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4 Ways to Lower the Cost of Your Meds

Lately, the U.S. government has had a seemingly laser-like focus on reducing the cost of prescriptions. If you’re taking an expensive medication, you feel the financial pain of it right now - it’s almost painful as the condition for which you’re treating with said medication!

So what is one to do when the cost for your medication skyrockets?

Let’s first look at the reasons why your cost may go up unexpectedly.

Many health plans have a deductible for prescriptions. This deductible is often separate from the “medical deductible”, which is for your doctor visits and care. (For those who need the reminder, a “deductible” is the money that you pay before the insurance kicks in and begins contributing to your costs.)

In other words, if you take a medication that costs $500/month and your Rx deductible is $500, your first refill in January of each year is going to be a painful $500 bill.

After the deductible is met, your cost may go down to a certain copay, which depends on what “tier” the insurance company places the drug on. As a rule, Tier 1 meds are usually generic meds and Tier 5 are expensive brand name meds. 

Special note: If you are on Medicare, your Part D coverage will have you paying that copay until you and the insurance company have paid a combined $5,030 (2024) towards the cost of your meds. This is called the Initial Coverage Limit. From that point, you pay 25% of the cost of your medications until you, (not including the insurance company) have paid $8,000 towards the cost of your own meds. From that point, you are fully covered and no longer responsible. In 2025, this will be reduced to $2,000.

Hopefully, this explains why your Rx costs can vary. Now that we’ve established the varying costs, let’s talk about how we can lower them:

  1. Take a generic instead of a brand name. This seems obvious, but some doctors will prescribe a brand name drug without thinking twice. They may have reasons for it, or it may just be because they don’t have to pay for it. Unless there is a medical reason for using the brand name, or unless a generic doesn’t exist, ask for the doctor to prescribe the generic.

  2. Use online Rx coupon services. Many people are familiar with GoodRx - however there are alternatives that are worth looking at if GoodRx doesn’t show you a price you like. Another one worth exploring is SingleCare. Keep in mind that you cannot use these online coupons with your insurance. It’s one or the other. Using a coupon would bypass your insurance, making you a “cash” payor.

  3. Patient Assistance Programs. Most Rx manufacturers have special programs for people who cannot afford their medications, often called Patient Assistance Programs. Sometimes they are offered directly from the company and sometimes they set up a separate organization to administer the financial help. There is an application process for this and you have to prove that you don’t have the financial means to pay for their medication. Often, you can see the income criteria before even applying. Even if your income is slightly above, it may still be worth completing an application. The result can be extremely favorable, and I have seen people get $0 copays for expensive medications. To find these programs, do a Google search for "patient assistance program [name of medication]".

  4. Ask for a different medication. If your medication is expensive, and even the generic is expensive -  which sometimes happens - ask your doc for a different medication “in the same therapeutic category”. Basically, a medication that does the same thing. The saying, “There’s more than one way to skin a cat” applies here too. Sometimes this may not be a viable option because of your medical history or interactions with other meds you’re taking, but it’s worth a shot. A different medication may be a fraction of the price of the one you’re currently prescribed, even if both are generic.

At a time where everything is rapidly increasing in price, hopefully you find a way to ease the burden when it comes to your prescriptions.

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