5 Ways You Can Manage Rising Prescription Drug Costs

No insurance? Here are some ideas on how to cope

Contributors: Elaine Wyllie, MD and Robert Wyllie, MD

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Research shows that the average price of medications in the United States is rising at nearly 10 percent per year. This affects the treatment of epilepsy and other medical conditions.

If you or your loved one has epilepsy, then perhaps you will recognize your own medication among these examples. From 2013 to 2016, the list or average wholesale price rose significantly for brand-name versions of zonisamide (185 percent), clobazam (96 percent), lamotrigine (75 percent), oxcarbazepine (65 percent), lacosamide (42 percent), topiramate (39 percent), valproate (32 percent) and levetiracetam (27 percent).

For some of these antiepileptic medications, such as clobazam, lamotrigine and lacosamide, only expensive brand formulations are available.

For the other five drugs, generic formulations provide more affordable options. The cost of epilepsy generics so far has remained stable over time, but there are no long-term guarantees.

For example, in February 2015, Valeant Pharmaceuticals obtained the rights to two well-established heart medications and raised the prices many-fold that same day.

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How prescriptions work under health insurance

If you have health insurance, then fortunately, the price you pay may be substantially less than the list price.

Insurers contract with organizations called pharmacy benefit managers to negotiate price discounts with drug companies, and then cover part of your cost after you have paid the deductible upfront.

Some insurance plans require that you also pay part of the cost even after you have met the deductible, and this is called a copay. As a rule of thumb, plans that cost more per month usually have lower deductibles and copays.

But even with a solid insurance plan, if your drug is not on the insurer’s preferred list, or if it is being prescribed off label — meaning for a use that is not approved by the U.S. Food and Drug Administration — then the insurer may not cover it.

For patients without low-cost alternatives, the financial burden of drug therapy may be serious.

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Change may come

People are starting to take notice. A recent poll reported in Kaiser Health News found that the majority of Americans want restraints on drug prices.

Eighty-two percent of respondents said they want Medicare to negotiate prices with the companies, which Congress does not allow. Seventy-eight percent favor limiting the amount companies can charge for high-cost drugs, and more than two-thirds want to let Americans buy drugs imported from Canada.

Public pressure may eventually spark change.

What you can do now

In the meantime, what can you do to manage the costs? As concerned physicians, we offer the following suggestions.

  • Ask your doctor or pharmacist whether a generic form of your drug, or an appropriate less-expensive brand-name alternative, is available.
  • Enlist support in negotiating coverage for your prescription, if the drug you require is not on your insurer’s preferred list.
  • Compare prices on websites such as Good Rx or Consumer Reports Best Drugs for Less. Blink Health goes a step further and allows you to pay for your drugs online and then pick them up at your local pharmacy.
  • Know the out-of-pocket obligations of your insurance plan and consider whether you should change. Plans that cost less per month may appear tempting at first but then turn out to be more costly in the long run because of higher deductibles and copays.
  • Inquire whether your pharmacy or retail store offers drug discount cards, or whether you might qualify for the drug company’s patient assistance program.

In today’s challenging drug-cost environment, it’s important to take charge and manage your family’s situation. Maintaining open communication with your health care provider is an important part of the plan.

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