Has this happened to you lately? You go to refill one of your regular prescriptions at the pharmacy and the copay has gone up — a lot.
That’s a nasty little surprise that’s happened to 1 in 3 Americans in the last 12 months, according to a new Consumer Reports survey of more than 1,000 adults taking prescription meds. Those hit with sticker shock said they paid an average $39 above the usual cost for their prescription, with 1 in 10 paying $100 or more out of pocket.
Drug prices have been rising — sometimes dramatically — in the past few years. A recent AARP report found the cost for 280 generic prescription medications most commonly used by those 50-plus fell by the smallest percentage since 2006, with 1 in 4 rising in price.
As Consumer Reports noted, these drug price increases often occur with no warning. Shortages or cutbacks in supply can trigger sudden price changes, which can then cause the insurance company to reduce coverage of the drug.
In the survey, most people (81 percent) simply paid the higher price, although some tried to negotiate a better deal: One in 4 said they called their insurance company to see if it would cover a greater percentage of the cost, or asked their doctor or pharmacist to switch their prescription to a lower-cost medication. Only 17 percent said they tried calling around at other pharmacies for a cheaper price.
Many said the price increase caused them to skip medical care or put off paying other bills to save money. A third of adults age 55 and older reported they cut back on groceries.
Part of the problem is that most people don’t realize their drug price has gone up until they get to the pharmacy. To avoid that unpleasant surprise, consumers “need to have a conversation about cost with their doctor before going to pharmacy,” said Lisa Gill, prescription drugs editor at Consumer Reports.
If you’re unsure whether your insurance will cover it, “the doctor can look it up,” she said. Yes, “it’s a pain and doctors don’t really want to,” she adds, “but consumers have to advocate for themselves and doctors have to think about these things.” After all, whether patients can afford their medications is an important consideration in helping them do what’s best for their health, she said.
Here are some other ways to find the lowest drug prices:
• Ask your doctor to review your medications. Some may be no longer needed, which could save you money. You also might be able to switch some to a generic or other less expensive alternative.
• Shop around. Call other drugstores, both chains and independents, in your area. It’s amazing how much prices can vary. For example, Consumer Reports found prices for generic diabetes drug pioglitazone (Actos) ranged from $328 for a month’s supply to $20 in the Des Moines, Iowa, area. If you live in an urban area, check pharmacy prices in suburban or rural areas, where they sometimes can be lower.
• Ask for the lowest price. Don’t assume the first price quoted is the lowest. That’s especially true if you’re paying out of pocket. A Target pharmacy in Des Moines first quoted Consumer Reports secret shoppers $191 for a drug, then came down to $160. However, an independent pharmacy seven miles away said its price for the same drug was just $7.50.
• Make sure your prescribed drug is covered by your insurance. If it’s not , ask your doctor to prescribe a different drug that is on your plan’s list of covered drugs. If that’s not possible or your doctor says it’s not a good idea, ask him or her to petition your insurance company to cover the drug. If your health plan denies your request, you can file an appeal.
• Consider other medications if the price is too high. Ask the pharmacist or your doctor if there is a more affordable drug in the same class of medications or if there’s an acceptable alternative. Ask for a generic version if you’ve been taking a brand-name drug.
• Use your insurance company’s mail-order service. For certain medications, using mail order may help you save money.
• Try getting your prescription from Costco. The warehouse club fills prescriptions for nonmembers, and Consumer Reports has found it usually has the lowest retail prices on medications.
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