7-Strategies for Decreasing Out-of-Pocket Medication Costs

GENERIC MEDICATIONS

The most obvious and important tactic is to always use generics when available. Generic medicines are essentially copies of brand-name medications and are monitored by the FDA to ensure they are equally as effective and safe as their brand-name counterparts. They contain the same active ingredient as the brand-name medicine, and they are subject to the same government rules about strength, quality, and purity.

Using generic medications can save patients a tremendous amount of money. According to UpToDate, an average 30-day supply of a “brand-name” prescription medicine costs about $250 a month without insurance coverage, whereas the average generic drug costs about $25 a month without insurance. In fact, as we discuss below, many generic drugs cost only $4 per month from a number of drug stores.

When prescribing a medication, you should always check to see if there is a:

• Generic form available for that brand-name medication: for example, levothyroxine instead of Synthroid for hypothyroidism. A handy resource for for finding generic alternatives is the FDA’s Orange Book and its app-equivalent, OB Express 2.0. These cover generics for both prescription and over-the-counter pharmaceuticals.
• Another medicine available in generic form that will treat the condition: for example, there are many different antidepressants, statins, and oral contraceptive pills available. While not every brand-name medication has a generic form available, it is almost always possible to use a different medication within that same drug class that will be equally effective.
• A different formulation of the brand-name medicine that is available as a generic: for example, Toprol XL (metoprolol succinate) vs Metroprolol tartrate; Glumetza (extended-release metformin) vs metformin
• Lower-cost brand medicine: If a generic medication is not available, oftentimes there is another brand-name medicine that can be used to treat the condition that could be more cost-effective.

ORDERING IN BULK

Patients may be able to save money by ordering medications in bulk. For example, ordering a 3-month supply of medications can cost less (for example, discount medications are often $4 for a month supply and $10 for a 90-day supply) and require fewer co-pays over the course of a year for the patient.

One study found a 29% decrease in out-of-pocket costs with using 3-month vs 1-month supply.

THERAPEUTIC ALTERNATIVES

OVER-THE-COUNTER (OTC) MEDICATIONS

Some medications are available at a lower cost without a prescription (over-the-counter (OTC) medications).

OTC medications are approved by the FDA and are guaranteed to be safe and effective.

For example, medications for reflux/heartburn like Nexium or Prilosec are available as lower-cost non-prescription versions. Ibuprofen can be obtained without a prescription at much lower cost, and often times can be even cheaper when purchased in bulk. For example, Costco Wholesale sells a pack of 1000 200mg Ibuprofen caplets for $8.79, or about 1 cent a caplet. The same medication in a brand name 50 caplet bottle sells for $6.99, or 14 cents a caplet, a 93% markup from the bulk price for the same medication. Even for the same volume of caplets, a non-brand name can save money. A 50 caplet bottle of drug-store-brand 200mg Ibuprofen sells for $5.49, or 11 cents a caplet, still 21% lower cost per tablet than the brand name.

LESS EXPENSIVE BRAND-NAME MEDICATIONS

For many conditions, there are multiple medication options available. Drug coverage plans are often “tiered,” meaning that different medications will cost patients different out-of-pocket amounts depending on which tier that medication is in.

Although it may be challenging for prescribers to always know which are the “preferred drugs” for a given insurance plan, it is important that they, at the very least, alert patients that there could be alternatives available so they should check with their insurance and the medication can be changed to a different drug that will be equally effective. Better yet, physicians can work with clinical pharmacists who can help ensure that new prescriptions are personalized to be the best option for a given patient. Many electronic medical records are now building in tools that provide alerts about which medications are on the formulary or are preferred by the patient’s insurance plan.

MEDICATION REVIEW

Of course, the most effective way to decrease cost, pill burden and medication regimen complexity simultaneously is to stop medications that patients do not need.

Sometimes medications are started for a specific indication, such as PPI medication for a gastric ulcer, and are never discontinued even after the problem has resolved. Or, even worse, we have seen patients who were started on a PPI as prophylaxis while intubated in an ICU, and then the med was simply added to their list. Years later, they were still taking a PPI though nobody really knew why anymore.

As patients’ overall conditions change, sometimes certain medications are no longer helpful, such as a statin for primary prevention in a patient who has terminal cancer.

By regularly reviewing medications and practicing the principles of “conservative prescribing,” clinicians can make a big difference for patients.

“Deprescribing” describes the process of intentionally tapering, stopping, discontinuing, or withdrawing medications, with the goal of improving outcomes by improving a person’s health and/or reducing the risk of adverse side effects.

There are a number of resources to assist with identifying medications that may be inappropriate for use in the elderly, including the Beers Criteria and the STOPP criteria.

SPLITTING PILLS

Sometimes higher dose tablets, which can cost the same as a lower dosage, can be split. This could effectively save up to 50% each month for patients.

For example, if a patient takes a 20mg dose of a certain drug, the 40mg version of the same drug may cost the exact same amount, so the 40mg pills can be prescribed and the patient can split the pill each day.

CAUTION: NOT ALL PILLS CAN BE SPLIT.
IMPORTANT TO CONSULT WITH A DOCTOR.

As per GoodRx.com, here are some important things to consider before pill splitting:

• Pill splitters can be bought at most pharmacies for around $5.

• Some immediate-release tablets may be split, and tablets that are scored have been evaluated by the FDA for safety.

• Not all pills can be split.

DON’T SPLIT DRUGS WITH:

an enteric coating
(designed to protect the stomach)

drugs that are time-release or long-acting

drugs taken more often than once a day

drugs in capsules

prepackaged drugs in specific doses
(like birth control pills)

• Pill splitting is also not recommended for situations where the patient might not understand the concept or be capable of splitting a pill. Pill splitting often requires fine tactile skills, and is not for everyone.

• Recommend to patients that they use a pill box and ensure both halves of the same pill are taken within a 48-hour period. This will minimize variation that comes from uneven pill splitting.

• For a complete list of pills that should not be crushed, see the Institute for Safe Medication Practices list.