What’s the Cure for the High Cost of Prescriptions?

Photo Illustration: The dramatic rise in the cost of Epipens

The recent uproar over the cost of EpiPens, the life saving self-injection device that contains epinephrine, a chemical that narrows blood vessels and opens airways in the lungs to offset an allergic reaction, has garnered tremendous media attention and consumer outrage. Through massive marketing and outreach efforts by the manufacturer, Mylan, EpiPen has become to the go-to device for anyone facing a potentially serious or life-threatening allergic reaction. It is a brand that has “become” the device, like Kleenex has “become” tissues, and Jet Ski has become the catch-all for personal watercraft.

The EpiPen price has been raised 17 times in 11 years. When Mylan bought the device from Merck KgAA, a German company, in 2007, it cost $124 for a two-pack. Today, a two-pack costs more than $600. And there is no real competitor in the market, as Auvi-Q, a similar product launched in 2013 by Sanofi, was withdrawn in 2015 because of dosing issues. Mylan controls 94% of this market.

Under fire from all sides for the last few weeks, Mylan announced it would rapidly bring to market a generic, but is unclear how much impact this will have.

A complicated scenario

Here’s what I learned when I was researching this issue: while Mylan does control the price of the product, it does not control the price to consumers — health insurance companies do. According to an article published recently by Ronny Gal, Ph.D., a senior analyst at the investment bank Sanford C. Bernstein & Co. (I found it on a fascinating website called drugchannels.net), in the wake of Sanofi pulling its drug, “Mylan was in a position to price up Epipen, which they did — by 15% in November and by another 15% in May. … The (insurance) payors got mad and raised the pain level on patients — raising copays and toughening medical policies (this is important, Mylan does not determine price to consumers, payors do). As Epipen is broadly purchased ahead of the new school year, the pain became acute for many families over the past month. There were lots of posts on mother’s networks, the media caught wind of the story and now we have multiple politicians jumping on the bandwagon.”

This got me thinking about the cost of prescriptions in general. Way, way back in the good old days of the mid-1980s, when I first entered the working world, I had a $5 co-pay on my prescriptions. Over the years, as insurance plans have morphed and HMOs were invented and employers began searching for ways to save money, we had a tiered prescription plan that started at $5 for basic generic drugs and ended at $50 for really important stuff.

Today, under my husband’s company’s insurance plan, we have a $3,000 annual deductible we have to meet. Until we hit that $3K, we pay out of pocket for EVERYTHING. This has ended up being quite an education, especially since we are at the age now where there are daily medications for things like blood pressure and prostate. Luckily (or unluckily), we have had a run of bad health and met the deductible for the first time, about halfway through the year.

It is these broad-deductible types of plans (which I think more and more of us are opting for as a way to save up front on the premiums taken out of the paycheck) that are making many of us painfully aware of the full cost of prescription drugs.

As Matthew Herper recently noted in an article on forbes.com, “If a customer is paying a $73 co-payment on a $600 device, this is a good deal. But a lot of consumers no longer simply have a co-pay on their drug purchases. They have a large deductible — an amount of money they must spend before their insurance kicks in. A Kaiser Family Foundation survey last September found 24% of consumers had high-deductible plans. ObamaCare is one reason for the rise, but another is that employers are turning to these plans more frequently.” Remember, too, that is the insurers who are determining the costs to the consumers by manipulating copays, discounts and rebates, not Mylan.

And in multiple interviews, Mylan chief executive Heather Bresch has made it a point to note that Mylan “only” gets $275 of the $608 list price for two EpiPens.

Hunting for affordable medications

The high cost of his prescriptions led my husband on a mission to figure out the lowest-cost way we could deal with it. Because even generics — if there are any — aren’t cheap anymore. He discovered a website called GoodRX, which not only showed him the price of his medications at all our area pharmacies, but also offered a big-discount coupon. So my husband now gets his medications at WalMart, which is considerably cheaper than other pharmacies in our area, and uses the coupons. There are other similar websites out there.

Another smart strategy is to always ask your doctor for samples and coupons. They have closets FULL of samples. Our son has acne, and when we went to the doctor to have it looked at, he prescribed two medications, one being Epiduo. This is $300-$400 for 1 small tube and it’s not covered by most Medicare and insurance plans (including ours). Now, acne is not life-threatening, but for a 15-year-old boy, it might feel like it.

Luckily, our doctor loaded me up with samples and also gave me a one-time coupon. We filled it once, using that coupon (cost to us $45). Since then we have just used the samples. His prescription for clindamycin phosphate was almost as expensive, but I discovered there are over the counter creams that have the same ingredient, and with pharmacy coupons I can get it cheaper than it would be with prescription discounts.

Hunting for discounts, rebates and coupons, asking your doctor for as many samples as they will spare, shopping from pharmacy to pharmacy to get the best price (the disparity among stores is shocking as well), and making sure you understand your insurance coverage and are getting the most out of it — these are all keys to helping to manage the cost of your medications. Needless to say, I am not looking forward to those golden years, when our medications increase and our ability to pay goes down.

How about you? What tips do you have for managing the cost of your prescriptions? Tell us here in the comments or on our Facebook page!

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There are 6 comments to "What’s the Cure for the High Cost of Prescriptions?".

  1. jestjack says 07 September 2016 at 03:28

    Thank you for this timely article. Another area of concern is the rising cost of diabetes meds and testing materials. DW was diagnosed a while back and the drugs for her care have went up significantly. In addition our premiums continue to go up annually at 10% or better. Our plan is a “grandfathered” plan that does not comply with all of the ACA requirements but seems to meet our needs. It is a high deductible plan with little coverage for prescription drugs. But like you, for better or worse, it looks like we will hit our deductible by the end of September this year. Then we only pay 20% of costs until we hit our “out of pocket limit”. Then coverage is 100%. My thought is this is only going to get worse and being an informed consumer is one of the few options we have. The ACA plans which were supposed to address this problem actually made the problem worse. I viewed plans with $13K out of pocket caps and $7K deductibles. The answer I got was that folks would be more discerning when seeking treatment as they had “skin in the game”. My thought is, it makes care more expensive….causing some to do without.

  2. Donna Freedman says 07 September 2016 at 11:30

    Here’s an excerpt from the “Staying Healthy” chapter of my new book, “Your Playbook For Tough Times: Living Large On Small Change, For The Short Term Or The Long Haul”:

    Maintenance meds and short-term drug regimens alike can take a huge bite out of your healthcare budget. Some insurance plans include mail-order pharmacy privileges, which can save you some money.

    But not always. When I switched insurance plans I was paying $4 a month for generic maintenance meds, so I sent both prescriptions off to the mail-order pharmacy. One came in at $8 for three months’ worth. The other cost me more than $29 for 90 days. Whoops. Learn from my mistake: Read the generic medications list VERY carefully.

    Even if you’re not on maintenance meds, the cost of curing even a simple illness can be surprisingly high. Use one or more of the following tips to get the most for your healthcare dollars.

    — Common meds may be free. Some supermarket pharmacies offer certain antibiotics, generic Lipitor, prenatal and children’s vitamins, the diabetes drug Metformin and other medications without charge. Among the grocery chains providing free medications are Amigos United, Giant Eagle, Meijer, Price Chopper, Publix, Reasor’s, Schnucks, ShopRite and Wegman’s.

    — Ask for help. A certain number of discounted or even free drugs are available for those on extremely limited incomes. You can apply for assistance through groups like NeedyMeds (http://www.needymeds.org/), the Chronic Disease Fund (http://www.mygooddays.org/) and the Partnership for Prescription Assistance (https://www.pparx.org/).

    — Go generic. Wal-Mart first offered $4 prescriptions a decade ago and other stores and pharmacies jumped on the bandwagon. Use a site called MedTipster.com to find generic equivalents of the drugs you need, whether maintenance or short-term, and then check the formularies for local stores offering $4 scripts.

    — Split pills. If you need a 10-mg drug, it could be possible to buy 20-mg pills for about the same price, then use a pill-splitter to halve them. Note: You must ask your provider about this, since not all drugs can be safely divided.

    About online pharmacies: Even if you don’t have a mail-order pharmacy associated with your insurance plan, it’s still possible to buy online. Due diligence is necessary, however, since some Internet drugstores are bogus. The Mayo Clinic website notes that in some cases prescriptions have “turned out to contain no active ingredient or to contain the wrong medicine.”

    It is illegal to ship non-FDA-approved drugs into the United States. You should order only from online pharmacies in the U.S. Although some people think it’s safe to use Canadian virtual pharmacies, the National Association of Boards of Pharmacy notes that some rogue northerners source their drugs from countries where standards may be lax and counterfeit pills more common.

    To find an approved source, run the pharmacy’s name through LegitScript.com.

    (Hope that helps!)

  3. Michael Maag says 09 September 2016 at 12:31

    Here’s another great tool for saving on prescription meds: https://www.blinkhealth.com.

    They have awesome prices on millions of prescriptions available to everyone with or without insurance.

  4. Kym says 09 September 2016 at 19:55

    I recently read about a site called goodrx.com for ways to save on prescriptions and checked it out. I found coupons for some of my daughter’s meds, including her EpiPen, and saved the cost of my co-pays. The EpiPen coupon is good for three refills, so that one will save me $120 this year. We’ve been fortunate to have access to decent health care plans through my husband’s employer, so I wasn’t aware of the rising cost of the EpiPens until recently. Goodrx.com also shows the cost of the prescriptions at several stores for comparison as well.

    By the way, is there anyone on earth as well-informed as Donna Freedman? I learn something new every time. Love her.

  5. STop ignoring the obvious says 17 September 2016 at 06:20

    The “cure” is insurance companies actually negotiating with pharma, instead of investing in them.

    Political will, instead of “oh gosh, buy generic!”

  6. D.Orlando says 10 October 2016 at 09:22

    I am a practicing doctor, and for the record we barely get samples. If we hand you samples, you’re lucky because we feel bad about the cost of medicine and happen to have a gift. Otherwise, we just hope your insurance covers your medicines. Good Rx is useful, I use it a lot before prescribing to the uninsured.

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