How I Save Money on Prescription Medication
For the past three years, May has become annual exam month for my entire family. I visit my OB-GYN, BabyGirl visits our PCP (as of this year, also the OB-GYN), and Precious has her wellness visit/annual vaccines at the Vet. Needless to say, medical expenses in May exceed any other month of the year. So far, I’ve spent $356 in medical expenses, which include co-pays, Rx, and OTCs. Now that the month is over, I want to share how I saved money on Rx.
Information Gathering: When I stopped by the pharmacy to pick up two Rx - one for myself and one for BG - the cashier said my total was $100. What?!?! Wait a minute. I already pay $91 for premiums every pay period and $30 for each specialist visit. I could not understand why I had to pay so much for an Rx, which is usually $7-$20 each.
I asked the pharmacist if there were any generics available and she said no. Now what the heck kind of special medication is this with no generic version? Then I asked for the name of the meds so I could go home and look them up online. When I logged into my insurance provider’s website, I searched for the Rx name, its purpose, side effects, alternatives, etc. After about 10 minutes, I found exactly what I was looking for…and a bonus…the primary active ingredients. Armed with information and a better understanding, I made a few phone calls.
First up, I called my insurance company. I wanted to know WHY my out of pocket costs (OOPC) were $50 for each Rx. I was told because the meds were “non-formulary” which is just another word to mean “not on the HMO preferred list so you’re on your own sucka!” Yea…ok.
First Rx: Then I called my doctor’s office to explain the situation. I asked the nurse if there was a reason the doctor prescribed THAT specific med. I explained that my insurance company had a “preferred med list” and there was another med with the same % of the primary active ingredient. I also asked if she could call in an alternative Rx, which would make my out of pocket costs $10 vs. $50. We discussed the purpose of the original med and why my doctor preferred that specific brand. I don’t have a medical degree, so I was not about to press the issue, but that didn’t mean I had to like it. After hearing the hesitation in my voice, the nurse asked:
Nurse: How close are you to the office?
Single Ma: I’m at home right now. About 15 minutes away without traffic. Why?
Nurse: We might have a sample here in the office. Let me check.
Single Ma: [on hold]
Nurse: Yes, we have a sample. Will that solve the problem for you?
Single Ma: Of course.
Nurse: We close at 2pm today. Stop by to pick it up when you can.
Single Ma: Great, thanks!
OOPC: $50 –> $0
Second Rx: I called BG’s doctor and had a similar conversation. They didn’t offer a sample, but they agreed that one of the alternatives would work just fine - reducing my out of pocket costs from $50 to $10. The nurse called in the alternative Rx and I was all set.
While waiting for the prescription to be filled, I browsed on my insurance provider’s website. I discovered that a 30 day supply would cost $10 but a 90 day supply would cost $20. Hmm…another $10 savings. So I called the pharmacy to make sure they received the alternative Rx and asked if they could fill a 90 day supply. I was told the doctor would have to authorize it because some meds have to be restricted. Otherwise, they could only dispense a 30 day supply.
You know what I did right? I called BG’s doctor back! LOL I asked them to call the pharmacy again and specify a 90 supply with 3 refills vs. a 30 day supply with 11 refills. She said no problem, and within minutes, it was done. Great!
OOPC: $150 for 90 day supply ($50/30 days) –> $20 for 90 day supply
This experience taught me a very important lesson. In order to save money on Rx, I should:
- Understand the Rx
- Understand the details of my insurance coverage
- Ask for FREE samples first
- If #3 is N/A, ask for the generic alternative
- Never be afraid to ask the doctor to explain their med choices
One of my girlfriends thought I was out of my mind to question WHY my doctor prescribed a certain med, then had the nerve to ask for an alternative. LOL I told her these doctors are “practicing” but I’m not a guinea pig. Besides, this is MY body, MY money, and ultimately MY decision - so I have a right to know, ask questions, and understand. And you do too!
At the end of the day, we received the appropriate meds and saved $180.
~*~*~*~*~*~Work to achieve, not to acquire.
And as always, BE FABULOUS!
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It’s happened to me many times where a drug my doctor has prescribed is “non-formulatory” and therefore much more expensive than my usual prescription costs. But each time I’ve spoken to my doctor personally, and he’s happy to prescribe something else. (I usually do the mail order to get the 90-day supply for less, and I call and have the pharmacy staff tell me which drugs do the same things and ARE formulatory. I then give the names to the doctor to make it easier for him.) Often doctors have no idea how much drugs cost on the various plans, so there’s nothing wrong with doing your homework and having the conversation, when warranted!
Lol at not being a guinea pig! Another way to save on meds (like BC pills) is to get them via your insurance company’s mail order pharmacy. That will eliminate the trips to the local pharmacy thus saving you gas :o)
If you go the mail order route make sure you are getting the 90 day supply like Single Ma instructs. Although, please remember that not all meds are available via mail order pharmacy.
I know that’s right!!! Most times I go in there armed with my mail order prescription form.. its so bad that my docs have the fax # in their file
LOL They usually give me samples of the med to last me until my mail order arrives.
If its something I MUST take immediately.. then they call it into my local pharmacy. I haven’t used a local pharmacist in so long.. the convenience and the cost was NOT cute compared to the mail order. Although with my new insurance plan my rx’s are at a max $10 LOL including the non formulary ones LOL I love it!!
Way to go SM
wow i’m impressed with the initative you took. i never thought about doing internet research and calling the doctor to see about getting a different version of the medicine. i think i just assume that the doctor knows best. guess i needed the reminder that when you assume…..
thanks for the ideas!
hi! I’m a medical student and I just want to congratulate you on making some really smart moves. Not all generics are the same however, and sometimes, the ‘original’ for some reason just happen to work better (no one knows why really…)and then docs prefer to prescribe those over generics because they had some bad experience with a particular generic drug and sometimes it may be worth it to pay for the original drug. But many times, if there is a generic available, go with the generic. you are what i would call a very well informed patient!
That is why my doctor wouldn’t recommend the generic for my Rx. Didn’t have time to provide all those details in the post. Thanks. [-SM]
I have done the things with prescriptions that were mentioned here. I can tolerate my blood pressure medication just fine in the generic version. The other pill I take daily is Synthroid. I found out the hard way that the generic versions of this drug were not any good-my TSH levels bounced around unpredictably. I was smart enough to ask for coupons one day at the doctor’s office. The assistant gave me a hand full of them - saved me $10 for a 90 day supply. Then I did something even bolder….I called around to Costo, Walgreens, WalMart, and HEB and asked the suggested retail price. My copay for a 90 day supply with my insurance was $75 through the mail order - but I couldn’t use the coupon. I found out that the RETAIL PRICE AT COSTCO WHERE I COULD USE THE COUPON came out to about $50! Not only that, but the insurance copay was MORE than the suggested retail price at Walgreens - which ended up being the most expensive of all the places I called.
When I left that company and filled out my exit forms, I told HR in no uncertain terms that making MONEY off of people’s medications where it could be purchased at full retail price was immoral.
Jasmine, what you call original or patented brand drug has a certain % of active ingredients to be effective.
Once the patent is up and generic medications are created, they are allowed by FDA to have up to 20% (!) less of the active ingredient(s) than brand-thus they do not work as well if the dosage prescribed is the same as was with the brand name drug.
Dosage needs to be higher with generic and this takes patience from the medical professional as well as patient since it is trial and error at that point.
Edie, Synthroid-actually its generic forn-Levoxyl 30 day supply of 125mg costs $19.99 at CVS
however if your health insurance company has a set amount of co-pay for generic/brand medication then it does not matter that it costs $19.99 in this case
if co-pay is $30 for generic meds -then you pay $30 and not $19.99 as you would expect.
That is how insurance companies balance high pharmaceutical costs-they loose some on higher cost meds, but gain on lower costing meds
Thanks for providing the additional explanations. [-SM]
Also make sure you check out the RX list at Wal-Mart, they have expanded their $4.00 generic list and I have heard that some Target’s also offer it…
Also at some walgreens they have a walk in clinic that is open 7 days a week and in the evenings, called Take Care. They accept insurance and you pay what your copay would be for the dr… It was a lifesaver for me when my doctor couldn’t get me in for 3 days, I was able to walk in there and be seen and they called me the next day to check on me!
Awesome. I know that if I ever go through a bad patch again I may have to get on another antidepressant. So I plan to talk to my doctor about the different generic options, how well each of them works, and ask her to start me out with those. Because I do not want to be paying $85 outright or $25 with coverage (depending on whether or not I’ve met my deductible). Thanks for the tip about calling the insurance company too.
Good job Single Ma!
Here’s how this Frugal Mama does it:
1. Always ask for free samples from the doctor.
2. Determine if generic will do the job. For my DD, anti-seizure and thyroid must be name brand. Once the insurance co. refused to pay for the brand name and insisted she could do with generic, she had a grand-mal seizure - the worst. You better believe I and her neurologist fought with the insurance co and I am happy to report she’s been back on brand name for two years and has been seizure-free
3. For maintenance or on-going meds I have the dr. write the RX for 90 day vs. 30 day. As stated, it’s cheaper to get them this way.
4. Check Costco, BJ’s, Wal-Mart, and Target’s price to see if it’s lower than my co-pay.
5. See if there’s a coupon out there to get a gift card for a new or transferred RX. CVS, Rite-Aid, Walgreens & Target frequently puts these in there sales flyers. Often times this can be a money maker.
6. For those 30 day meds, I always fill them 5 or so days before the due date. The insurance will allow anywhere from 3 - 7 days before the due date. This gives me several more pills over the years time.
7. Lastly and most important, determine if a health change will eliminate the need for a drug. I kicked my exercise up a notch (OK I started working out regularly) and was able to eliminate high blood pressure meds.
Can you call my insurance company and find out why they did not pay for my lab charges? Makes no sense to me and I keep forgetting to call them.
Here’s another one. Drug companies almost always provide vouchers/coupons/cards to save money off your copay for brand name medications. For those meds that you must take the brand, remember to ask your doc if they have a voucher. I work in a physician’s office and we try to remember to give them out, but don’t always. I use a lot of brand products prescribed by my dermatologist that my bootleg insurance doesn’t cover. These surely come in handy!
And if there’s anyone with a low-income without insurance, every drug company offers a Patient Assitance Program that will provide you with the medication for free (or a minimal copay) if you qualify. Your doctor’s office should know about this and can help you with the paperwork for FREE! Don’t get suckered into paying a company a fee to do the paperwork for you!
My two cents!
Great tips! Especially about the low income assistance. Thanks! [-SM]
I hope people aren’t really considering always asking for free samples from their doctor. I understand that, in this case, the receptionist offered the meds to Single Ma to get the situation resolved, but I don’t think free meds should be sought every time. I’m a med student too and I know that many practices try to keep the free samples for people with serious diseases requiring long-term use of an expensive medication, especially patients who are low-income earners. Alternatively, the meds get used in the doctor’s pro bono or charity work (often collected up by other doctors if yours isn’t him/herself actively involved). I guess it’s just something to think about. That said, I really admire Single Ma’s tenacity to get the best price by phoning around and being an informed consumer.
Thank you for this post. I love your tenacity. When I think about it, I do ask for samples or genetics especially for new prescriptions. My parents, who are on a fixed income, do as well. However, no matter what kind of prescriptions I get from the doctor, I take time to look up the drug on the internet so I can review side effects and ingredients before I go to the pharmacy. (More than once, I have taken a prescription to the pharmacy only to be told that the prescription can’t be filled because I am allergic to certain ingredients.) I encourage everyone to do the same. You can save time AND money on your prescriptions.
I understand exactly how expensive prescriptions can get even with insurance, taking over $3,000 worth of medication every single month I learned how to lower my co-pays really fast since I was paying 10-20% each month. I always ask if a generic version is available and have made sure I know as much as possible about the medications I do take and the ones used to treat my condition. That does not mean I was able to reduce co-pays on everything but I did find a few resources for when that isn’t possible. 1. some doctors get a regular and large supply of samples for certain medications, I always ask if this is the case when given a new script for a name brand med with no generic 2. I am disabled so I qualify for programs that others might not 3. I ask for help when the choice is between getting my meds or paying bills/ eating. 4. I use mail order when I can because this saves a lot of money through my prescription insurance company.
It takes great courage to question the doctor. I asked the doctor why he said my son had mono (meaning what are the symptoms?) and he answered, “My examination!”