If you're taking prescription medications and you have insurance, maybe you feel pretty lucky when all you have to do is pay a "small" copay each time you get a new bottle of pills. But are you? Believe it or not, many people, perhaps most people with insurance, often pay far too much for their prescriptions.
I'll always ask a new patient about the cost of their medications. A patient might tell me (for example) "I have high blood pressure," and then hand me a prescription he recently bought of amlodipine (a common medication for high blood pressure). So I'll ask, "How much did you pay for this amlodipine?" "Not much," he'll say. "I have insurance, so it only costs me $10 a month."
It only takes a few phone calls to change his view. I'll often start by calling the pharmacy where he bought the medication (CVS for example) and ask, "If someone buys your club card for a $15 annual fee, how much would three months (90 pills) of amlodipine cost? Answer: $12. Next, I'll call Costco and ask: "How much will a full year's supply (365 pills) of amlodipine cost a person who doesn't use insurance?" Answer: $26.49! For a full year!
So, what's going on? Why do patients get such bad deals when they use their insurance?
Part of it comes from the fact that there are really two kinds of prescription medications: Brand-name medications and generic medications. The first are very expensive. The second, amazingly cheap.
How much of a difference in price is there between the two? Most generic medications are about 95 to 99 percent cheaper than their brand-named equivalents! (That's right. As much as 100 times cheaper!) That's not an exaggeration. The pharmacy usually pays at least $300 to $500 for 100 pills for a brand-name medication. If it's generic, the exact same medication might cost anywhere from $2 to $10 for 100 pills. Actually, to return to our starting example, that's how the prices of Norvasc (the brand-name medication) and amlodipine (generic, but the exact same drug) compare at Costco.com.
Now, you might be thinking: "There must be some difference between the $400 drug and the $10 drug." But there's not. And here's why:
The FDA mandates that all generic drugs are tested to make sure they have exactly the same effect as their brand named equivalent before they can be sold in the U.S. So you get the same medication in the same dose with the same effect but it costs nearly 100 times less money. And that means that you can get many of these medications at Costco, Wal-Mart or Target for less than what most people pay in insurance copays for these medications. I'm not talking about just a few medications either. Here is a list I've made of more than 100 commonly prescribed generic medications along with their most recent cash price at Costco (for as much as a year's supply in many cases).
So why do so many people think they're lucky to put down a copay that's three times the cost of the medications they're buying? Probably because not all prescription medications are inexpensive. If you actually need a brand-name medication and don't have insurance, the cost might well break you. This can create a lot of uncertainty and both insurance companies and pharmacies are happy to profit from that uncertainty. Most patients are confused enough to be grateful about a copay that's really more than the price of the drug they're buying. That confusion is worth a lot of money to pharmacies and insurance companies.
Close to 80 percent of the prescriptions filled in the U.S. now are for generic medications. So using your insurance to buy many of these medications isn't saving you money, it's costing you money.
What's more, if your doctor prescribes you a brand-name medication, it still might not be the best option for you. Doctors never have to pay anything for the medications they prescribe and typically have no clue how much they really cost. As a result, they often will hand you a free sample for a brand-name medication to get you to try it without ever considering generic alternatives that do exactly the same thing. Even with insurance, some brand name medications might cost you $50 to $100 a month and, if the medication isn't covered, it could cost you far more.
Most people are rather hesitant to talk about money and will rarely discuss the cost of a drug or a test with their doctor. This is unfortunate because many people will stop taking medications simply because they can't afford them.
If you are willing to discuss money with your doctor it can help in two ways:
1) You can educate your doctor about the cost of medications. Most doctors have no idea how much any of the medications they prescribe cost so feel free to print out the list I compiled and bring a copy to your doctor.
2) It could save you hundreds, if not thousands, of dollars a year.
So, don't be shy. You know all those ads (usually for overpriced brand-name medications) that say "Ask your doctor?" Next time, "ask your doctor" just how much that new prescription will cost. And don't take "I don't know" for an answer. You could save yourself a lot of money, and help the rest of his patients, too.
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