an insurance co-pay?  You would think that a pharmacist might tell you this, and if you ask, they will.  However, they are so busy that they are not necessarily going to recommend paying out of pocket.  In addition, there are companies like GoodRx.com that have coupons which can save you alot of money on both branded and generic medications by bypassing insurance. Finally, for those under 65, the drug companies have coupons on their wesbite that can lower the cost of your co-pay.  In some cases, you may pay practically nothing for a very expensive branded medication.
• Have you checked your Medicare Part D plans during open enrollment?- For seniors, many pay for medications using Part D plans.  Picking the right one can be incredibly confusing, and often comes down to the best price on the medications that you are currently taking.  Unfortunately, these prices change from year to year.  In September, you should have received annual notice of change sent in the mail which can tell you changes in what your Part D plan pays for.  It is very important to check this as changes from year to year could cost you hundreds of dollars.  Open enrollment is only for a limited time each year, so please check any changes in your Part D plan.

Author Matthew L. Mintz, MD, FACP