My health insurer recently refused to pay for one of my prescription drugs because I don’t have the specific disease the drug is supposed to treat. Instead, I have some other condition that also happens to be remedied by the pill. If you think this decision makes sense, then you’re a perfect candidate to work for an insurance company.
The drug is expensive, about $30 per pill, and most people with my condition need about 56 pills (four weeks’ worth). That brings the cost to over $1,600. If the insurer had approved, my copay would have been $40. So when it denied my coverage it was a lot of money.
Ah, but the story doesn’t end there, and, actually, there’s a happy ending. In fact, there’s a potential happy ending for all of you who are stuck paying for an expensive drug without the benefit of having prescription drug coverage or if you’re one of those with a prescription drug insurance donut hole.
Call the Drug Maker
Most of you have seen the pharmaceutical ads on TV or in print that say something to the effect of, “If you need assistance paying for this medicine, [fill in the drug company] will help.”
(MORE: 10 Things to Know Before Using an Online Pharmacy)
So when my coverage was denied, I called the maker of the prescribed drug and asked what kind of help it could provide. I anticipated the company saying it would take a percentage off if I could prove I was low-income and couldn't afford the full price. That’s not what it said at all.
The rep said the drug company would try to intervene with my insurer to help convince it that mine is a coverable condition. Remember, it’s in a pharmaceutical maker's interest to convince insurers that its drug can be used for multiple conditions. While the appeal was playing out — likely to last months — the drug maker agreed to provide up to three months worth of the pill at no charge to me. That, too, would take some time — a couple of weeks to get the drug to me — which wasn’t going to help me when I needed it, which was right away. Still, I thought I’d pursue that path.
No Need to Pay Retail
But then I learned something that turned the whole story upside down: There are coupons online, available to anyone, that discount the drug 20 percent to 70 percent. The pharmacist at Costco told me about this and I’ll be forever grateful to her for that piece of information.
So I Googled the drug and added the word “coupon.” Up popped many references, and one in particular caught my eye: internetdrugcoupons.com. This company provides a free (the website's emphasis) pharmacy discount card that’s good for every FDA-approved drug. The site said that it is “paid a small amount from the pharmaceutical companies, there are no exclusions or minimums, there are no denials, it doesn’t enroll you in anything and it works just like a coupon.” The company underscored that the card is not insurance and may even provide a lower cost to the consumer than if you’re covered by prescription drug insurance.
(MORE: Why Free Drug Samples May Cost You Too Much)
The company compared its discount card to AAA, which, as we all know, offers discounts on hotel stays and other travel expenses. Well, you wouldn’t dream of paying retail for a hotel room, so why would you do it with a prescription drug? The answer is, you don’t have to.
A Big Savings
Sure enough, when I brought my coupon to my local CVS where I usually get my prescriptions filled, pharmacist Lisa Yurechko looked up the drug, the BIN, PCN and GRP codes listed on the coupon and announced that the cost to me would be $432, about 70 percent less than the $1,600 I would have had to pay.
Dumbstruck, I quickly said, “Let’s do half, because my doc said that we should first try it for two weeks.” I walked away with 28 pills for just over $200. That’s still a lot more than my copay would have been, but a welcome change from the $800 I originally would have had to pay for 28 pills.
“How does this work?” I asked Yurechko. “I mean, who pays?” Surely CVS isn’t footing the bill for this discount.
“The drug company pays,” Yurechko said. “They reduce the price, just like any coupon. It’s as simple as that.”
“Wouldn’t it be nice if the companies just lowered the price instead of making us find coupons,” I lamented. “I mean, what about the people who are not computer literate? They probably need it more than I do.”
(MORE: 5 Unexpected Side Effects of Common Medications)
To her credit, Yurechko agreed and told me that she often tells patients that they should look online for coupons and ask their doctors for free samples.
Armed with that information, I’ve put together the following seven tips to save on prescription drugs. They're based on my experience as a regular consumer and aren’t meant to be taken as medical advice:
My 7 Tips to Save on Prescription Drugs
1. Unless the doctor makes it a point to prescribe the brand name, buy the generic. In almost all cases, the active ingredients are the same and should save you a bundle, even if your insurance covers you. Copays for generic drugs are usually less than for the name brand.
2. Ask your doctor for free samples. Most doctors have samples of branded drugs from pharmaceutical companies and while that may not be the full complement you need, it will reduce the number you have to purchase. (For the downside of free samples, see Why Free Drug Samples Can Cost You Too Much.)
3. If larger doses of the drugs are available and the pill comes in tablet form, get your doctor to prescribe the larger dose. Then, cut the pills in half (or in quarters, as appropriate). Make sure the particular tablet can be cut with an inexpensive pill cutter available at most drugstores. But note that there are some pills that cannot be cut or are too small to cut. Your pharmacist can advise you accordingly.
4. COUPON! Google your drug name and the word “coupon” to see which discounts are available. Internetdrugcoupons.com is one site that offers coupons, and there are others. Did I mention the discount can be as much as 70 percent?
5. Get comparative prices, especially from the big box stores (such as Costco and Walmart).
6. Consider using a mail-order pharmacy service. But be sure to check out the particular pharmacy thoroughly. And although Canadian pharmacies are generally reputable, try to steer clear of companies from other countries unless you have personal experience with them.
7. Call the customer service department at the pharmaceutical company that makes the drug. Many companies offer discounts or free samples, especially for people who are low-income or simply on a fixed income, as many of us are who are retired. Some companies will appeal to your insurer on your behalf to cover the drug.
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