"You can save as much as 40 percent on leading brand-name drugs...."
"You can receive up to a 10 to 50 percent discount off of the retail price just by showing your card...."
"Savings of up to 65 percent on preferred brand-name prescription drugs...."
–from ads for three prescription discount cards

With the price of an average prescription at $50 and rising, scrambling to keep up with drug costs is at best a hassle. If you are aging, or are caring for aging parents, the effort can become desperate. Older people are more likely to be in ill health and need multiple medications–the average senior citizen rang up $1,756 in prescriptions last year–and less likely to be able to afford them. Two out of five people on Medicare have no coverage for prescription drugs, a recent study suggests, and "gap" coverage is costing more and giving less.

Enter plastic: prescription discount cards. Relatively new but proliferating rapidly, most of these cards are available to anyone but some only to Medicare beneficiaries or to members of groups such as the American Automobile Association or AARP. Some cards are sponsored by drugstore chains, still others by private issuers. All claim to reduce drug costs.

And they do. But by an incredible 40 percent or more? Not for most people. Not for Clara Mertens of Long Branch, N.J., who at 75 years old has to stay on top of the prescriptions she and her 82-year-old husband need for ailments that include arthritis, high blood pressure, elevated cholesterol, and glaucoma–and pay for them on a fixed income slightly above $22,000. The couple spent at least $4,300 in cash for prescriptions in 2001. Last week, wondering why she was paying almost full price for drugs, Mertens asked her pharmacist about the discount on her AARP card, which advertises savings of up to 55 percent. Mertens's savings were rarely above 10 percent, the pharmacist told her. "I couldn't believe it," she says.

Believe it. Figures from the firm that administers the AARP card indicate 11.5 percent savings on a sampling of brand-name drugs commonly prescribed for older people, and 39 percent on a cross section of generics. An investigation by the General Accounting Office last December and a report from the Kaiser Family Foundation in February showed that high discounts can be found but mostly on low-priced generics. A 50 percent discount on a $10 generic saves only $5. For one-time prescriptions, the cards don't seem worth it. For drugs to treat chronic ills like diabetes, they can make a difference, if you're willing to spend hours shopping around–and still the biggest savings may turn up online and even out of the country.

Off what?Even if the claims were more candid, choosing a "discount" card wouldn't be easy. Some cards charge an enrollment fee, most charge a monthly or annual fee, and some charge both. And discount off what price? A true benchmark is the retail price that a cash customer who can't get a price break would pay, a retail price based on information from thousands of pharmacies. That is how AdvancePCS calculates discounts on its RxSavings Plan card, which also is one of the few cards that are free and available to anyone.

But some cards use the "average wholesale price," or AWP, as the reference. The AWP is not the average wholesale price charged to distributors or other middle men. Its real function is for calculating reimbursements to physicians by Medicare and other third parties. Drug manufacturers can set a drug's AWP at any level, and strong evidence suggests that AWPs are inflated. Last year an investigation by the inspector general's office of the U.S. Department of Health and Human Services found that the AWPs for 24 Medicare-reimbursed drugs were pumped up by as much as 84 percent. A discount off such a grossly inflated price won't amount to much, if anything. Not surprisingly, ads rarely say how discounts are figured.

Moreover, prices change and drugs move on and off a card's list of medications. And you may find that your favorite pharmacy won't accept a card. While some 40,000 drugstores will take the AdvancePCS RxSavings Plan card, for example, 20,000 others, including most of the 4,000-plus CVS stores, won't.

The cards vary so much in almost every respect, in fact, that comparison shopping is all but impossible. "If you're a frail 85-year-old woman living alone and not surfing the Web every day or not up to calling around, it's very difficult to sort all this out," says Kaiser's Kristina Hanson, a senior health-policy analyst.

Almost no one argues that shopping for prescription cards will save you a few dollars if you suddenly need a prescription antibiotic or pain reliever. The reason? You'd have to get more than one card to improve the odds that the prescription will be covered. "How many cards can seniors carry around in their wallet?" observes Amanda McCloskey, health policy director for Families USA, a Washington, D.C.-based advocacy group.

But people whose chronic conditions need to be controlled by a number of expensive medications might save enough money to make a search worthwhile. To make sure you and your physician have the widest possible choice of medications, choose a card with an "open formulary"–an unrestricted list of drugs. A reference to a "preferred drug list" in an ad or brochure signals fewer choices.

One option, although limited to a few medications, could let lower-income Medicare beneficiaries chop costs by 75 percent or more. That's by using free cards recently issued by four pharmaceutical manufacturers. Lipitor, for example, a cholesterol-lowering drug with a retail price of about $72 for a one-month supply, costs $15 with Pfizer's Share Card. Applicants must fall below an annual income threshold–$18,000 or $26,000 for individuals and $26,000 or $35,000 for couples, depending on the card. And of the 50 most-prescribed drugs, the four cards only cover 12. The programs are:

• Share Card (Pfizer; 800-717-6005). Members pay $15 for a one-month supply of any Pfizer drug.

• LillyAnswers (Eli Lilly; 877-795-4559). Members pay $12 for a one-month supply of any Lilly drug.

• Orange Card (GlaxoSmithKline; 888-672-6436). Claimed discounts averaging 30 percent on Glaxo drugs.

• CareCard (Novartis; 866-974-2273). Claimed discounts of 30 percent to 40 percent on Novartis drugs.

Using manufacturers' cards could become easier in late May, when the National Association of Chain Drug Stores plans to roll out PharmacyCareOne, a card intended to consolidate as many manufacturers' programs as possible.

O Canada! There is also the Canada option. Thanks to government price controls, brand-name drugs can be breathtakingly cheap when purchased from the north, as busloads of older people living near the border have done for some time. For those beyond the snow belt, going online is a good option. The process is only slightly more complicated than ordering online from a U.S. supplier, and the drugs are just as safe. But not all prescription medications are cheaper to the north. A recent analysis by the Fraser Institute, a research group in Vancouver, found that generic drugs can be more expensive.

Switching to generics or to cheaper brands also can slash your drug bill. For $12.95, Rxaminer (www.rxaminer.com) will identify the alternatives for a medicine cabinet's worth of prescriptions for you to print out and discuss with your doctor and pharmacist.

At the very least, anyone on Medicare should ask at the pharmacy counter about a senior discount. At her four drugstores in Seattle, co-owner Holly Whitcomb Henry won't accept any discount cards other than those from manufacturers. ...