How to Control the Cost of Prescription Drugs

By FOXBusiness

For more than a decade generic drugs have been bringing down costs at the prescription drug counter. Experts say those costs could shrink even more if consumers grew more comfortable with generic versions of popular drugs, and doctors prescribed them more.

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Consider that nearly half of all Americans regularly takes one prescription medication, according to a Consumer Reports National Research Center August 2011 survey tracking consumer attitudes and spending habits on prescription drugs. That number naturally increases for seniors: 70% of consumers aged 55 and over and 77% aged 65 and over take prescription medications, the poll says.

That demographic alone computed to $307 billion in drug spending in 2010, according to IMS.

Individually, the monthly out-of-pocket cost for the average consumer taking prescription drugs is $59.00, and 12% of Americans spend $100 or more.

The numbers have been dropping, however, according to Lisa Gill, prescription drug editor at Consumer Reports Health. Consumers and their physicians have been turning more to generic drugs to cut down on spending as opposed to taking matters into their own hands. In the latter instance, consumers often skip dosages, take themselves off drug regimens or take expired medications all because of cost.

Generics, experts say, constitute as much as an 80% savings in retail cost. In fact, over the past 12 years, the use of FDA-approved generic prescription drugs has saved the U.S. health-care system more than $1 trillion, according to the Generic Pharmaceutical Association and the IMS Institute for Health Informatics.

And at the current generic utilization rate, more than $3 billion is being saved every week as American consumers and patients rely on generic medications.

Cost a huge factor and bioequivalence

According to the survey, doctors could do more to insulate their patients from undue expenses, such as prescribe cheaper generic drugs. Physicians routinely fail to prescribe money-saving generics, and very few doctors raise the issue of cost during patient visits, according to the survey.

In response, the American Medical Association (AMA) says that its policy on prescribing supports physicians writing a script for either generic or brand name drugs. Physicians should supplement medical judgments with cost considerations, recognizing that generic drugs frequently can be less costly alternatives to brand-name products, AMA says.

What’s essential, however, is that physicians receive adequate information about the bioequivalence of generic drugs, which means they release the same amount of the drug at the same rate as their brand-name counterpart.

Brand Allegiance 

Consumers often believe that doctors prescribe a brand because it’s what they know, says Mark A. Cesarano, a managing consultant at the Savitz Organization. They also have misgivings about the influence of pharmaceutical companies and their sales representatives on physicians, he says.

Non-English speaking consumers view generics as “second class,” experts say. Typically, they try to purchase brand names and spend way more than is required.

The elderly, too, show some resistance to generic drugs and as they navigate through the dreaded " donut hole" of Part D coverage, when they go from paying copays to 100% for their drugs, they will now receive considerable relief on brand name drugs.

In 2011 and 2012, the donut hole will kick in when a Medicare beneficiary has spent $2,930 in retail costs. Health care reform mandates that seniors will get 50% off brand names, and 7% off generics. In 2012, the generic discount will increase to 14%.

After leaving the donut hole phase of the prescription drug plan, a Medicare Part D beneficiary enters into the last phase of prescription coverage, or catastrophic coverage. From this point on, the Medicare Part D beneficiary pays $2.60 per month for generics, $6.50 per month for name brand medications or 5percent of the medication's retail cost, whichever cost is higher.

Consumers tend to cling to bits and pieces of information and can have misconceptions about brand names, says Michael Cleary, a pharmacist at Baron’s Drug Store, an independent pharmacy in Westfield, NJ.

“But customers, even those that can avoid higher costs, are looking at affordability, so there’s not so much resistance to generics anymore.” And, he says, if you really think about it even brands differ slightly batch-to-batch.

Cleary also points out that insurers prefer generics; “Consumers can’t have their cake and eat it too.”

People don’t necessarily want to hear this, however, says Cesarano. Insurers and employers who self-insure or pay for a third-party plan are often painted as “big bad guys. But when an insurer or an employer who self-insures pays more on a bill, there’s less to go in your pocket.” Almost $85 per script can be saved monthly with a generic prescription versus a brand.

Alternate Therapies 

The popularity of corporate wellness programs and the mandate for free preventive care—all tenets of health-care reform—may help get Americans on track to combat conditions like high cholesterol, high blood pressure and obesity. Life style changes, for example, smoking cessation, combined with diet and exercise go a long way, too.

Using these methods, physicians can and do cite examples of outcomes that eliminate the need for medication, totally. Experts say about 50% of Americans use some kind of supplement and alternative therapy with limited degrees of satisfaction—with chiropractic particularly popular.

Savitz says many plans support chiropractic care but limit the number of visits or cap the amount paid on claims.

Chiropractic is is not addressed in health care reform, according to Savitz, even though consumers ask for the coverage.

Plans are typically resistant; even the government does not regard chiropractic as a specialty on the same par with going to the dentist or a doctor.

“It’s a murky area,” Savitz says.

Here are more tips on how to save money on prescription drug costs:

1) Bring your medication bottles and a copy of your insurance plan's formulary to your appointment with your doctor—and tell him or her cost counts.

2) Pharmacists can be a helpful resource and can point a consumer to a discount drug program.  They know the pros and cons of drugs and their costs and they likely have a comprehensive record of an individual’s medicines.

3) Avoid free samples when possible because they’re tend to be offered for newer, more expensive medications for which no generic is available, and that can cost a consumer when its time to fill the prescription.

4) Some retail chains have discount generic drug programs: $10 for a three month supply of 90 pills. Walmart, Kmart, Walgreens CVS, Target, Sam’s Club and some supermarket pharmacies are among the chains that have this offering.

5) Shop around among pharmacies in your area and don’t overlook your independent pharmacy. Some independent pharmacies offer among the lowest prices and consistently beat out everyone else

6) Look at legitimate websites for online deals. Do not order drugs from other countries online--they are not controlled by the FDA. Gill says sometimes websites look like a company supplier is based in Canada, but is not, and is not regulated by Canada’s equivalent to the U.S. FDA.

7) Tell your pharmacist you want to pay less for your drug. Pharmacies in every state can automatically switch your drug if your drug has a generic equivalent without having to call your physician for approval.

8) Determine whether a particular condition from which you are suffering has an over-the-counter drug that will work as well as a prescription, either brand or generic

9) If you have a serious chronic condition like HIV, Hepatitis C, diabetes, psoriasis or cancer, which may or may not not have biosimilars or generic substitutes but is a drug you can’t live without and presents you with huge medication bill every month, be aware that manufacturers offer discount programs to make these drugs affordable. Write or call for the assistance you need.

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