One of the toughest parts of my job is seeing patients who don't take their medicines because they can't afford them. It happens frequently, and it's becoming more common as people lose their jobs and their health insurance. And for many conditions, like high blood pressure, not taking prescription medicines can be extremely dangerous, triggering strokes and heart attacks.
Out of necessity, I've had to find ways of treating conditions on a shoe-string budget, whenever possible. Despite the ridiculously high cost of prescription medicines, it is possible to find relatively inexpensive treatments for many common, uncomplicated, bread-and-butter medical problems. Unfortunately, many doctors don't seem to be aware of their patients' difficulties filling prescriptions, and put them on expensive newer medicines when older, less expensive generic drugs would work just as well (or, some might argue, better, since patients are more likely to fill a prescription they can afford).
When a new medicine is introduced for sale in the US, its manufacturer has exclusive rights to its sale and can charge a high price. The pharmaceutical companies give these medicines a catchy "trade" name, market them to doctors, and often pay a lot to advertise them. But it's important to remember that just because a drug is new, that doesn't mean that it's any better than the medicines that are already on the market. After several years, other companies are allowed to manufacture the same drug, though they can't use the trade name. These competing drugs are called generic. They're cheaper than trade medicines and in the vast majority of cases work just as well (there are a few exceptions, such as thyroid medicine). Generics aren't advertised by any drug company, but the "first line" treatments for many conditions, such as high blood pressure, are available in generic form.
The Federal Food and Drug Administration (FDA) mandates that generics meet the same quality standards as brand name drugs. FDA inspectors routinely compare the potency and bioavailability (meaning, how much gets into the bloodstream) of generics and their comparable brand drugs, and "they're virtually always within the 10 percent margin," according to Dr. Sidney Wolfe, a longtime consumer advocate who serves as director of the Public Citizen Health Research Group.
A few types of medications, including the anti-seizure drug phenytoin (or dilantin), and the anti-clotting drug warfarin (or Coumadin), have a narrow therapeutic range, so small fluctuations in blood levels can potentially be dangerous. But most other medications can be switched from the trade to the generic brand without a problem. "In the course of a year, there are as many recalls for brand medications as for generics," Wolfe said.
As a physician who takes care of low-income, mostly uninsured people, I've learned to accommodate my patients' financial circumstances by using generic drugs when possible and by letting patients know about pharmacies that sell these generics at a relatively low cost. Below are some of the places where I direct patients. (By the way, none of the companies I'm mentioning have paid me in any way, and I don't own individual stock in any of them.)
1. Target and Walmart. Both provide a month's supply of certain generic drugs for four dollars, and offer hundreds of different medicines in their programs. You can see their four- dollar medication lists here and here. The lists include medicines that are considered "first line" therapies for high blood pressure and heart failure. There are some notable exceptions -- for example, the newer diabetes medicines and proton-pump inhibitors (which reduce stomach acid) aren't there.
Neither list includes any drugs that aren't yet available in generic form. If you are on a more expensive "trade" medicine, you might want to ask your doctor if a less expensive drug that's available in generic form could safely be used instead. For example, I recently saw a patient whose previous doctor had prescribed valsartan, a medicine that's not available in generic form, for her uncomplicated high blood pressure. She lost her job, couldn't afford the medicine and hadn't taken it in a month. I was able to substitute lisinopril, a medication for high blood pressure that is on the Target list, and she's been taking it without problems.
Target and Walmart see the four-dollar programs as "loss leaders" -- it actually costs them more than four dollars to buy, package and sell the medicines on their list. The companies are hoping they'll make a profit anyway, because people who come in for the inexpensive medicines often buy other things as well. When the companies introduced the four-dollar medicine programs a few years ago, many people criticized them for trying to put small independent pharmacies out of business. Personally, I have mixed feelings about the programs, since I've found independent drug stores are friendlier and provide better service than the chain stores. But it does my patients no good if I write prescriptions they can't fill.
2. CVS, Walgreen's, and Rite Aid have similar discount generic programs, but you need to sign up for a "savings pass" or "membership" for each. Walgreen's charges a $20 membership fee and CVS charges $10 annually for individual people to get the generics at low cost. More about these companies' programs can be found here, and here.
3. Local grocery store chains with pharmacies sometimes have reduced cost generics, too. Where I live, Publix Supermarket's pharmacies offer a 14-day supply of certain frequently prescribed antibiotics, including penicillin, for free. If your supermarket has a pharmacy, you may want to check their website to see if they have a discount plan.
What if you are on a medicine that isn't available as a generic and that has no acceptable substitute? Many drug companies have patient assistance programs, which provide medicines at little or no cost to low income people. The best place to find out about these is through NeedyMeds.org, a nonprofit group that is not affiliated with any drug companies. Its website has a long list of prescription medicines with links to information about how to get them cheaply.
The patient assistance programs usually require that patients and their doctors fill out a lot of forms and send in proof of income and other paperwork. This can feel overwhelming, but the NeedyMeds website has a link to lists of groups that help people fill out these forms. (The NeedyMeds staff do not fill these forms out for you.) The website also can direct you to Medicaid programs in different states as well as to groups that help people with certain diseases, such as epilepsy and HIV.
What about the websites you may have seen advertising cheap medicines from Canada? According to the FDA, some of the online pharmacies purporting to be Canadian really are sending medicines from other countries, and the pills may be fake or may contain dangerous ingredients. It's also technically illegal to buy prescription medicines from another country, though an FDA spokesperson told me that they "use discretion" in their enforcement and most likely aren't going to start arresting people who are buying their personal, medically necessary prescribed medicines this way. If you are wondering if an online pharmacy is legitimate, the National Association of Boards of Pharmacy has a verification program you can use to check.
A similar version of this article ran on the website of New America Media, a nonprofit association of ethnic media.
Follow Erin N. Marcus, M.D. on Twitter: www.twitter.com/ErinNMarcusMD