A Little Initiative Can Help Lower Your Medication Costs
A trip to the drugstore may produce mixed emotions these days.
Happiness that there are so many medications that can keep you off the surgeon’s table, out of the hospital, away from the doctor’s office.
And anger and fear that those very same drugs are going up in price so fast that they will gouge a hole in your budget, especially if you lack good health insurance.
For older people, it’s a real financial menace: Americans older than 65 comprise 13% of the population, but they take more than a third of all medications. That is why the discussion of expanding Medicare to cover prescription drugs is going to be such a hot issue in congressional campaigns and probably the presidential election too.
For consumers of all ages, trouble lies ahead, in the form of higher co-payments each time they get a prescription filled. Or maybe a tighter formulary--an approved list of drugs from which the insurance company encourages doctors to prescribe medications and for which it charges a lower co-payment. If you want a drug outside the formulary, you will pay a bigger share of costs.
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Here are some strategies that can help protect your wallet.
Doctors are besieged by pharmaceutical salespeople who are eager to load them up with free samples of drugs. Don’t be shy about telling your doctor if you might have trouble paying for a costly drug, and don’t hesitate to ask for samples.
My friend “Dr. Eddie,” a veteran of the Los Angeles medical scene, has this advice: If you have a seasonal allergy problem, schedule your annual physical at the start of allergy season. Your doctor usually has a generous supply of antihistamine samples on hand, courtesy of the drug companies. The physician may have enough pills for a month’s supply to get the patient through the worst of the sneezing and wheezing season.
Sometimes patients don’t really need a prescription drug; they can do just as well with an over-the-counter medication available at the drugstore. But some patients, intent on saving money, insist on getting the prescription because insurance pays the bill. By demanding a prescription from the doctor, though, they are helping to drive up spending by their health plan and insurance rates in general. So why not follow the doctor’s advice when she says an over-the-counter medicine will suffice?
For those who are sick and lacking health insurance, drug costs can be overwhelming. An array of conditions and diseases, such as cancer, diabetes, congestive heart failure and arthritis, among others, can result in tremendous bills.
To assist such people, drug companies have programs to distribute costly medications for free. Each company has its own list of drugs and rules for making them available without charge. Demand is rising rapidly: In 1996 about 800,000 patients received 1.8 million prescriptions through those programs. By 1998, the totals jumped to 1.5 million people and 2.8 million medications. The savings for 1998 totaled $500 million.
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For information about this program, you can write PhRMA, the pharmaceutical industry’s trade group, and request the Directory of Prescription Drug Patient Assistance Programs, 1999-2000. The address is: PhRMA, Public Affairs Division, 1100 15th St. NW, Suite 900, Washington, D.C., 20005. Or you can go to the group’s Web site at https://www.PhRMA.org.
States are trying various programs to help ease the burden of rising drug prices. California offers a drug discount for people on Medicare--those older than 65 and the disabled of all ages. The program allows Medicare recipients to buy drugs at the same discount price the state gets when it purchases prescriptions for the Medi-Cal program, the federal-state health plan for poor people.
There are about 5,000 pharmacies throughout the state that offer the drug discount programs for both Medicare and Medi-Cal. The program has been highly popular since it began in February.
Readers of this column have shared some of their experiences with California’s discount since we first mentioned the program in March. Our advice was to shop carefully because drug prices vary widely and many stores have their own discounts. Readers proved they are sharp consumers.
Doris J. Annonsen, for example, needed a three-month supply of Tambocor. At the Sav-on drugstore, the regular price was $525. The discount price for Medicare beneficiaries was $414. But the best deal came from the AARP mail-order pharmacy, $393.40. For her Fosomax prescription, however, Sav-on had the best price, “and they didn’t even charge me the 15 cents for doing the price check,” she said in an e-mail. (Pharmacies are allowed to add 15 cents to the bill for ordering a drug at the discount price from the state or for simply checking the price of a prescription.)
Even with discounts, however, consumers such as Annonsen still worry about paying for their medications. Her cost for Tambocor has jumped 69% since 1997, “and it is a very real burden,” she writes.
To help consumers compare prices, state Sen. Jackie Speier (D-San Francisco), author of the bill that created the discount program for people on Medicare, is asking state officials to post the names of the most commonly used drugs and their Medi-Cal discount prices on a publicly available Web site.
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For questions about the state program, you can call the Health Insurance Counseling and Advocacy Program, or HICAP, at (800) 434-0222, which can put you in touch with a local HICAP counselor. If you believe that a pharmacy is not complying with the law, you can call the Department of Health Services’ complaint line at (916) 657-4302, or send an e-mail to sb393rx@dhs.ca.gov.
Lots of low-income people in the counties throughout California get their medical checkups, treatments and prescriptions through a network of community clinics for people without health insurance. But the rising cost of drugs has been cutting into the budgets of these already financially pressed clinics.
Some help for these community clinics is now available through a little-known program called Pharmaceuticals and Indigent Care, run by the Public Health Institute, a nonprofit organization based in Berkeley.
The program is funded with $148 million collected when 19 drug companies settled charges in a lawsuit that accused them of overbilling consumers in California. Because of the difficulties in identifying the individual customers who overpaid for drugs, the settlement required that the money go to benefit California taxpayers. The funds were set aside to pay for drugs for the indigent--a cost that taxpayers would otherwise bear.
The money will allow clinics to continue dispensing prescriptions without limiting other services, said Kathryn Duke, program director. Some local clinics may not know the money is available, she said, so the information on applications is available from the program Web site at https://www.picprogram.org.
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A reader who had difficulty navigating the health-care system reminds us of this good advice: Pay attention to deadlines. N. Thomas wrote about wanting to apply for benefits under COBRA, the Consolidated Omnibus Reconciliation Act, which allows a worker who leaves a job to keep company health insurance for 18 months by paying the full premium.
However, Thomas forgot to fill out an application for COBRA and return it within 30 days, so the policy excluded any preexisting medical conditions. “Had my application been processed before the 30-day limit, I would have been able to obtain coverage with no exclusions,” the reader wrote. “After being refused, my ‘agent’ advised me with an ‘Oh, I thought you knew’ comment. Needless to say, the harm was already done.”
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Bob Rosenblatt welcomes your questions, suggestions and tips about coping with the changing world of health care. You can contact him by writing: Bob Rosenblatt, Health section, Los Angeles Times, 202 W. 1st St., Los Angeles, CA 90053, or by e-mail at bob.rosenblatt@latimes.com
