Consumer Reports
December 29, 2014
Americans spend a lot out of pocket on their medications—an average of $732 per year for those who regularly take a drug, according to the most recent CR Best Buy Drugs national poll. But new changes to Medicare and commercial drug coverage may make it tougher this year to get a good deal. Here are the biggest prescription drug traps we’ve found and how you can avoid them:
Trap No. 1: Using your insurance instead of paying out of pocket
Stores such as CVS, Rite Aid, Target, Walgreens, and Walmart offer discounted generic drugs for as little as $10 for a three-month supply. You just pay a few dollars out of pocket—that could be cheaper than your insurance. Even the store’s retail price might be less expensive than your co-pay.
Save instead: Ask the pharmacist whether paying cash or using your insurance is cheaper. Some pharmacies must bill claims through your insurance company unless you request otherwise. “It’s always a good idea to compare your insurance co-pay to the pharmacy’s everyday retail price,” advises Victor Curtis, R.Ph., senior vice president of pharmacy at Costco Wholesale.
Can I really get cheaper meds if I don’t use my insurance?
Trap No. 2: Using ‘nonpreferred’ generic drugs
Most health insurance plans lump all generics into one cost-sharing tier. But some plans have created a second tier of “nonpreferred” generics that reflect the higher costs of certain generic drugs. Those drugs could cost you up to $33 per co-pay, according to a report by Kaiser Family Foundation, vs. a standard $10 generic co-pay.
Save instead: Before you sign up or renew your plan, make sure your medications are on the plan’s preferred list—called a “formulary”—and work with your doctor to ensure that you’re taking preferred generics whenever possible. That’s true with all of your drugs, too, because health insurance plans can change what’s covered on their formularies often.
Trap No. 3: Automatically signing up for mail-order prescriptions
Some insurance plans might offer (or possibly require) maintenance prescriptions that are filled and delivered by their mail-order service. Although it can be convenient, the costs can actually be higher than a regular pharmacy’s. That’s according to a 2013 analysis by the Centers for Medicare & Medicaid Services, which showed that mail-order pharmacies frequently charge Medicare prescription drug plans more—as much as 83 percent more—than community pharmacies.
Save instead: Before you sign up, check mail-order prices with your health plan and compare them with your local pharmacy. Also be sure to fill all of your prescriptions at one pharmacy when possible, so your pharmacist has your full record and can flag any potentially dangerous interactions.
Trap No. 4: Assuming your doctor will mind your wallet
According to the same CR Best Buy Drugs poll, almost no one (5 percent) learned the cost of medication at his or her doctor’s office. Instead, most (61 percent) found out when they picked up their prescription from the pharmacy. And more than half said they were reluctant to discuss cost with their doctor.
Save instead: Tell your doctor that cost, as well as effectiveness and safety, is important to you. And ask whether you can stop any drugs you no longer need.
Get these meds for $4
The following common meds are available at Target and Walmart for $4 for a 30-day supply.
Generic name (Brand) Used to treat
Albuterol (Proventil), 2 mg Asthma
Citalopram (Celexa), 20 mg Depression
Fluoxetine (Prozac), 20 mg Depression
Levothyroxine (Synthroid), 75 mcg Hypothyroidism
Lovastatin (Altoprev), 20 mg High cholesterol
Lisinopril (Prinivil), 10 mg High blood pressure
Metformin (Glucophage), 850 mg Type 2 diabetes
Metoprolol (Lopressor), 50 mg High blood pressure
Trazodone (Oleptro), 50 mg Depression, Insomnia
Warfarin (Coumadin), 4mg Stroke prevention
This article originally appeared in the January 2015 issue of Consumer Reports On Health. This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).