First, let me say right up front that I don't view drug companies as "bad guys" — their investments in research have produced dozens of medications that are responsible for most of the progress in health care during the last 25 years. They do good work, and they are entitled to profits — in fact, they need profits in order to invest in more research.
That said, the simple fact is that the cost of medications remains a crushing burden for the people paying for health care in the United States — and, increasingly, that means you. Patients are being required to pick up a growing portion of health care costs, and nowhere is this trend more apparent than at the drug store. Millions of Americans now get their medications according to a three-tier copay plan, in which they pay low copays for generic medications, medium copays for preferred brand drugs, and high copays for others.
For patients with cardiovascular disease, state-of-the-art treatment often requires taking three, four, or even more drugs every day — forever! A copayment of $25 for one drug may not seem so bad, but when you multiply that times four drugs, once a month … For many people, the choice between food and medications becomes all too real.
What can you do to hold down your costs without compromising your health? Here are a few basic strategies:
- Tell your doctor that money is an issue. Physicians often assume incorrectly that insurance is going to pick up all of the cost of medications, or may be oblivious to the financial impact of the prescriptions that they write. If you simply tell the physician that you are interested in keeping your out-of-pocket expenses to a minimum, there is virtually always something he or she can do to alter your regimen without sacrificing effectiveness.
- Ask if your medications have generic versions. Generics are much less expensive than brand-name drugs, and many patients incorrectly assume that "you get what you pay for." However, the true cost of making most pills is trivial — it is all the research and development that is expensive. Once a medication has outlived its patent protection, and many companies are allowed to make "generic" versions, the price can fall to pennies per day. Generic medications are carefully regulated by the U.S. Food and Drug Administration, so their quality is dependable. And now, a whole generation of miracle drugs are becoming generic, so you can expect their prices to fall. Ask your doctor if you can be switched to generic versions of your current medications.
- Switch to generic drugs within the same class. Even if your medication does not have a generic version, there are often generics for other drugs within the same class of medications. This is true for the most important classes of cardiovascular medications — ACE inhibitors, calcium channel blockers, beta-blockers and statins. Of course, people respond differently to different drugs, and you would need to see your doctor again to be sure that the generic medication was having the same effect. But this extra visit or two to the doctor to check that your blood pressure, or cholesterol, or heart exam was satisfactory could save you lots of money over a year or two by reducing your copayment.
- Don't pay for more than you need. If you have no insurance coverage for medications, and your doctor prescribes a new medication, ask him or her to write you a prescription for just a week or so. You can see if the medication agrees with you, and whether the dosage is right. Then, if the drug works out, you can fill a long-term prescription. This strategy will help you avoid ending up with a stockpile of medications that didn't work out — but that you paid for!
- Don't ignore the value of diet and exercise. Finally, the painful truth is that lifestyle changes such as diet and exercise really do work, and many people can reduce or even stop their medications if they can buckle down and make real changes in what they eat and how they live. Do not stop your pills and then make changes in lifestyle — make the changes, and then ask your doctor which of your medications may no longer be needed.
Thomas H. Lee, M.D., is the chief executive officer for Partners Community HealthCare Inc. He is a professor of medicine at Harvard Medical School. He is an internist and cardiologist at Brigham and Women's Hospital. Dr. Lee is the chairman of the Cardiovascular Measurement Assessment Panel of the National Committee for Quality Assurance.