Cutting Your Drug Costs

by Richard O. Johnson

Consumer Advocate and Founder of NotBarter.com The Los Angeles Skills Pool

Revised March 20, 2011

Health-related costs—including drug costs—rise faster than any other personal expense. The purpose of this article is to help you fight that trend.

In addition to important general tips, this survey will cover local bargains, private and nonprofit programs, government programs, Canadian pharmacies, and how best to shop online or by mail, linking you to websites with which to pursue the various options. It will also warn you against phony savings.

A. General Tips

These tips apply whether you're buying medications at your corner drugstore or online (or by mail), even from another country. However, buying in person is usually the most expensive way to go, sometimes by a huge margin.

Shop around. Prices vary tremendously, for drugs online and in-store. Compare prices at PharmacyChecker.com, highly recommended.

Ask your doctor for free samples for short-term use*, but otherwise...

Use generics or (for over-the-counter drugs) store brands.

If there's no generic equivalent, ask your doc about a generic in the same family. An example would be switching from proton pump inhibitor Nexium to generic Prilosec (omeprazole), or from ACE inhibitor Mavik to lisinopril.

Split pills when possible. You can often save a bundle by purchasing your medication at double the dosage and splitting it. (Don't try to split capsules or time-release medications. Ask the pharmacist if in doubt.) Drug stores sell inexpensive pill splitters.

The other side of the pill splitting coin is that you may be able to save money if your doctor approves doubling up. For example, a 20 mg pill once a day might be as effective as a 10 mg pill twice a day.

*If you have to continue with the sample drug, its use may prove a false economy—since that medication may turn out to be much more expensive than an older competitor that's equally effective.

B. Bargains at Pharmacy Chains

You can obtain superb values on generic prescription drugs at several chains, currently including Wal-Mart, Sam's Club, Target, and Walgreen's. At this writing, for example, a 30-day supply at Wal-Mart or Target will set you back just $4.00.

For brand-name prescriptions, Kmart's GoldK program offers discounts up to 10 percent. GoldK offers up to 20% off on generics.

C. Private and Nonprofit Programs

You don't have to be destitute or welfare-eligible to qualify for one or more of these programs, some of whose income caps may surprise you.

1. Partnership for Prescription Assistance.

This mega-program takes in nearly 300 individual programs, which give discounts as high as 100%.

The bad news is that (depending on the program) you may have to re-apply as often as every 90 days, and pick up the medication at your doctor's.

Each affiliated program has its own requirements and benefits. Rather than wade through the details for each, you can check out the Partnership for Prescription Assistance, where a short questionnaire will lead you to programs matching your situation. Or call (888) 477-2669.

2. Together Rx Access

This program, at www.togetherrxaccess.com/Tx/jsp/legal.jsp, can save you 25% to 40% off the cost of 300 or so brand-name prescription drugs and other prescription products. It's for applicants not eligible for Medicare, with a yearly income no higher than $45,000 for a single, and $105,000 for a family of five (as examples). Some generics are covered too.

3. Rx Outreach

Discounted prices for over 150 generic drugs at $20 for a 6-month supply, hundreds more at somewhat higher prices. Income limits depend on family size. Go to www.rxoutreach.com.

4. Co-Pay Relief Program, Patient Advocate Foundation

Direct financial support for insured patients, including Medicare Part D beneficiaries, on the basis of financial need. Counselors personally guide applicants through the enrollment process. www.copays.org

5. National Organization for Rare Disorders

Programs to assist the uninsured or under-insured to secure life-saving or life-sustaining medications. www.rarediseases.org/programs/medication

6. Pfizer Helpful Answers

Points you to 7 Pfizer assistance programs, plus other industry programs and government programs. www.pfizerhelpfulanswers.com

7. Pharmaceutical Assistance Program

Comprehensive alphabetical list of drugs whose manufacturers provide assistance, with detailed information about each program. www.medicare.gov/pap/index.asp

8. Benefits Checkup

Questionnaires that will direct you to available help in many areas, including prescription drugs and various other needs. www.benefitscheckup.org/moreprograms.cfm?partner_id=0

D. Government Programs

1. VA

Get the dope at www.va.gov/healtheligibility

2. Medicare

To choose a Medicare drug plan, use Prescription Drug Plan Finder.

3. Children's Health Insurance Program (CHIP)

Families eligible for CHIP may earn as much as three times the federal poverty level ($66,150 for a family of four in 2009), depending on the state. The program covers medical, dental, and hospital care as well as prescriptions. The website of California's CHIP, known as the Healthy Families Program, is at www.healthyfamilies.ca.gov.

4. National Financial Resources Guidebook for Patients

State-by-state directory of information for patients seeking financial relief for medical and other needs. www.patientadvocate.org/report.php

E. Canadian Pharmacies

To discourage the purchase of cheaper drugs from across the border, some have advanced various arguments, which are largely bogus. For example, it's not true that Canadian drugs are unsafe. An October 2003 study by the Illinois Office of Special Advocate for Prescription Drugs found that:

Canada's manufacturing and regulatory system is comparable to that of the U.S., and
Canada's pricing and distribution system is less likely than ours to foster drug counterfeiting.

These findings are supported by a June 2004 report of the U.S. Government Accountability Office, which found zero irregularities in Canadian drugs it ordered.

(You need to be aware, though, that a generic drug is probably cheaper in the U.S. )

The best single criterion for safe purchase of Canadian medications is accreditation by CIPA, the Canadian International Pharmacy Association. You'll also want to consider the criteria in the following section.

F. Shopping Online or by Mail

Following these guidelines could save you a lot of grief whether you're ordering from a pharmacy in or out of the U.S.

Look for a real address, and access to a real pharmacist. A Canadian pharmacy should display its Canadian license or registration number. Any pharmacy should require and maintain a patient medical history.
Avoid online evaluations. These evaluations bypass the need for your own doctor's prescription, but open you up to drugs that may be unsafe for your situation.
Look for a toll-free customer service number.
In addition to price (see Sec. A, above) consider shipping times and shipping costs.
See if the site will accept your health plan. If you can't find out before your order, look elsewhere.
Check out privacy protection. Reputable sites restrict access to your information, such as your credit card number or list of prescriptions. Reputable Canadian pharmacies will conform to PIPEDA, the Canadian privacy act.
Online pharmacies should process payments securely. And any pharmacy should be set up to deliver efficiently what and when it promises.
Ask if the drug has unusual storage requirements. A few medications require refrigeration or can't tolerate extreme temperatures. In those cases, it's prudent to shop locally.
Check the product upon arrival. Make sure it's completely sealed, and—if it's a brand-name product—that it looks just like the pills and package you've used before. (This may not apply to out-of-country orders.) Check the expiration date also, to be certain you'll have time to use it all.
If an online company is within the U.S., look for the VIPPS seal. VIPPS means "Verified Internet Pharmacy Practices Sites," and tells you that the National Association of Boards of Pharmacy certifies that the site complies with the licensing and inspection requirements of its state and other states to which it dispenses.

G. A Good Resource

While I'm a great fan of Consumer Reports, because of their pricing policies I can't endorse the paid online version. However, CR does publish some free webpages, and one such resource you'll want to check out is Consumer Reports Best Buy Drugs. This site suggests drugs "that can effectively meet your medical needs and give you better value for your health care dollar."

H. Phony Savings

Except for the first, these cautions were presented in the pages of Consumer Reports on Health (CROH), an offshoot of Consumer Reports:

First off, beware of scamsters who want you to pay for pointing you to sources of discounts. Their sources will be no better than the sources in this article, which are all free. And of course you're no more likely to be accepted if you paid for the referral.

CROH relates that according to a study of discount medical cards by Georgetown University's Health Policy Institute, "nearly all were worthless." These cards, marketed to the uninsured at a monthly fee, are largely unregulated and have been the subject of lawsuits by attorneys general of several states.

Be wary of gray-market or counterfeit drugs, which may be ineffective, contaminated, or mislabeled, and can be dangerous. These can be obtained from discount drug websites, from Mexican border pharmacies, and from legitimate U.S. pharmacies that purchased outside authorized channels. In April of 2005, federal officials in Utah indicted seven distributors for selling more than 40 such drugs to over 80 pharmacies across the U.S. To protect yourself, follow the guidelines in Section F above (and Section E, if you're ordering from Canada).

This article was adapted from one originally prepared for members of NotBarter.com The Los Angeles Skills Pool. For more information about NotBarter.com, click here.



	Cutting Your Drug Costs by Richard O. Johnson Consumer Advocate and Founder of NotBarter.com The Los Angeles Skills Pool Revised March 20, 2011 Health-related costs—including drug costs—rise faster than any other personal expense. The purpose of this article is to help you fight that trend. In addition to important general tips, this survey will cover local bargains, private and nonprofit programs, government programs, Canadian pharmacies, and how best to shop online or by mail, linking you to websites with which to pursue the various options. It will also warn you against phony savings. A. General Tips These tips apply whether you're buying medications at your corner drugstore or online (or by mail), even from another country. However, buying in person is usually the most expensive way to go, sometimes by a huge margin. Shop around. Prices vary tremendously, for drugs online and in-store. Compare prices at PharmacyChecker.com, highly recommended. Ask your doctor for free samples for short-term use, but otherwise... Use generics or (for over-the-counter drugs) store brands. If there's no generic equivalent, ask your doc about a generic in the same family. An example would be switching from proton pump inhibitor Nexium to generic Prilosec (omeprazole), or from ACE inhibitor Mavik to lisinopril. Split pills when possible. You can often save a bundle by purchasing your medication at double the dosage and splitting it. (Don't try to split capsules or time-release medications. Ask the pharmacist if in doubt.) Drug stores sell inexpensive pill splitters. The other side of the pill splitting coin is that you may be able to save money if your doctor approves doubling up. For example, a 20 mg pill once a day might be as effective as a 10 mg pill twice a day. If you have to continue with the sample drug, its use may prove a false economy—since that medication may turn out to be much more expensive than an older competitor that's equally effective. B. Bargains at Pharmacy Chains You can obtain superb values on generic prescription drugs at several chains, currently including Wal-Mart, Sam's Club, Target, and Walgreen's. At this writing, for example, a 30-day supply at Wal-Mart or Target will set you back just $4.00. For brand-name prescriptions, Kmart's GoldK program offers discounts up to 10 percent. GoldK offers up to 20% off on generics. C. Private and Nonprofit Programs You don't have to be destitute or welfare-eligible to qualify for one or more of these programs, some of whose income caps may surprise you. 1. Partnership for Prescription Assistance. This mega-program takes in nearly 300 individual programs, which give discounts as high as 100%. The bad news is that (depending on the program) you may have to re-apply as often as every 90 days, and pick up the medication at your doctor's. Each affiliated program has its own requirements and benefits. Rather than wade through the details for each, you can check out the Partnership for Prescription Assistance, where a short questionnaire will lead you to programs matching your situation. Or call (888) 477-2669. 2. Together Rx Access This program, at www.togetherrxaccess.com/Tx/jsp/legal.jsp, can save you 25% to 40% off the cost of 300 or so brand-name prescription drugs and other prescription products. It's for applicants not eligible for Medicare, with a yearly income no higher than $45,000 for a single, and $105,000 for a family of five (as examples). Some generics are covered too. 3. Rx Outreach Discounted prices for over 150 generic drugs at $20 for a 6-month supply, hundreds more at somewhat higher prices. Income limits depend on family size. Go to www.rxoutreach.com. 4. Co-Pay Relief Program, Patient Advocate Foundation Direct financial support for insured patients, including Medicare Part D beneficiaries, on the basis of financial need. Counselors personally guide applicants through the enrollment process. www.copays.org 5. National Organization for Rare Disorders Programs to assist the uninsured or under-insured to secure life-saving or life-sustaining medications. www.rarediseases.org/programs/medication 6. Pfizer Helpful Answers Points you to 7 Pfizer assistance programs, plus other industry programs and government programs. www.pfizerhelpfulanswers.com 7. Pharmaceutical Assistance Program Comprehensive alphabetical list of drugs whose manufacturers provide assistance, with detailed information about each program. www.medicare.gov/pap/index.asp 8. Benefits Checkup Questionnaires that will direct you to available help in many areas, including prescription drugs and various other needs. www.benefitscheckup.org/moreprograms.cfm?partner_id=0 D. Government Programs 1. VA Get the dope at www.va.gov/healtheligibility 2. Medicare To choose a Medicare drug plan, use Prescription Drug Plan Finder. 3. Children's Health Insurance Program (CHIP) Families eligible for CHIP may earn as much as three times the federal poverty level ($66,150 for a family of four in 2009), depending on the state. The program covers medical, dental, and hospital care as well as prescriptions. The website of California's CHIP, known as the Healthy Families Program, is at www.healthyfamilies.ca.gov. 4. National Financial Resources Guidebook for Patients State-by-state directory of information for patients seeking financial relief for medical and other needs. www.patientadvocate.org/report.php E. Canadian Pharmacies To discourage the purchase of cheaper drugs from across the border, some have advanced various arguments, which are largely bogus. For example, it's not true that Canadian drugs are unsafe. An October 2003 study by the Illinois Office of Special Advocate for Prescription Drugs found that: Canada's manufacturing and regulatory system is comparable to that of the U.S., and Canada's pricing and distribution system is less likely than ours to foster drug counterfeiting. These findings are supported by a June 2004 report of the U.S. Government Accountability Office, which found zero irregularities in Canadian drugs it ordered. (You need to be aware, though, that a generic drug is probably cheaper in the U.S. ) The best single criterion for safe purchase of Canadian medications is accreditation by CIPA, the Canadian International Pharmacy Association. You'll also want to consider the criteria in the following section. F. Shopping Online or by Mail Following these guidelines could save you a lot of grief whether you're ordering from a pharmacy in or out of the U.S. Look for a real address, and access to a real pharmacist. A Canadian pharmacy should display its Canadian license or registration number. Any pharmacy should require and maintain a patient medical history. Avoid online evaluations. These evaluations bypass the need for your own doctor's prescription, but open you up to drugs that may be unsafe for your situation. Look for a toll-free customer service number. In addition to price (see Sec. A, above) consider shipping times and shipping costs. See if the site will accept your health plan. If you can't find out before your order, look elsewhere. Check out privacy protection. Reputable sites restrict access to your information, such as your credit card number or list of prescriptions. Reputable Canadian pharmacies will conform to PIPEDA, the Canadian privacy act. Online pharmacies should process payments securely. And any pharmacy should be set up to deliver efficiently what and when it promises. Ask if the drug has unusual storage requirements. A few medications require refrigeration or can't tolerate extreme temperatures. In those cases, it's prudent to shop locally. Check the product upon arrival. Make sure it's completely sealed, and—if it's a brand-name product—that it looks just like the pills and package you've used before. (This may not apply to out-of-country orders.) Check the expiration date also, to be certain you'll have time to use it all. If an online company is within the U.S., look for the VIPPS seal. VIPPS means "Verified Internet Pharmacy Practices Sites," and tells you that the National Association of Boards of Pharmacy certifies that the site complies with the licensing and inspection requirements of its state and other states to which it dispenses. G. A Good Resource While I'm a great fan of Consumer Reports, because of their pricing policies I can't endorse the paid online version. However, CR does publish some free webpages, and one such resource you'll want to check out is Consumer Reports Best Buy Drugs. This site suggests drugs "that can effectively meet your medical needs and give you better value for your health care dollar." H. Phony Savings Except for the first, these cautions were presented in the pages of Consumer Reports on Health (CROH), an offshoot of Consumer Reports: First off, beware of scamsters who want you to pay for pointing you to sources of discounts. Their sources will be no better than the sources in this article, which are all free. And of course you're no more likely to be accepted if you paid for the referral. CROH relates that according to a study of discount medical cards by Georgetown University's Health Policy Institute, "nearly all were worthless." These cards, marketed to the uninsured at a monthly fee, are largely unregulated and have been the subject of lawsuits by attorneys general of several states. Be wary of gray-market or counterfeit drugs, which may be ineffective, contaminated, or mislabeled, and can be dangerous. These can be obtained from discount drug websites, from Mexican border pharmacies, and from legitimate U.S. pharmacies that purchased outside authorized channels. In April of 2005, federal officials in Utah indicted seven distributors for selling more than 40 such drugs to over 80 pharmacies across the U.S. To protect yourself, follow the guidelines in Section F above (and Section E, if you're ordering from Canada). This article was adapted from one originally prepared for members of NotBarter.com The Los Angeles Skills Pool. For more information about NotBarter.com, click here.