Dealing with high-cost prescriptions

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Pay less for prescriptions If you have health insuranceyet still struggle to pay for your prescription medications, you’re far from alone.

One in four Americans who regularly take prescription drugs say they pay more out-of-pocket for their medications than they did a year ago, while 14 percent, or one in seven, don’t fill their prescriptions because it is too expensive, according to a survey conducted by Consumer Reports.

Nicole Hebbert, vice president of pateint access and engagement for United BioSource Corp. (UBC), says that high-cost prescriptions can lead to people who need medicine walking out of pharmacies empty-handed.

“Folks end up walking away from the retail counter, lost,” says Hebbert.

Thankfully, if you face challenges paying for your medications, there are a number of options that may provide help. Here are four of them.

1. Patient assistance programs

Patient assistance programs (PAPs) are run by pharmaceutical companies. They give away billions of dollars worth of drugs to patients who meet certain eligibility criteria, says Richard Sagall, president of NeedyMeds, a nonprofit that provides information for consumers who have troubles paying for their medications or medical care.

The criteria to qualify for each program vary, Sagall says. “Some are tighter, some are more liberal in how they help,” he says.

You don’t necessarily need to be indigent to qualify, however. Some will assist you if you earn up to 200 percent of the federal poverty level, and others will help if you earn up to 400 percent of the federal poverty level, Sagall says. A family of four earning 400 percent of the poverty level has an annual income of $97,000.

UBC focuses on helping patients in need of biotech and specialty medications. Some of these might cost $2,000 for a 30-day supply. “That really becomes a financial hardship for a patient,” Hebbert says.

A patient who meets the criteria may receive free medication for a year, and if needed can reapply for assistance the following year.

2. Copay cards

These cards are generally offered by prescription drug manufacturers, and if you have insurance, they can help you reduce your copay.

You’ll typically find these cards online or may be able to obtain one from your doctor, and they’ll reduce your copay or eliminate it.

Studies have shown high copayments are “linked to poor adherence,” and patients don’t take medications as prescribed, according to the health policy division of the National Consumers League.

Copay cards only work if you have private insurance. If you have Medicare, Medicaid or are part of another federal or state program, you’ll need to look elsewhere to reduce your costs.

3. Drug discount cards

These cards can also help reduce the amount you pay for your medication, and often can be found online. They may be offered by state governments, pharmaceutical companies, nonprofits or retailers.

Some of these cards can be used if you have Medicare, and you don’t need to have insurance to be able to use these cards.

But beware that some of these cards have pricey upfront fees, so be sure to check the costs before you sign up.

Sagall says fees are generally lower if you get your card through a nonprofit rather than a for-profit company.

Organizations such as AAA and AARP offer such cards for free to their members, and they can be used at most pharmacies.

One thing to keep in mind is that you can’t use drug discount cards to supplement your insurance. You’ll either need to use your insurance or the drug discount card to purchase that particular medication.

4. Generics

Don’t forget to ask your physician whether you can take a generic medication instead of a name brand. If a generic is available, it might cost less than the price you’d receive with a drug discount card or copay card.

Many generic medications are available at retailers for $4, and some cost even less. The FDA reports that generic drugs are 80 to 85 percent cheaper on average than brand-name products, and that that discount doesn’t necessarily signal a lower-quality product: Generic drug manufacturers are able to offer lower prices because they do not pay for the same marketing efforts that name-brand companies often do, or the costly clinical trials required for new drugs.

Evaluating your options

It isn’t always easy to determine where you can turn for assistance with high prescription costs.

“It can become very difficult to find the best deal,” Sagall says. Consumers may find prices vary from retailer to retailer, or even within stores operated by one company.

Hebbert recommends asking your pharmacist about prescription drug assistance programs. You also may be able to find help on drug manufacturer websites, or on the website for the medication itself.

“As the price increases and the copayment increases, the burden shifts to the patient,” she says.

If you’re frustrated with the drug coverage your current health insurance plan offers, you may also wish to re-examine your coverage options during the next open enrollment period. The open enrollment for the Affordable Care Act ended in many states on Dec. 15, but some states are extending the deadline, so check the marketplace website in your state.

In the meantime, here are a few sites to check for assistance with your medications:

NeedyMeds – A nonprofit that provides information for consumers who have troubles paying for their medications or medical care. Offers a drug discount card.
Partnership for Prescription Assistance – Sponsored by biopharmaceutical research companies, this helps uninsured and financially struggling patients who lack prescription coverage find access to PAPs.
RxOutreach – A nonprofit pharmacy that provides affordable medications.
RxAssist – Provides a database of PAPs. It’s part of the Center for Primary Care and Prevention at Memorial Hospital of Rhode Island.