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This is a guest post from Shiva, who wrote to offer some advice on how to shop for prescription medicine: don’t assume that the new new stuff is better!
I am a general internist — a physician who provides primary care to adult patients — and am on the faculty of a medical school, where I teach medical students and residents. One of my interests is the excess marketing and use of expensive yet marginally effective prescription drugs.
I have found in clinical practice that the most effective medications tend to actually be “tried and true” ones approved over ten years ago with thousands of patient years of post marketing safety and efficacy data available. Rarely is the latest the greatest.
Unfortunately (this is hard for me to admit), my profession has been overrun by the pharmaceutical industry — you are very likely to be prescribed expensive brand name medications that are no more effective (in some cases less effective and/or less safe) than older, cheaper, and more thoroughly studied medications.
Here are two websites I recently found from Consumer Reports and Public Citizen that summarize the costs and benefits of various drugs prescribed for common conditions. They do it better than most reviews in the medical literature:
- Consumer Reports Best Buy Drugs — “Free guidance for consumers on prescription medications.”
- worstpills.org — “Your expert, independent second opinion for prescription drug information.”
While physicians should be looking out for their patients regarding out-of-pocket costs, the reality is most physicians don’t even know ball-park prices of the medications we prescribe.
Given the underinsured status of many Americans — especially related to pharmacy benefits — meeting your doctor armed with information about the relative cost-effectiveness of the drugs for your condition is essential for both your physical and financial health. And in terms of drug advertising, I recommend ignoring the magazine, newspaper, and television ads. We can all become “branded” within the blink of an eye. Don’t let the flashy advertising dollars sell you on what’s best for your health.
Remember: Check for coupons and rebates before having your prescriptions filled.
This article is about Health & Fitness, Hints and Tips, Money Hacks Thursday, 4th October 2007 (by J.D. Roth)
October 4th, 2007 at 5:07 am
My biggest problem with the pharmaceutical world is that they create products that treat symptoms and not cure illness (besides antibiotics). The reason being? Profit!
October 4th, 2007 at 6:22 am
This is why I try alternative medicine. I have some recipes and alternatives I had obtained from my mother and grandmother to curb any common cold, flu or fever.
Anything bigger than that, I have no choice but be a mercy of the big industry that takes advantage of me. I guess a blog on educating people in medicine is required….anyone fancy doing that?
October 4th, 2007 at 6:56 am
Every patient should go to their doctor’s office with a copy of their formulary, the list of medications that are covered by your health plan, or a list of reduced-price medications available at Walmart/Target/wherever.
While a doctor’s first instinct may be to prescribe the drug that the pharm rep just told him about over an expensive lunch, the doctor will also take a look at your list and prescribe something that will be covered for you, or at least be able to explain why (s)he is recommending something different.
Most doctors are willing to work with you by trying things that are less expensive, but with so many different health plans and coverages, it’s a rare one who can keep up with what will be covered for you. The easier you make it for them to pick something affordable, the more likely you’ll be able to get what you want.
In meager defense of physicians, they are also being bombarded by patients demanding the new drugs that they are seeing advertised on TV and in magazines. Many of these folks assume that newer is better and pay little respect to their doctors’ recommendations. So between the drug reps and these eager patients, doctors are more likely to have the newer drugs at the top of the list.
October 4th, 2007 at 7:14 am
Or better yet, have a healthy lifestyle that leads to not having to see the doctor in the first place.
I see a chiropractor regularly and am making progress toward eating “raw”, instead of processed foods (its harder than you might think if you aren’t used to it).
I have seen a medical doctor once in the last four years as a result. The one time was for an emergency room visit after a motorcycle crash. Oops.
October 4th, 2007 at 8:21 am
Old world remedies almost always work better for common ailments, listen to your grandma’s advice! Also stick to drug store brands for things like asperin and ibuprofen. These are really some of the best drugs of our time and have been perfected for the end user.
October 4th, 2007 at 8:48 am
Direct to consumer marketing of prescription drugs should be banned.
In addition, doctors should be prohibited from accepting gifts, incentives, give aways and travel from the pharmaceutical companies.
Lastly: generic, generic, generic. It’s the same chemical formula with a less fancy name and less flashy packaging, and it’s just as carefully regulated.
October 4th, 2007 at 9:09 am
I love how everyone takes the attitude that the Pharmaceutical industry is evil. I am a rep, and I hope you don’t throw out my comments with that statement. I also agree that many times generics can do the job, but there are people out there that can only benefit from newer meds. I have seen it a hundred times. As for generics - the 80 / 20 rule applies. As much of 20% of any generic drug can be different from its brand name - these are mostly binders, but can effect the efficacy of the drug - elimination Cmax rates, etc. As for the expensive lunches - i am maxed out at $100 per doc and all of his staff. A typical doc has between 3 and 5 staff to handle the insurance company! The staff and doc demand the best - nothing less - high end meals for lunch! The whole healthcare industry is screwed up - but please dont just blame the pharma companies - I would look to the insurance companies.
As for saving money - look to your PBM (pharmacy benefit manager) and their PDL (preferred drug list). By the way - we drug reps are trained to tell the docs where we stand and often provide this info - docs dont care. Also, go to the website of the drug you are taking, many have free trials that you can do over and over. PDLs can change quarterly so make sure you keep an eye on it. And finally, 3 month mail order scripts are usually the best bang for your buck if you are on a drug for chronic conditions. Best of luck!
October 4th, 2007 at 9:20 am
I work in the pharma industry and I strongly agree with Debi. The formulary is what determines what your insurance covers and what it does not. You can have the next miracle drug but if it’s not on your formulary you won’t be covered for it and may not even get a prescription for it. There’s a reason the big pharma manufacturers pay a lot of money to get on formularies, it’s because this sells more drugs. So look at the formulary before you go to the doctor and before you pick a health plan.
October 4th, 2007 at 9:27 am
Great article! I haven’t had to take any prescription medications in well over a year *knocks on wood*
Thank you for the websites, they appear to be a great starting point for further research.
October 4th, 2007 at 10:13 am
A suggestion for self-pay folks –
Shop around. When I had to pay for my own Zoloft, I found that my monthly prescription could vary by $50 a month from pharmacy to pharmacy. Also, some pills are designed to be split - and having your doc prescribe a half pill of a 100 mg instead of a whole 50mg can be cheaper. Again, when I paid for Zoloft, 30 100mg pills ($105) were only $10 more than 30 50mg ($95) pills. Since I could split the 100mg, I got 60 days for a little more than the price of 30 day. (Of course, this is ONLY recommended for pills that are scored and designed to be split).
October 4th, 2007 at 11:25 am
Please use your pharmacist as a resource as well. We dispense the same medications hundreds of times a month and can tell you, the patient, what we have seen working and what isn’t working. Your pharmacist is more accessible than the average doctor and would love to talk about savings and what drugs will work best in certain situations. Please note that retail pharmacies push generics because they are huge moneymakers and secondarily because they can save you money. The drug rep who commented above is correct in saying that generics can vary by up to 20% efficacy and still be approved by the FDA.
October 4th, 2007 at 11:32 am
It’s worth staying on top of your costs even if you are on generics. I take the generic for prozac, fluoxetine, and if I don’t tell them explicitly “no insurance” when I request the renewal they run it as an insurance submission.
The problem with that is, I have my doctor write it for me in 90 day supplies. Costco’s cash price for 90 pills was $18 the last time I filled it. My insurance, however, will only do 1 month supplies at a time and my co-pay is $10.
By staying on top of the situation and cutting the number of trips I have to make to the pharmacy by 2/3 I get to save $12. I notice now looking at the Costco web page (you can check online their prescription prices) that they have dropped the price of those pills to $10 for 100, meaning I’d be losing $20 if I followed my insurance company’s system!
October 4th, 2007 at 12:24 pm
What gets me is the commercials that make it seem like if you care about getting better, you’d be taking X drug - case in point, one I take: Humira. The Humira commercials make it sound like this wonderful drug can “fix” your rheumatoid arthritis, shows people dancing, knitting, doing all sorts of active things. In real life, though, this class of TNF blockers is not living up to the hype for very many of the users. The sad thing is, I’m afraid to stop taking it (although I also take an older less expensive drug with a track record) just in case. And this is costing us $1300 a month, for two shots a month. I have a high deductible insurance with prescriptions included, so it actually runs us about $5000 a year, but that’s a LOT. Stop running so many darn commercials and cut the cost!
October 4th, 2007 at 1:54 pm
Good post. Yes, the best thing is to try to stay healthy, eat well, exercise, take good care of yourself and use alternative medicine for most common ailments. For the major stuff, you do need the doctors - like for cancer, or if you have a heart attack.
Education on your options is key. With healthcare you need to be your own advocate unfortunately you can’t count on your doctor for this. So educate yourself about all treatment options, medicines, alternative practices, everything - and then take that info into your doctor and discuss it. Also important is to be strong, stand up for what you want, set boundaries and ask the doctor to work within those wherever possible. Most doctors will listen if you are firm enough and if they don’t, get a doctor who will.
Oftentimes when doctors are resistant to doing things a different way they’re covering their asses. They are taught certain protocols for treatment and the malpractice ramifications if they deviate from these casually are huge. So when you push at them, they push back, hard, in order to make certain that you understand what you are asking and that you understand the risks potentially involved in what you are doing. When you explain that you understand and you still want to deviate from protocol then often they will bend.
I had a battle with cancer recently so I know of which I speak. I was fortunate in that my team of doctors were responsive, but it took me being very insistent and clear with them for that to happen.
October 4th, 2007 at 3:32 pm
I agree that cutting marketing costs would make alot of sense - especially as a rep I get 8-10 boxes a week of useless materials. I have heard it put a good way though - do you really think they would drop the cost of the drug - or would the CEO just get a bigger raise?
I also agree with the above - pharmacy shop! I have seen some pharmacies have as much as a $40 difference on a $200 / mo product. Also, I forgot to mention the patient assistance programs. Virtually every pharma company has free or reduced meds for low income families.
October 4th, 2007 at 4:36 pm
I’m trying to get on a generic anti-depressant like Don is. I’ve considered threatening my doctor with not being able to buy drugs, therefore not taking drugs. However, since I have no insurance I don’t have a doctor to threaten. I’m thinking of going to a clinic and seeing what they’ll do.
October 4th, 2007 at 8:41 pm
Talk to your pharmacist. That is it. S/he can give you alternatives to the brand names that you are taking. You can then ask your Dr. if S/he will authorize the change.
The brand name can also vary in active ingredient between batches.
The brand name companies have subsidiaries that make generics of their own branded products. Check it out.
October 4th, 2007 at 10:19 pm
It’s clear the pharmaceutical industry has made a fortune on drugs. They are in it for the profits–their employees may not be, but the company’s bottom line is making money.
That being said, I have saved switching to Target or Walmart’s (both offer it) $4 prescription plan. Two of my prescriptions (I paid $20 for one and $30 for the other) are on that list. I save $42 a month or $504 a year–and I already had my presciptions at Target so I didn’t have to do anything to get the lower price.
I’ve made everyone I know switch. Between my two parents, they are on 9 drugs and 7 of them are on the list. Their copay would’ve been $10 each, so they also are saving $42 a month or $504 a year. They didn’t switch drugs to save, these were drugs their doctors had already prescribed them but now they can say even more. The $4 is whether one has insurance or not.
October 5th, 2007 at 12:44 am
For most of my ailments I use herbs, that I pick on my own in the local hills. It’s surprising how affective they can be. Even for emotional/mental issues like depression (St. John’s Wort) or anxiety (Valerian, Lemon Balm). Then again this is Europe and even big pharma (Sandoz for instance) usually have a number of herbal remedies in their selling repertoire.
October 5th, 2007 at 3:08 am
As an interesting aside, in Canada socialist healthcare (in this case correct use of term as Canada is the only major country to ban private healthcare completely proper term is single payer system or universal healthcare) doesn’t pay for drugs so most prescriptions are paid as part of work benefits so most people don’t really care “what they cost” as 85% of the price is covered. For those without benefits most doctors will give away free samples or recommend the generic brand to save money.
In Germany prescriptions are paid for your health care provider and recently subject to a small deductible. Those that have private health care (about 5% of the population) generally get 100% coverage.
I don’t know about Spain I went straight to private health care instead of public because I didn’t speak the language. They don’t cover prescription drugs unless hospitalized. My general impression is drug prices are pretty reasonable.
October 5th, 2007 at 3:53 am
I would, Ed, but people seem very skittish about changing one’s antidepressants. I think they’re afraid that if they do, I’ll suddenly kill myself.
October 6th, 2007 at 6:42 am
As a general internist, during my residency, we often would work in the clinic where patients had little or no insurance. One way I was able to save patients money is actually to give patients prescriptions for half tablets. For example, Lisinopril, which is a common anti-hypertensive medication, costs 31.99 for 90 tablets for both 20 mg and 10 mg doses(prices from drugstore.com). If you can work with your doctor to figure out which of your medications can be cut then it can cut your costs by half on some of the meds. One caveat is that the medication can’t be a long acting medication(these sometimes end in XL or SR) since these medications are formulated and designed to release slowly into your bloodstream. That’s why it is important for you to go through the list with your doctor or pharmacist.
October 8th, 2007 at 9:30 am
One of my doctors suggested I check the prescription prices on Canadian Pharmacy Online: http://www.rxnorth.com/, because many of them are lower than a typical co-pay. And for meds that aren’t covered by my insurance, the savings can be quite large. I haven’t used it yet, but once hubby and I are both self-employed, this might be another good option to add to the ones mentioned above.
October 9th, 2007 at 12:36 pm
I found a discount card that has GREAT savings on older drugs. It’s at http://www.rxdrugcard.com. You can check drug prices on the website before you sign up. The monthly membership fee for a family is only $4.95. Check it out!
August 10th, 2008 at 11:02 pm
I thought it was illegal for Americans to buy pharmaceuticals from Canada?…Can’t the post office seize the packages?
August 10th, 2008 at 11:16 pm
i just left a post asking if it was legal to oder from foreign sources…I guess it is but I looked at the FDA.gov website and ran across the following. “FDA Test Results of Prescription Drugs from Bogus Canadian Website Show All Products Are Fake and Substandard” here is the address for this article: http://www.fda.gov/bbs/topics/news/2004/NEW01087.html
“Caveat Imptor” is the phrase of the day I guess…”Buyer Beware”
March 7th, 2010 at 7:20 pm
Excellent advice Shiva.
Another commonly used tips is to try a discount drug card. Even though these cards are intended for people without insurance, I’ve personally found that it can be cheaper than my insurance’s copay for certain drugs.
A google search for “drug cards” will bring up dozens of different programs. Here’s a few free ones that I’ve used:
http://www.medsavercard.com
http://rxfreecard.com