Saving Money on Prescription Drugs (revised)

by Caleb Reading

I posted a shorter version of this here back in February, but I have made some edits and useful additions. The original version is at: https://ludditeandroid.wordpress.com/2004/02/11/saving-money-on-prescription-drugs/

I work in a drug store; here are some of the money-saving techniques we tell our customers about:

If there’s a generic available, get it. I can only think of two drugs where it is difficult to switch to a generic: Coumadin (generic name: Warfarin Sodium) and Synthroid (generic name: Levothroid). But this is not because of any flaw in the generics. Warfarin is an anticoagulant, and Levothroid is for the thyroid. Because they both require such a delicate balance in the system, it’s not recommended to switch brands. If a doctor writes you a prescription for Synthroid or Coumadin, get the generic the very first time, or you may be stuck taking the overpriced brand name until a dosage change is required.

Make sure the doctor is making the generic available If the doctor writes a prescription for a brand name then writes “DAW” or “dispense as written” or checks a box on the script that says that, ask them why they aren’t allowing you to get the generic. If you come into the drugstore with a DAW script for a brand name, we can’t legally give you the generic unless the doctor authorizes a new prescription.
Also, there are some brand name drugs without a generic that are in the same family of drugs as a different brandname that has a generic available. Ultracet, for example, contains acetaminophen along with the same drug as Ultram (generic name: Tramadol). It might save you money to get a prescription for Tramadol and take OTC acetaminophen instead. If the doctor writes a prescription for acetaminophen, the pharmacist may be able to run the OTC acetaminophen through as a prescription so you don’t have to pay sales tax on it. Which brings us to the next tip:

Some OTC’s can be run through as prescriptions so you don’t have to pay sales tax Also, if this is an OTC that legally can be ran through as a prescription, you may also be able to tax deduct it. [UPDATED TO ADD: Note the word “some“.  This rarely works so DON’T SCREAM AT US if we say we can’t do it.]

Avoid drugs that re-patent themselves with new names to keep you from changing to generics. The most successful drug I can think of that employs this dirty trick is Nexium (the “new” purple pill). Nexium is the same basic molecule as Prilosec (which is OTC and has a very affordable generic, Omeprazole), only Nexium is a “left hand” molecule and Prilosec is a mix of “right hand” and “left hand” molecules.  The standard dose of Omeprazole is 20 mg and the standard dose of Nexium is 40 mg.  Drug reps went around saying how much “better” Nexium worked by comparing 20 mg of Omeprazole to 40 mg of Nexium.  It’s twice as much.  So what if twice as much worked better?  Take two Omeprazole and pocket an extra thousand dollars per year then.  That’s not an exaggeration.  Nexium is extremely expensive compared to Omeprazole.

Another notable example is how Eli Lilly has re-patented Prozac (fluoxetine) as three other “new” drugs (Serafem, Fontex, and Symbyax*) then proceeded to advertise the hell out of Serafem as a treatment for pre-menstrual depression to get women to pay the premium for it instead of buying generic fluoxetine instead.
[* Symbyax is actually a combination of fluoxetine and olanzapine]

Make sure you have refills before you drive to the drugstore This will save you gas and time. Calling the drugstore is the best way to check this, and be sure to also request the refill over the phone at the same time . Just because a bottle you have says “x number of refills” doesn’t guarantee you have that many. The prescription may have expired (most expire after six months or one year), or you may be looking at an older bottle.

Splitting pills Certain drugs (Lipitor and Zocor especially) cost very little more for a higher dose. If you don’t pay a flat copay, ask how much money you could save if you bought half as many pills in a double dose and split them (assuming it’s in a form that can be split). It’s possible with some drugs to quarter pills (if the doctor’s okay with that), but the drugstore won’t do this for you because pills have a tendency to crumble and the drugstore doesn’t want to be held liable for that.

If your insurance and the government allows (and you have enough refills), getting more than one month at a time might save you money. There is a per-ticket fee for every prescription (to pay for the bottle, label, sack, paperwork, etc), so getting several months at once (if feasible) can remove some of the per-ticket fees if you don’t have a flat copay. If you have a flat copay, you may be able to get more than one month (3 months at a time usually, called a “vacation override”) and only pay the one copay. This depends on your insurer though, so please don’t blame the pharmacist if your insurer doesn’t allow it. And, no, throwing a tantrum like a bratty child will not convince us to commit insurance fraud for you (it’s unbelievable how many times we get that every day). For control drugs, there is very little possibility that you can get more than one month at a time. Please do not expect the pharmacist to break the law for you. It’s not going to happen.

Check into discount programs If you have no prescription drug company, our store has a free discount card from our drug supplier that we give out. The typical discount is 15% if the drug is on that plan. If you saw a discount card on a television ad, it’s probably crap. Maybe not, but that seems to be the trend. You may want to ask your pharmacist for recommendations. Some of these cards charge us a $4 fee just to run something through, but then the price they want to set is only $2 more than the cost of the drug (not even counting other overhead costs). Obviously, we don’t take those cards, because we are barely keeping afloat with a 1.3% profit margin and aren’t about to start losing money on every one of these prescriptions.

Some other programs that may be very helpful on certain drugs, if you qualify (usually requires low income and/or advanced age), include the following:

http://www.togetherrx.com/ — Last I checked, the income cut-off for this was $28,000 for singles and $38,000 for couples. This card can shave up to 40% off any drug manufactured by Abbott Labs, AstraZeneca, Aventis, Bristol-Myers Squibb, GlaxoSmithKline, Johnson & Johnson, or Novartis.

http://www.careplan.novartis.com/index2.html — “25 to 40% off selected Novartis medicines for Medicare recipients earning $18,000-$28,000/yr ($24,000-$38,000 per couple)* without prescription drug coverage”

http://www.lillyanswers.com/en/index.html — “for Medicare-enrolled seniors and Medicare-enrolled people with disabilities who have: No other prescription drug coverage and Individual annual income below $18,000 or household income below $24,000”

http://www.pfizerforliving.com/pfl/index.jsp — I’m almost certain this card is being discontinued because pfizer seems to think the new Medicare cards eliminate the need for their Sharecards.

http://us.gsk.com/card/index.htm — “The Orange Card is for seniors and the disabled enrolled in Medicare who have annual incomes below $30,000 single/$40,000 couple and are currently without public or private insurance coverage for prescription medicines. […] The Orange Card is designed to provide an average savings of 30% per prescription off the usual price eligible seniors without presciption drug insurance pay at their pharmacy.”

Those are the plans I’m familiar with, but there are more out there. If you don’t qualify for any of those (if too young, for example) you can do a google search for “prescription assistance”. Caveat Emptor.

I can’t stress enough, do not blame us if your card is crap. We didn’t buy it, and we don’t run the company who sold it to you. We couldn’t read your mind and call your house to warn you at 2 am about the card you just saw on a late-night ad. We aren’t psychic, and we aren’t your momma.

Inform your doctor of what your card(s) cover With all the thousands of insurance plans out there, neither we nor your doctor are going to know what your exact formulary list looks like. Keep track of every mailing you get from your insurer, as even those magazines they may send you that look like junk sometimes contain drug formulary updates. If you know your card covers Lipitor but not Crestor, for example, you can tell your doctor that before they write that prescription for Crestor. They’d probably rather have you on their second choice rather than not taking anything at all. If you keep track of your formulary list, you can also plan ahead if a drug you’re on is about to be dropped or raised to a higher copay. Also keep in mind that most doctors don’t know exactly what the Average Wholesale Price of the drugs are. If a doctor tells you something costs “about $50” don’t call us crooks if it turns out to be $75, and don’t assume it’s okay to buy a carton of smokes on the way to the drug store because you’ll still have $51 left afterwards. The doctors don’t have to sell the drug, so they aren’t always familiar with the price.

There may be rebates available Items I know of that we currently have rebates available for here at the store are Flonase ($5 off, redeemed at the cash register) and Aciphex ($30 off, mail in rebate). As far as I know, these two rebates can be used for each refill, provided you obtain enough non-expired rebate forms. We cannot take expired rebate checks, and it’s not our responsibility to call drug companies for you to sign you up for rebate check mail-in rebates.

Here are some other rebates available via the internet:

$5 off every refill of flonase and some free gifts (they must be marking that stuff up like gangbusters):
http://www.allergyrewards.com/

7 Prevacid capsules free:
https://www.prevacid.com/prevacid_offers/prevacid_offer/default.asp

4 Sonata capsules free:
https://maxvps005.maximumasp.com/v005u28qau/sonata/consumer/free_trial.asp

Up to $10 off Rhinocort Aqua:
http://www.rhinocortaqua.com/c/save/kit.asp?promo=10

7-day trial of Celebrex:
http://www.celebrex.com/free_7_day_trial.asp

Nasonex rebate (site loads very slowly):
http://www.nasonex.com/nasx/application?namespace=coupon&origin=unauth_home.jsp&event=coupon&web_program_id=00000400

The only one of these rebates I linked to that I consider to be a good offer is the Flonase one (if you need it). The others aren’t particularly great unless you really need to be on the drug anyway. Most of the drugs that have free trial-offers are marked up so high by the drug company that they get all that money back from you and more very quickly. We at the drugstore would rather see you buy a generic instead. That leaves you with more money to spend within our own community.

Don’t over-medicate Taking more medications than you actually need is not only costly, but it can adversely affect your future insurance rates and your health. Don’t insist on Vicodin (hydrocodone and acetaminophen 5/500) for a pain that can be handled with cheap, OTC generic acetaminophen. Consider taking loratadine (generic claritin) if it works for you rather than going with the prescription non-sedating antihistamine that costs you and your insurer $40 each every month. Keep track of where the money is going. Feel free to ask how much something would cost without insurance. It’s good to know.

Please do not be rude to the people at the drugstore. Not all of these tips are going to work in every situation. Often your insurance or a law may get in the way. We didn’t pick your insurance, and we have to abide by the law. If you are mean to us when we’re trying to help you, we will be less likely to tell you about money-saving opportunities in the future because we will be in a hurry to get you out of the store and far away from us. If we do have some of those aforementioned rebate checks on hand, for example, we’d only give them to the difficult customers if we have an excess of them. The people least likely to get extra services and specials are the people who whine about entitlements and who don’t say a simple “thank you” when they get a freebie. Nice customers are our top priority, and we go out of our way to help these people.

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UPDATED TO ADD:

Somebody asked me why I didn’t list mail order prescriptions as a way to save money.  The reason I didn’t put mail-order pharmacies on the list is because I have personal objections to them. Some insurance companies own controlling interest in or receive kickbacks from the mail order outfit they endorse. When they do that, it’s taking money from one pocket and putting it in the other, all the while bullying small, independent, rural businesses like ours closer to insolvency. If we get shut down, the nearest brick-and-morter drug store is a very long drive away. This is a factory town. Many people simply and absolutely can not go on a long, expensive drive for an emergency supply of something. If we went bankrupt, I and my coworkers could find new jobs and bounce back okay eventually, but the most vulnerable members of our community would be facing a health crisis.  That’s not saving them money in the long run. And I don’t consider this kind of insurance company manipulation to be “free market” behavior, either.

On top of that, at least twice a month someone comes into our little store and has to pay cash completely out-of-pocket for anywhere from 3 to 10 days worth of prescriptions that didn’t arrive from the mail order company in time. They’ve already been run through insurance and dispensed by the mail order company, so we absolutely can’t get them to go through the insurance. Unfortunately, the people often can’t get through to whoever’s really responsible for the mix-up, so many of them take out their frustration on us.

So, no, I’m not going to recommend mail-order.

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