Tips for Dealing With High Prescription Costs

May 20, 2016

Tips for Dealing With High Prescription Costs

Tired of struggling to pay for high prescription costs?

Even if you have insurance, the copays and deductibles can cost a great deal. Here are some tips to try and keep the price down while still getting the medication you need.

Drug Formularies

Most patients don’t know that their insurance plan has a Drug Formulary. This is an approved list of drugs where the prices have been negotiated and the drugs have been determined to work for most people.

This list has different sections called Tiers. The newer or more expensive the drug, the higher the Tier and the higher the out-of-pocket cost.

You can ask your doctor to prescribe a drug that’s on your plan’s formulary, which can help keep your costs down. Then, if that drug doesn’t have the results you and your doctor would like, you can try a more expensive one.

It’s very important that your doctor document the time period, results and side effects (if any). Note that newer drugs often have fewer side effects. When I was a pharmaceutical representative, doctors often wanted to try a new drug for the patients who were experiencing adverse affects that lowered their quality of life.

Check the manufacturers’ website

If your prescription costs are high and you’re having trouble with the copayment, check the drug’s website. Many manufacturers offer an advantage program that reduces your out-of-pocket expenses. For example, a popular drug to prevent heartburn offered one such advantage plan, where users could fill out a form with their information and receive more than 30% off of their copay. That can be a significant amount.

Remember to also ask your doctor for samples of a medication if you’re trying it for the first time. This can extend your re-fill time and make sure the prescription actually works for you.

Other options

Find out if your healthplan has a mail-order option; you may be able to get a 90-day supply for one copay.

Some pharmacies and hospitals will also waive copays if you meet the low-income standard. Ask your pharmacy if they offer this program and fill out the required forms.

If you belong to Medicare Part D plan but cannot afford your medications, you can apply for federal assistance. The Social Security Administration has an application, and qualification is based on income. To apply online, visit www.socialsecurity.gov.

This application can also enroll you in the Medicare Savings Program, which helps pay your Medicare costs. To be sure you get all the benefits you qualify for, complete the entire Extra Help application, even if you do not think you qualify for Extra Help.

Communicate with your doctor, keep your follow-up appointments and take your medication exactly as prescribed. Ask for samples, call your insurance company and visit the drug’s website. You may be able to save money and avoid unexpectedly high prescription costs.

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About the Author

is a certified medical biller and coder (CPC) and a Certified Professional Compliance Officer (CPCO). She works as an academic coach at Ultimate Medical Academy for the Medical Billing and Coding, Medical Office and Billing Specialist and Medical Administrative Assistant programs. She has extensive experience in the insurance industry dealing with billing, auditing, compliance and sales.

The views expressed herein are those of the author and do not necessarily reflect those of Ultimate Medical Academy.

The UMA Blog covers information and advice for employers and workers at the intersection of healthcare, education and employment. Our contributors are intimately familiar with a wide range of subjects covering professional development, career advancement, workplace politics, healthcare industry specific topics, personal finance, education and so much more. Learn what you need to get ahead and stay ahead.

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