You may have to do a little legwork -- talk to your doctor, shop around, find a discount card -- but bargains are out there in most cases.
You don't have to be uninsured to worry about the cost of prescription drugs.
Increasingly, employers are boosting co-payments and placing restrictions on what medicines are covered under company insurance plans. And though Medicare Part D has helped pay for millions of prescriptions, many seniors still struggle with the cost of their medications.
Yet people find ways to rein in the cost, and some pharmacies, drug companies and Web sites are helping their efforts. Here's what you need to know to get started on trimming your medicine bills:
Check your policy, if you have one. If your health insurance covers prescription drugs, it may have lower co-pays for generic drugs. A typical co-pay is $10 or $20 for a generic prescription and $30 or more for a brand-name version.
Many insurers have arrangements with mail-order pharmacies that allow patients to get three-month supplies of many "maintenance," or long-term, medications, either at a discount or with lower co-pays -- one or two months' worth of co-pays, for example, instead of having to pay for all three months. Your policy also may cap how much it will pay out annually for prescriptions or pay only for drugs on its formulary, which is a preferred list of medications.
Enlist your doctor and your pharmacist. If you want to cap your drug costs, you need these professionals as allies. Your physician knows your medical history and can discuss alternative therapies with you, while your pharmacist may be more aware of the specific costs of those alternatives. Also, pharmacists tend to be more clued in about what prescription drugs are about to be available over the counter.
Ask whether a prescription is necessary. There are plenty of over-the-counter medications that often work as well as their prescription counterparts. Some of these OTC remedies, such as Claritin for allergies or Prilosec for heartburn, were prescription-only until relatively recently.
Other OTC medicines have a long history of effectiveness. Consumer Reports recently noted, for example, that nonprescription drugs containing antihistamines -- such as Benadryl, Nytol, Sominex, Tylenol PM and Unisom -- can be just as helpful for occasional sleeplessness as more heavily promoted (and expensive) prescription medications such as Ambien, Lunesta, Rozerem and Sonata.
Or maybe the answer isn't a drug at all. Maybe what you really need is to take better care of yourself. Your Money message board poster "umich24" reports saving about 50% on drug costs simply by asking whether a drug is actually required.
"I always ask the doctor if the prescription is REALLY necessary, or if extra sleep, some vitamins, or a home remedy will do the trick," umich24 wrote. "You'd be surprised what the answer is the majority of the time."
If you're overweight, don't get enough exercise, eat a lousy diet or constantly are stressed, fixing those issues also can save you a bundle in the long run.
"I know that some people simply have uncontrollable high blood pressure, diabetes, etc., but if your doctor warns you about (being) pre-diabetes . . . take him seriously and make the lifestyle changes," poster "BerryBlack" wrote. "It might not work -- some people are going to have these conditions no matter what they do -- but it's better to avoid the problem to start with rather than pay for meds after things have gone to hell."
Ask about drug alternatives. If a prescription is necessary, find out first if there is a generic version that might work for you. Generics are basically former brand-name drugs whose patents have expired. The average prescription for a generic cost $29.82 in 2005, according to the National Association of Chain Drug Stores, while the average brand-name prescription cost $101.71.
Web sites such as Rxaminer, founded by a cardiologist, can help you explore potential alternatives to many brand-name drugs. Obviously, you'll want to discuss the options with your physician.
There isn't always a generic equivalent. That's where "pill splitting" can come in handy. Since increased dosages of a drug often don't cost substantially more, your doctor can in some cases prescribe a larger pill that you can slice using a splitter available for $5 at most pharmacies.
Someone taking a 10-milligram daily dose of the high-cholesterol medication Lipitor, for example, would pay $1,020 annually for the medication. If she took half of a 20-milligram pill, by contrast, she could lower the cost to $732, according to Rxaminer.
Not all pills can or should be split, though, and this is not a do-it-yourself project. Talk to your doctor first.
Your doctor also may be able to write the prescription in a way that takes best advantage of your insurance policy's co-pays. Your Money poster "Loomatic" used to face a $30 co-pay for each six-pill box of Relpax, a migraine medication Loomatic bought six times a year.
"The last time I went to the doctor, I mentioned that I was going to switch to our mail-order plan to try to save money," Loomatic wrote. "So she wrote my prescription for 36 pills, and I mailed it in. I got all six boxes at once, with only one co-pay of $30. And it is a huge relief to know that I won't be running out of migraine medicine anytime soon!"
Though buying in bulk often results in savings, sometimes you might want to ask for less, particularly if you're not sure how you'll react to the drug or if it's a painkiller that might not be necessary.
"My daughter was prescribed Lortab after her ear tube surgery and she used two doses from a full bottle," Your Money poster "Table for 2" wrote. "So here is a $150 bottle of painkiller that she only used twice."
Ask for samples. If there's no generic equivalent, your doctor may be able to supply you with enough free samples of a prescription drug to at least reduce your costs somewhat. Most physicians have a closet full of prescription-drug samples, thanks to free-handed drug vendors.
Shop around. Once you've got your prescription in hand, a little time spent on the Web and on the phone can save bundles of money. By the way, you should put as much or even more effort into shopping your generic prescriptions as you do your brand-name ones. The price you pay for a generic can vary by 80% or more, depending on where you buy it, while a brand-name drug's cost typically varies by only 10% or so.
"We call around to different pharmacies when we start on a new long-term medicine," Your Money poster "pleroma8" wrote. "We have found that there is a big difference on cost when comparing one pharmacy to another one."
Seriously. One Houston physician who compared prices for a 90-day supply of generic Prozac found the cost ranged from a high of $117 at a chain pharmacy to a low of $12 at a warehouse club, according to Stephen J. Dubner, a co-author of the best-selling economics book "Freakonomics." And now you can get many generics for even less:
Take advantage of the generic-drug price war. Kmart and Wal-Mart kicked off the trend, and now it's spread to other big chains. Wal-Mart, Sam's Club and Target offer hundreds of generic prescriptions for $4 a month. Kmart offers more than 200 generic prescriptions for $15 for a 90-day supply, while Wegmans offers 90-day supplies for $11.99.
Prices may be higher in some states; California, for example, has a law against pricing drugs below their cost, so some prescriptions on the list will be more expensive there.
Look for coupons and deals. Head to a brand-name drug's official Web site to see whether there are coupons or other rebates available.
Poster "alirae75," whose husband has diabetes, said his doctor usually has rebate forms for insulin and other supplies. "We also register on the sites so that we are updated, occasionally getting a rebate form or check in the mail," alirae75 wrote.
Use your flexible-spending plan. These workplace plans allow you to put aside pretax money to pay for health care and medicines. (Over-the-counter drugs are often included; ask your human-resources department for details.) You have to estimate in advance how much you'll spend, and you must use up the money before the plan's year ends, or you'll lose it. But every $1,000 you contribute saves you $250 in taxes if you're in the 25% federal tax bracket, so it's a great break for many families.
Discount prescription cards. If you don't have insurance, you may be able to use a drug discount card to get reduced prices on medicines. Some cards are free; others have monthly or annual fees. Check the card out carefully before you buy, though, because there have been some scams. You can find out more at the RxAssist Web site. A discount drug card that's free and accepted at 53,000 pharmacies nationwide can be found at PS Card. Some drug companies also offer free cards that offer discounts ranging from 15% to 40% on brand-name drugs, although eligibility may depend on income and other factors. Three to try: Pfizer, Together Rx Access and Merck.
Sign up for prescription assistance. If you're low income, you may qualify for discounted or free drugs from a patchwork of state, nonprofit and drug-company programs. One place to start looking is the Partnership for Prescription Assistance. Other resources include NeedyMeds, the American Society of Health-System Pharmacists, the Eldercare Locator and the Access to Benefits Coalition.
Go to Canada or Mexico. There's no question many drugs are significantly cheaper north or south of the border than they are in the United States. The problem is that it's against the law to "re-import" drugs made in the U.S. and sold outside our borders. (A "personal use" exception exists only for drugs that aren't approved for use in the U.S.) Of course, the legal restrictions don't stop millions of Americans from crossing the borders for drugs, but the U.S. Food and Drug Administration cautions that there are potential safety issues. Consider yourself warned.
Buy online. If you can't get to Mexico or Canada conveniently, you may be tempted to buy from a foreign-based pharmacy online. Again, there are safety and accreditation issues. Definitely don't buy from an online pharmacy that doesn't require a prescription. You can reduce your risk by using a site that carries the National Association of Boards of Pharmacy's Verified Internet Pharmacy Practice Sites (VIPPS) mark, but don't take the pharmacy's word for it; check at the national association's site to make sure the certification is legitimate.
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