How to Save Money on Drugs (2)

Shop Around for the Best Price
The same kind of comparison shopping you might do for a car or a coffeemaker can pay off for drugs.
• Buy by mail. If your prescription drugs are covered by insurance, see if the insurer has a mail-order pharmacy. Some offer lower co-payments.
• Call around. You’ll find that drug prices vary from store to store. Try independent pharmacies, national chains, and megastores such as Wal-Mart and Costco.
• Go online. You can find bargains or quickly compare drug prices on the Internet. (If you don’t have a computer, the ones at your public library are free to use, and many librarians will help you find information.) Many brick-andmortar pharmacies have websites that offer discounts on prescription drugs. So do “virtual” pharmacies, which do all their business online. For the most part, shopping for prescription drugs online is safe. One way to tell if the site is legitimate is the VIPPS (Verified Internet Pharmacy Practice Sites) seal of approval from the National Association of Boards of Pharmacy. You can also check with the board to see if an online pharmacy is licensed and in good standing.

Join a Group
Some organizations offer savings on prescription drugs as a perk. If you’re a member of AARP, for example, you can join its MembeRx Choice plan for $20 a year. It offers savings on topselling
drugs. If you served in the military, you may be eligible for the TRICARE Pharmacy or Senior Pharmacy programs. Buying groups such as the Peoples Prescription Plan and the United States
Pharmaceutical Group also offer savings and are open to everyone. (Find more information in the Resources.)

Look for Low-Income Options
Some money-saving options are aimed at low- to middle-income seniors without any drug insurance. The Together Rx Card, for example, provides savings on more than 150 widely prescribed medicines. Some states provide assistance with prescription drugs to low-income seniors or people with disabilities who do notqualify for Medicaid. To quickly find out if your state has such a benefit or if you qualify for other programs, try the National Council on the Aging’s BenefitsCheckUp Web site. (For more information, see the Resources.)

Reduce Your Need for Drugs
If you’re serious about cutting your drug bill, get serious about adopting a healthier lifestyle, which may cut the need for medication. Don’t stop taking your pills first and then try to make lifestyle changes. Make the changes first. When you start getting results, then talk with your doctor about medication changes.

How to Save Money on Drugs (1)

You don’t need the newscasters to tell you that prescription drug prices are on the rise or that insurers are covering less of the cost. For some people, the out-of-pocket outlay for prescription drugs extracts little more than a quiet moan at the cash register. For others, it means skipping medicine or meals in order to pay. Here are some tips for cutting costs.
Get Your Doctor’s Help
Unless a doctor knows you’re trying to cut corners, he or she won’t take price into consideration when filling out the prescription pad. But most doctors are willing and able to help once you mention your concern. Here are a few things to ask about:
• Generic drugs. Buying generic drugs instead of the more expensive brand-name versions is one of the most effective ways to cut your monthly drug bill. For example, a month’s supply of the 20 mg dose of the brand-name statin Mevacor costs about $70, while the same amount of generic lovastatin costs about $35. There’s no need to worry that a cheaper price means less quality. The Food and Drug Administration (FDA) regulates the production of generics just as carefully as brand-name drugs. The only difference may be in the inactive ingredients—things like fillers, coatings, and flavorings. Some doctors worry that the inactive ingredients change how much of the active ingredients the body absorbs. The FDA doesn’t share this concern, though. Some classes of drugs are so new that generic forms aren’t yet available. If your doctor prescribes one of these, ask if there’s a slightly older type of drug that does much the same thing.
• Cheaper brand-name drugs. Sometimes you can trade off convenience for savings. For instance, if your doctor suggests a brand-name combination drug, ask if you can save money by taking the component drugs one by one. In other cases, you can save by taking an older drug two or three times a day instead of using a newer (and more expensive) once-a-day formulation.
• Starting small. When you start a new drug, ask your doctor to give you a prescription for just a week or two. This way you can see if the dosage is right and if the drug agrees with you. If everything goes well, then you can fill a longer-term prescription. If it doesn’t, you aren’t stuck
with a stockpile of pills you paid for but can’t use.
• Starting low. Ask about starting a drug at the lowest possible dose, especially for a drug that’s relatively new.
• Splitting the difference. You expect to pay about twice as much for a two-pound box of pasta as you do for a onepound box. But the same pricing concept doesn’t always apply to drugs. Often, you can save money by asking your doctor to prescribe pills in twice the dosage you need.
Then you can cut them in half to double the number of doses. This approach is not for everyone, and it can’t be done for all drugs. Capsules and timed-release formulas, in particular, should never be split.

Dealing with Hospital Costs If You Have Insurance

If you have insurance in any form—HMO, Medicaid, Medicare, indemnity, and so on—you must understand that the insurance company is likely not going to cover everything the hospital bills you for. The first place to start, therefore, is to look at your policy to determine what is covered and what is not. These are the questions you need answered:

• If the insurance is managed care insurance, is the hospital part of the plan’s network? Network hospitals have negotiated rates with the plan and you will be covered for a lot of the hospital’s charges based on your policy. If the hospital is not in the network, you will have to pay for all or a big portion of the charges, unless the visit was due to an emergency. With Medicare and Medicaid, the hospital just has to be certified as a Medicare or Medicaid provider for you to get the benefits (nearly all hospitals are). With indemnity insurance, you can go to any hospital of your choosing but remember the plan will only pay a portion of the charges that it determines to be usual and customary. Also remember the caps on your insurance. If you exceed that cap, you are responsible for 100 percent of the charges.
• What aspects of the “hotel” and “medical” charges are covered? Your insurance plan does not give you free reign to ask for five-star services. If your plan pays only for a shared room and you ask for a private room, you will be charged for the difference. This applies to
  other services that you request outside the customary services, for example, asking for a special diet.

In looking at the “medical” aspect of your bill, be sure that you follow your plan’s protocol. In an HMO plan, for example, you should be admitted to a network hospital by your PCP or a specialist to whom you were referred by your PCP. While in the hospital, be sure that consultations are done with your PCP’s approval and/or the doctors are all affiliated with the hospital and are in the plan’s network. While this might sound cumbersome and difficult to handle especially if you are very sick, it might mean the difference between coming out financially unscathed and having to file for bankruptcy. If you can’t handle it, find a friend or family member to help you with this. Remember, procedures that physicians perform account for the bulk of hospital charges, so handle this aspect with all seriousness.

Dealing with Hospital Costs If You Do Not Have Health Insurance

If you do not have insurance, do everything you can to stay away from the hospital. In an emergency you may not have a choice, but if it is an urgent or elective procedure, investigate the possibility of using an urgicenter or surgicenter before using the hospital. If you have to use a hospital, look at government hospitals first, then community hospitals, then university hospitals, and specialty hospitals last. If you end up in a hospital, remember that no hospital can turn you away for treatment especially if it is an emergency. Keep the following in mind in dealing with hospital costs if you do not have insurance:

• The first thing to do if you need hospitalization, especially for an elective procedure where you can plan ahead, is to determine if you qualify for any insurance program. Are you poor enough to qualify for Medicaid? Are there any government programs that can give you
  assistance? Call your state health office to find out. Do you belong to a group through which you can get some form of health coverage? Do these things before you get into the hospital because if you do them after, even if you get the insurance, it might not cover a cost that was incurred prior to your getting the coverage.
• Always get a second or third opinion about any procedure. Many treatments have alternatives and sometimes you might not even need the procedure at all. Be sure, however, that you do not stay away from a treatment because of the cost, but rather because another well-respected professional determined that it is not necessary.
• Check out government-run clinics and hospitals. These establishments are not only less expensive but will charge you based on your income, that is, on a sliding scale, and will work out payment plans that you can live with.
• The government subsidizes most hospitals, especially teaching hospitals, because they are expected to take care of individuals who cannot pay for what the hospital charges. In these cases, the hospital will charge you on a sliding scale based on income and you can negotiate a payment plan.
• If you have a complicated or rare disease, one that in all likelihood is very expensive to treat, look into participating in clinical trials. In clinical trials, all your expenses will be paid for including, in some cases, your transportation. Be sure you understand what will be
  done and realize that if it is what is known as a double-blind trial, you might not be getting the active treatment but might be getting a fake treatment or placebo and neither you nor your doctor will know until the end. Not all studies are double blind, however. Some are known as open trials, where you and your doctor know exactly what you are getting.
• Avoid unnecessary services like private rooms and special meals if you can.
• If you need medication that can be brought in from the outside, like Tylenol or even some prescription drugs, it might be cheaper to get them from an outside pharmacy than from the hospital pharmacy. Discuss this with your doctor and let the nurses help you with the
  medication regimens.
• Discuss any consultations with other doctors ahead of time and be sure they are absolutely needed so you don’t end up with more physician charges than are necessary. When you get the bill, go over it with a fine-tooth comb. Very few patients do and there have been stories of hospitals charging exorbitant amounts sometimes for services that were not even rendered. You should realize that all bills are negotiable. Start by getting a sense of
  what the hospital charges the government for that service. You can get that information from the AHD web site (www.ahd.com). Then negotiate from there. When you have reached a satisfactory amount, you can work out a payment plan with the hospital that you can live with.

Individuals in Search of Health Insurance

If you do not have health coverage, either through the government or through a private employer, you are left to find one for yourself. It is a daunting task, one that has left more than 40 million Americans with no health insurance coverage. If this is the case for you and you are seeking health insurance, you may be faced with a number of challenges:

• Insurance companies are reluctant to insure most people with preexisting medical conditions. If they do offer coverage, the premiums are extremely high.
• Many benefits such as maternity care, mental health, and prescription drugs are usually excluded.
• The application process can be long and very intrusive.

Some states have created laws to help control these practices. They include:

• Preventing insurance companies from eliminating coverage for preexisting medical conditions. These laws do not, however, force the insurance companies to accept an applicant, only that if the applicant is accepted then their preexisting condition must be covered. Insurance companies are then free not to accept an individual with a preexisting condition, or to accept one and charge much higher premiums.
• Creating high-risk pools to provide coverage for individuals who have been turned down because of their conditions. These policies are usually more expensive but do provide coverage that would otherwise not be available. An individual with
AIDS, for example, would have a hard time getting regular insurance. A high-risk pool insurance would provide coverage for that individual.
• Creating laws that require health insurance companies to provide health insurance at premiums that are set on a market by market basis. This means that the state is broken up into different markets, and for each market the company creates a rate without regard to age, sex, or health status. Every individual in that market gets the same rate and benefits. For healthier individuals, these programs tend to be more expensive than regular plans.

If you are looking to buy health insurance, contact your state’s department of insurance. Any company that sells health insurance in a state has to be licensed in that state and must comply with the insurance laws of that state regarding what it can and cannot do. Appendix A lists the phone numbers of the insurance departments of the different states.

Paying for Physician Services When You Have Insurance Coverage

When you have HMO coverage, your physician visits are covered by your copay, which can range from $5 to $20. That is all you pay, assuming that you visit the PCP that is designated in your plan. Your copay will also cover the tests that the physician performs in his or her office, such as a blood test, urinalysis, EKG (heart exam), or X ray. If any of these tests have to be performed outside the physician’s office,you are still covered and will not incur any additional costs as long as your PCP is the one who authorized the test. If you have to see a specialist, you will also pay only a copay as long as your PCP referred you to the specialist and the specialist is in the plan network. If you visit a specialist without a referral from your PCP, even if that specialist is in the network, the insurance company will not cover it.
In an HMO plan, the physician has already agreed to the fee schedule and cannot charge the patient any more than the insurance will pay. In fact, the patient has no paperwork to deal with and except for the office visit copay, has nothing else to do in term of the charges. However,
the whole system falls apart if you have to see a physician outside the network. A lot of insurance companies will not cover out-of-network visits except for emergency situations.
If you have an indemnity plan, you can visit whichever physician you want but the company will pay only a percentage, usually 80 percent of what is deemed usual and customary. Physicians have all the control in terms of how much they can charge. The insurance company decides how much it wants to pay and the patient has to pay for the rest. There is a lot of paperwork to contend with and the patient usually ends up spending a lot of money out of pocket, whether he or she is seeing a PCP or a specialist. A patient concerned about the cost of a physician visit who has indemnity insurance should therefore inquire ahead of time how much the visit will cost. Work out a financial plan in advance by talking to the doctor and office staff to get a firm estimate of the treatment cost.
One way to reduce your physician fees even with insurance is to use the phone. Every time you visit a physician for care, you are charged a copay or your share of the indemnity insurance. Many times these visits are to seek comfort when dealing with a chronic illness or just to ask some questions. Some of these questions can be handled over the phone and your physician can determine if you actually need to come in. Do not abuse this privilege, however. If you get into the habit of constantly calling your physician for every little issue and then keeping him or her on the phone for long periods of time, the physician may start ignoring you or actually charge you for the phone consult.
The most important aspect in managing the cost of physician services is to understand what is covered and what is not covered, as specified in your insurance manual. Remember, your policy is a contract. If a service was not part of that contract, it is nearly impossible to get the company to pay for it. If you have any doubt about a service, call the company ahead of time to get clarification and if they say it is covered, get a written notice to that effect. This way if it has to go to arbitration or a court, you have a document to back you up.

Drug Company Patient Assistance Programs

Nearly every major pharmaceutical company has a program to help those who cannot afford their medications. Each company has a number of criteria that have to be met for an individual to obtain free medication. Basically, there are two main criteria: insurance coverage and income.
Insurance Coverage
To qualify for assistance, you must not have any other health plan, either private or public, that covers prescription drugs. This means that even if you have health insurance, such as Medicare, as long as that insurance does not cover prescription drugs, you might still be eligible. Also, there should not be any state program that can cover you for that condition. So check with your state to see if you qualify. Just remember that even if your state has an assistance program, a special medical situation might allow you to qualify for assistance from a drug company.
Income
Usually, the patient must not earn above a certain income level to qualify for these programs. Sometimes the particular company states what that amount is, but in many cases there are no exact amounts that a company considers a cut-off point. These companies base their decisions
on a “hardship criterion.” In other words, you need to demonstrate that the cost of the medication represents a hardship to you because of your financial situation. You might earn up to $50,000 a year and still be eligible if your medications represent a significant portion of your expenses. Even a temporary hardship, such as a job loss or a divorce, can still allow you to qualify.
After you demonstrate that you have met its criteria, the drug company will send the medication to your doctor, who then gives it to you. Sometimes you can pick up the drug at your local pharmacy.
This program should be used for chronic conditions because the review process takes about two weeks or even longer, and obviously you can’t wait two weeks to treat a strep throat.
The companies usually supply from one to three months’ quantity of the drug. At the end of that period, the patient must recertify that they still meet the eligibility criteria to continue receiving the free medications.

Prescription Drugs and Healthcare Cost

Drugs today have not only caused us to live longer but they have also improved the quality of our lives. A lot of illnesses can be managed effectively with medications, reducing the need for hospitalization or nursing care. Thus, medications are cost-effective in managing our diseases. Newer and better drugs are being developed each year.
Many people, however, struggle with how to afford prescription drugs. The elderly, those 65 years old and older, are especially hit hard. This group, which is expected to double by the year 2030, uses about 35 percent of all prescription drugs.
The classes of people most affected by the high cost of prescription drugs are:

• People who have no health coverage.

• People who have health insurance but their policy does not provide prescription drug coverage. This applies to seniors on regular Medicare since Medicare does not provide prescription drug coverage.
• People who have insurance coverage but are given prescriptions that are not covered by their plan. This applies to individuals with managed care coverage who have been given a prescription for a drug that is not covered by the plan.
• Individuals with prescription coverage, especially those on multiple medications, who face increases in their share of the cost of the drugs.
  

The debate over the cost of prescriptions is often complex and emotional. Drug companies are in the business of producing drugs for a profit, and they have done a great job in producing newer medications that work better or safer than older medications. It costs a lot of money, to the tune of over $500 million, to get a product to the market effectively.
The debate has always centered on how much these drugs should cost. Drug companies need to get back the money spent in developing a new drug, but more importantly, they need the profits to be able to have enough resources to fund the research to produce the next generation
of drugs. Most of the new drugs used around the world are developed in the United States. This is because the U.S. market is the only market that allows drug companies to price their products using market forces as opposed to the government imposing price controls. This does not mean that drug companies can charge whatever they want. Market forces prevent them from doing so. Competition within the industry, either from other brands or from generics, when available,
helps to ensure that drugs are not priced as much as the manufacturer might like.
Another market force in play is demand for the drug. Newer medications usually are safer or work better than older medications. The drug company might have to spend a huge amount of money educating the public about the drug, in the form of advertisements and consumer brochures, to create a demand for the newer medication. With greater demand, the company can charge a bit more, just as the manufacturer of any product might be inclined to do.

Handling the Cost of Physician Services If You Do Not Have Insurance

If you do not have insurance that covers physician services, you should be thinking of how to get the services for free or at a reduced rate.
Sources of Free Care
There are various establishments that provide free physician services. These include schools, job sites, medical university centers, and community centers.
Many schools have health centers where any member of that establishment can go in and get a checkup for free. While some of these centers do not provide very comprehensive care, they provide decent enough care that might be sufficient for the needs of the individual.
A lot of employers also have health centers at their job sites. Some employers who do not provide health insurance for their workers do provide a facility for employees to get routine care and immunizations. These centers can handle some of the basic healthcare needs and follow-up care.
While medical university centers do not routinely provide free services, they are involved in medical studies and are always looking for volunteers. As part of getting involved in a study, you will be given a thorough physical exam and workup, for free. It is important to note, however, that this is not recommended as a way to get routine care, since this method provides no continuity of care—when the study is over, you have to move on or find another study. Also, medical studies, while a necessary part of medicine, carry risks. Be sure you thoroughly understand what you are getting into and are fully informed of the risks involved.
Community centers and churches often hold health fairs where physicians perform various services for free to the community. Again,while this might be a good short-term solution especially for those who have not been to a doctor in a while and might be worried about a condition but do not know where to start, it is still necessary to establish a long-term relationship with a physician or health center.
Physician Services at Reduced Fees
In trying to save on the cost of physician services, it is always good to remember that specialists charge more than generalists, so the more specialized the physician, the greater the chance of the fees being on the high side. To any extent possible, stay with PCPs, especially general and family physicians, because they cost less than internists. So first call around and inquire about their rates. Also inquire about payment plans. If you are afraid that the doctor might not agree to a plan ahead of time, visit the doctor and get the help you need. After that, tell him or her you can’t pay but would like to arrange for a payment plan. As long as you stick to the plan, you are not going to be sent to a credit collector. However, do this only when you are really desperate and need to see a doctor.
It is important to be able to communicate openly and trustingly with your physician, and this includes talking to him or her about the cost of any medical intervention. For those who are embarrassed to talkto their doctor about the cost of treatment, it may be comforting to know that the American Medical Association states the following in its Fundamental Elements of the Patient-Physician Relationship:
The patient has the right to receive information from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives. Patients should receive guidance from their physicians as to the optimal course of action. Patients are also entitled to obtain copies or summaries of their medical records, to have their questions answered, to be advised of potential conflicts of interest that their physicians might have, and to receive independent professional opinions.

Saving on Prescription Drugs When You Have Drug Coverage

If you have insurance that covers prescription drugs then you don’t have to worry about medication cost, right? Well, maybe or maybe not. Most probably, when you get a prescription from your doctor, you take it to your local pharmacy, and if you have managed care insurance,
you pay a copay—your share of the cost. The pharmacy then deals with the insurance company to get paid the other part of the medication cost. Most individuals have health coverage through managed care plans, and these plans provide prescription drug coverage with copays.
The copays are usually fixed amounts, between $10 and $30, depending on what the plan designates in your contract. Usually the amount is fixed for a year, and that is how much you pay, regardless of the actual cost of the medication. So, if the medication costs $100 and your copay is $10, you pay $10. If your doctor prescribes another medication that costs $200, you still pay only $10. Your insurance pays the difference to the pharmacy. Many managed care plans are now developing different copays for members based on the plan’s cost for the medication. So, for example, a member might be charged a copay of $10 for the generic version of a drug but will have to pay a copay of $30 for the brand name.
There is a catch to the copay system, however. For you to pay only the copay, your doctor must prescribe a medication that appears on what is called a formulary, which is the list of medications that the insurance company has decided it will pay for. If your doctor decides that the medication that is the most appropriate for you is not on the formulary, he or she has to call the insurance company to justify its use. If the insurance company is not satisfied with the explanation, you will have to pay the full price of the medication.
If you have indemnity insurance that covers prescriptions, you pay for the medication and then submit a claim form to the insurance company to get reimbursed for all or part of the medication cost.
In all of the above cases, the out-of-pocket costs are usually small and most people who need medications for an acute condition can easily manage the cost. It starts to be a bit more complicated and expensive, however, when an individual has several chronic conditions and/or is on several medications. Even when you obtain your medications with copays alone, if you have several chronic conditions such as high blood pressure, high cholesterol, and diabetes, and are on several maintenance drugs, these copays can add up pretty fast.
The first step in managing the cost of prescriptions is to determine if the disease is an acute condition or a chronic condition. Acute conditions are illnesses that usually come on suddenly and whose treatments require relatively short periods of time, from a one-time therapy to a month or two of medications. Examples of acute conditions are pain after you see a dentist, an infection such as a strep throat or an ear infection, or a cold. Managing these conditions is not as expensive because once the treatment regiment is completed, the disease is usually cured.
Chronic conditions, on the other hand, usually develop gradually and when diagnosed, have to be treated for longer periods. Chronic conditions like diabetes and high blood pressure have to be treated for longer periods of time, even for life. It is important to realize that with these conditions, you have to continue treating the disease even when you do not feel any symptoms. Many of these diseases have to be “managed” because we do not yet have cures for them. When patients fail to follow treatment directions like taking their medicine every day, the disease can become more complicated and more difficult to manage. The result is an even greater expenditure on healthcare.
There are two strategies for managing the cost of prescriptions when you have coverage: mail order and samples.

The Best Healthcare For Less

The debate over the cost of prescriptions is often complex and emotional. Drug companies are in the business of producing drugs for a profit, and they have done a great job in producing newer medications that work better or safer than older medications. It costs a lot of money, to the tune of over $500 million, to get a product to the market effectively.
The debate has always centered on how much these drugs should cost. Drug companies need to get back the money spent in developing a new drug, but more importantly, they need the profits to be able to have enough resources to fund the research to produce the next generation of drugs. Most of the new drugs used around the world are developed in the United States. This is because the U.S. market is the only market that allows drug companies to price their products using market forces as opposed to the government imposing price controls. This does not mean that drug companies can charge whatever they want. Market forces prevent them from doing so. Competition within the industry, either from other brands or from generics, when available,
helps to ensure that drugs are not priced as much as the manufacturer might like.
Another market force in play is demand for the drug. Newer medications usually are safer or work better than older medications. The drug company might have to spend a huge amount of money educating the public about the drug, in the form of advertisements and consumer brochures, to create a demand for the newer medication. With greater demand, the company can charge a bit more, just as the manufacturer of any product might be inclined to do.