 | Highlight on Drugs | | |
Protecting Yourself Against Drug Cost-Shifting
January 20, 2004
Last reviewed by Faculty of Harvard Medical School on May 28, 2008  By Harold J. DeMonaco, M.S.
Massachusetts General Hospital Many health insurance companies and drug benefit plans use a step system for determining out-of-pocket prices that subscribers pay for prescription drugs. Commonly the out-of-pocket expense is $5 to $10 per month for a generic product and $10 to $20 per month for a brand-name product. Often there is a third tier for "non-formulary" drugs with much higher co-payments, up to $50 per month. We are at a crossroad. Pharmaceutical companies have produced an ever-increasing number of medications that improve quality of life and longevity, but the economic cost has reached a breaking point. Cost-shifting to the individual can help to slow the total rise of drug expenditures, but it won't stop it. And the cost-shifting has the potential to increase the overall cost of medical care if people don't buy the drugs they need to prevent illness and its complications. Prescription drug costs will continue to be a major issue for the foreseeable future. The movement toward consumer-directed health care requires cost sharing by individuals in some form. The best way to deal with this trend is to become an educated consumer: Understand the options available, the trade-offs and the relative costs. Here are my seven ways to get the most from your health care dollar: - Always ask your health care professional about the choices available. Most symptoms and diseases have many different treatment options. Your health care professional should be willing to discuss the options he or she is comfortable prescribing. Common diseases and conditions have more choices available than less common ones.
- Always ask your health care professional to prescribe the generic form of a drug if there is one available. Generic drugs work just as well as brand-name drugs. The U.S. Food and Drug Administration has a strict set of rules that drug producers must live by. These rules for quality apply to both the brand-name maker and the generic maker of prescription drugs. The difference in price can be very large, and there is no difference in how well they work.
- If you are taking prescription drugs for a chronic condition such as high blood pressure, think about getting a three-month supply at a time, and consider using a mail-order pharmacy. The co-payments are usually less if your have prescription drug coverage in your health insurance. Many online pharmacies offer discounts for a three-month supply. Some managed-care insurance companies limit your choices of mail-order pharmacies. If you have a choice, always look for one, especially an Internet pharmacy, with a VIPPS seal of approval, issued by the National Association of Boards of Pharmacy.
- Pill-splitting is sometimes a good way to reduce your costs. Ask your pharmacist about tablet strength. Getting a tablet in twice the dose and cutting it in half sometime can reduce your cost by as much as one-half. For example, Moexipril (available as a generic or under the brand name Univasc) is a member of the angiotensin-converting enzyme (ACE) inhibitor group of drugs used to treat high blood pressure, heart failure and other diseases. Moexipril is available as a scored tablet containing either 7.5 milligrams or 15 milligrams. Both strengths are exactly the same price. By splitting the tablet, the cost of a month's supply drops by 50%. Note that not all tablets can be split. A good rule of thumb is to look for a scoring on the tablet.
- Most health-insurance plans have a preferred list of drugs, called a formulary. Many will penalize consumers by making them pay a larger co-payment for non-preferred drugs, or not covering the drug at all. Ask your health care professional to prescribe drugs that are on your insurance company's preferred list.
- Ask your pharmacist about less expensive drug options. He or she is in the best position to know which drugs can save you money, and you can then discuss with your doctor whether you can switch.
- Talk to your doctor not only about the potential risks and benefits of your medications, but also about price. All other things being equal, you may decide that one medicine is better than another on the basis of cost.
Harold J. DeMonaco, M.S., is senior clinical associate in the Decision Support and Quality Management Unit at the Massachusetts General Hospital and is currently a Visiting Scholar at the MIT Sloan School of Management. He is author of over 20 publications in the pharmacy and medical literature and routinely reviews manuscript submissions for eight medical journals.
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