Winning the medicine game

From the Los Angeles Times
YOUR MONEY
Winning the medicine game
With a lot of knowledge and a little begging, you can make your prescription bill easier to swallow.
By Jerry Hirsch

March 15, 2009

Prescription prices are putting the bite on household budgets. The recession is amplifying the pain as workers lose health coverage and employers cut back on drug benefits. More Americans are being forced to choose between buying food and buying medicine.

Still, there are plenty of ways to save money if you're willing to expend some effort. You'll need to be honest about your finances. You'll also have to educate yourself about pharmaceuticals, know your health plan, become a savvy shopper -- even beg on occasion.

"It really pays to do your research and be a smart consumer," said Roba Whiteley, executive director of Together Rx Access, a pharmaceutical industry-funded program that provides free and discounted drugs to the uninsured and working poor.

So, before you skip a dose, read on to learn how to play the medicine game.

Read the fine print

If you have health insurance, the first step to saving is to learn how your plan works.

You might have smaller co-payments if you fill prescriptions through the mail or at particular pharmacies.

Health plans give members an incentive to choose cheaper medicines through a tiered system of co-payments. The least expensive drugs might have a co-payment of $10 to $15, sometimes less, for a 30-day supply. More expensive drugs might be $25 or more. Some pharmaceuticals won't be covered at all.

Ask your doctor to check the plan and judge which is the least expensive, but still effective, drug for your condition.

Talk to the doc

If you're uninsured, strapped for cash or have a stingy insurance plan, tell your doctors. They can help.

Granada Hills allergist Jacob Offenberger sends uninsured patients home with samples. Others get prescriptions for the least expensive generics. Patients with high co-payments get rebate cards or coupons, often issued by the big drug manufacturers, for discounts on prescriptions.

Doctors should review your medicines periodically to see whether there are cheaper alternatives, or whether you still need them.

For example, Offenberger said, "Some people . . . need asthma medicines only during certain seasons."

Generics rule

A generic drug is a pharmaceutical no longer under patent protection. These medications are sold over the counter or at low cost as a generic prescription.

Over the next three years, drugs with $100 billion of annual sales will become generics as their patents run out, including the cholesterol-lowering statin Lipitor, asthma medication Advair and antipsychotic Seroquel. That means big savings for consumers because the prices for these drugs are expected to drop to a third of their current level.

Some pharmacy chains offer 30-day prescriptions for $4 and a 90-day supply of generics for as little as $10.

Still, it's important to talk with your doctor about whether a particular generic medication is appropriate for you. Federal law allows effectiveness levels for generics to vary slightly from those of their brand-name counterparts, which could lead your physician to recommend that you use only the brand-name drug.

Learn to beg

Don't be shy about asking for samples, lots of them. Big pharmaceutical makers ply doctors with samples as part of their marketing efforts to get them to prescribe their drugs. You might as well dip into that cookie jar for the medicines you need.

That's how retired teacher Lou Wiener of Santa Clarita stretches his budget. Wiener, 71, takes Aciphex, a gastric acid inhibitor for an esophageal condition. The cost of the drug, as well as the other medicines Wiener takes, pushes him into the notorious Medicare "doughnut hole," or coverage gap.

Medicare will stop paying for drugs this year when an individual's out-of-pocket costs plus the plan's costs reach $2,700. It won't start paying again until out-of-pocket costs reach $4,350. Getting caught in the middle -- the doughnut hole -- is costly.

"I get a month or two of Aciphex from the doctor at a time and that helps me for when I hit that doughnut hole," Wiener said.

Just one month of samples will reduce your annual expense for a drug by almost 10%.

There's a risk to this strategy: When the freebies stop, you'll probably be reluctant to switch to something cheaper.

"Once you start on a drug you tend to stay on it, even if there is a good generic. That's why the drug companies spend billions of dollars on sampling," said Joel Hay, a professor of pharmaceutical economics and policy at USC's School of Pharmacy.

Some university medical centers now prohibit their doctors from accepting samples.

Slice pills, and bills

Because of a quirk in drug pricing, a month's supply of, say, 20-milligram pills often costs no more than the 10-mg dosage.

That's the pharmaceutical equivalent of a two-for-one sale. Many consumers buy the bigger pills and split them in half. Insurers are pushing this strategy too. United HealthCare and Anthem Blue Cross supply their members with lists of drugs that can be split. They'll even send you a complimentary tool to do the job.

Critics say the practice can lead to unequal fragments -- and erratic dosing.

"This isn't something patients should do on their own," the Food and Drug Administration warned in a statement on the practice. Still, the agency acknowledged that, done with a doctor's knowledge and using the proper equipment, pill-splitting can save money.

Just remember:

* Not all drugs can be split. Those include time-released medications, capsules and gels. Consult your doctor or pharmacist.

* Use the right tool. Low-cost drug-splitters are available in most drugstores. Don't try this with a pocket knife, a razor blade or your teeth.

United HealthCare has a website -- www.halftablet.com -- that lists the drugs and their strengths that it considers safe to split.

Consider assistance

There are hundreds of programs nationwide that help low-income patients obtain medications at little or no cost. Many are listed with the Partnership for Prescription Assistance, a drug industry-managed clearinghouse.

About half the programs are run by large pharmaceutical companies. The rest are sponsored by makers of generic drugs, private foundations and government agencies. The partnership has helped about 5.5 million people nationally.

"Three out of four people who take the time to apply get help," said Ken Johnson, a senior vice president at the Pharmaceutical Research and Manufacturers of America, a trade group. "Often it is free drugs, and sometimes prescriptions for just $3 to $5, basically the cost of shipping."

But be careful. Scams abound.

"If you call a number and they say it will cost you $100 to join, or they ask for your checking account number, that should raise red flags," Johnson said.

To access the legitimate programs, consumers can call the clearinghouse at (888) 477-2669 weekdays from 8 a.m. to 8 p.m. Eastern time or go to www.pparx.org. They'll have to answer some screening questions to determine their financial eligibility and medical condition.

Generally, the maximum annual income for eligibility is $40,000 for a family of four and $20,000 to $25,000 for a family of two. But some programs are raising those limits to assist the rising number of Americans losing health insurance during this recession. It pays to check.

Discounts for all

Mindful that co-payments for name-brand prescriptions can be steep, manufacturers that want to keep your business may offer discounts or rebates to ease the sting.

For example, drug maker AstraZeneca has a program that limits your co-payment for the statin Crestor to $25 for a 30-day supply. Ask your doctor about these and other manufacturer discounts.

Another option is the PS Card, which offers discounts on prescriptions filled at over 56,000 drugstore and supermarket pharmacies nationwide, including CVS, Rite Aid, Walgreens, Wal-Mart and Target.

Founder Jim Robbins, a former United HealthCare executive, has negotiated discounts at these retailers, which he passes along to cardholders. Robbins earns his cut by collecting a referral fee "in the pennies" on each prescription. The card is free and anyone can sign up at www.pscard.com.

Karen Dang of Huntington Beach has medical insurance but her plan doesn't cover phentermine, an appetite suppressant. She saved $10 on a 30-day supply at Wal-Mart using the PS Card.

"At first I didn't believe you could get a discount, but then I used the card and it worked," said Dang, 27.

If you lose your job

Some laid-off employees can get a 65% subsidy, for up to nine months, to help defray the cost of continuing their healthcare coverage through the government-mandated COBRA program. This would help pay for prescriptions in the near term -- as well as other health expenses -- while they look for new work with medical benefits. The federal subsidy applies only to people who lost or lose their jobs between Sept. 1, 2008, and Dec. 31, 2009.

People who qualify pay their employers for 35% (instead of 100%) of the insurance premium for up to nine months. This can save thousands of dollars. After nine months, the payments return to 100%. For more information go to the Department of Labor's website: www.dol.gov/ebsa/cobra.html.

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