If you’ve ever paid the full price for a prescription medicine, you know – they can be very expensive. Filling a prescription for many common drugs can easily take more than $100 out of your wallet, even with insurance. Specialty drugs, like those used to treat cancer or hepatitis, are a whole different story – their average cost is more than the annual income of half of all American households.
With costs like these, it’s no wonder your health plan works to keep drug costs down where possible. We do what we can, but you play a big role in saving yourself money on drugs.
- Use generics whenever you can. Generic drugs can save you and your plan money every year – industry estimates are that Americans saved almost $239 billion in 2013 by choosing generics instead of brand name drugs. Generics have the same active ingredients as the brand name of the same drug. If your doctor hands you a prescription, ask if it’s generic. If not, ask why not, and ask if you can substitute the generic version. (Some states even require pharmacists to substitute generic drugs for brand name drugs in certain circumstances.) Generics are approved by the Food and Drug Administration, which has determined that they are equivalent to the branded drug.
- Ask your doctor about alternatives – and check prices. Many health plans offer online drug price tools. You may even be able to check the price tool on your smartphone while in the doctor’s office. Often there is more than one drug that will do the job; why not ask for the least expensive?
- Take the drug as ordered, for as long as your doctor said. If you have a problem, whether from side effects or because of the cost, call your doctor. Don’t just stop taking the medicine, even if you are beginning to feel better. You can create more problems for yourself that way – and that may cost you even more. This is especially important if you are taking a drug for a chronic condition such as high blood pressure or cholesterol. You may not feel any different if you stop taking the medicine, but you’ll increase your risk for potentially harmful and expensive conditions.
- If your health plan asks you to try a different drug before taking a new or more expensive one – do it. They’re asking because often, the first choice drug will treat your condition and cost both you and the plan less. Don’t be fooled into thinking you must have the newest, most-advertised drug. In many cases there are several drugs in the same class that have the same effect. Your doctor can select one that is right for you and is covered on your formulary.
- Take advantage of any care programs your health plan offers. With some medications or conditions, health plans might have a nurse check in to see how you are doing and help you stay on track with your care. The nurse is there to help you. Let him or her know if you are having any problems with your medicine or medical condition.
- Find the best place to get your medicines. Most people know they can get maintenance drugs by mail order at a lower cost – and that can save you a lot of money. But your health plan may have other ways for you to save with high-cost specialty drugs. For example, an Aetna program to help members get specialty medicines infused or injected at home or at their doctor’s office, instead of at a hospital, can cut the cost in half or more. If you need to take a specialty drug, call your health plan and ask about options.
If you have a problem, whether from side effects or because of the cost, call your doctor. Don’t just stop taking the medicine, even if you are beginning to feel better.
Behind the scenes, your health plan is also working to keep the cost of drugs down for you. Plans carefully track and evaluate new drugs as they move toward government approval and use independent panels of doctors and others to advise them on which drugs should be covered. They also negotiate with drug manufacturers to get the best deals possible on drug prices. When similar drugs are available from more than one manufacturer, your plan may get a better price for one of the drugs by making it preferred. That means you use the preferred drug unless there is a medical reason to use the other.
Remember, no matter how much of the cost of your drugs is covered by your health plan, you are still paying for rising costs, both at the pharmacy counter and in your insurance premiums. Do yourself a favor and save where you can.