Medication is life-saving for people who have a chronic illness like heart disease, cancer or diabetes. But unfortunately, about half do not take their medicines as prescribed. And a top reason is cost. In order to save money, nearly one out of every 12 U.S. adults skips a dose, takes less medication than they need or does not fill a prescription.
Young Fried is vice president of pharmacy services for HealthPartners. She says prescription drug costs are a big problem for people who have high-deductible health plans.
Not taking the right medicine as prescribed can also have a high cost. For example, a person with diabetes might try to save money by taking a lower dose of insulin. They won’t feel their best. And over time, doing this could lead to kidney, eye or heart problems. Those problems end up being much more costly than the medicine itself.
Doctors want to prescribe medicine that will work. And they want to prescribe medicine that patients can afford. But they are not always in a position to know how much a specific drug costs or whether there is another brand name or generic option available at a lower cost. That’s where health plans can help. We can flag medicines that might not be safe or effective, and when there is a lower cost choice.
3 signs you might be paying too much for medicine
- You got a coupon for a prescription drug, which is actually hiding its true costWhen drug companies introduce a new high-priced drug, they often spend millions of dollars on ads. Their goal is for consumers to ask their doctors for it. Sometimes, a drug company even offers coupons to the consumer to lower their initial out-of-pocket cost.For example, Dexilant is a medicine used to treat heartburn. It costs more than $300 for a month supply. However, it doesn’t work any better than other medicines that are available over the counter for around $30 a month. The drug company’s coupon reduces the consumer’s copay to $20. That’s less than what the consumer would pay for the over-the-counter medicine. On the surface it seems like a great deal. But your health plan is still paying the extra $270 cost for the medicine. Multiply this example by hundreds or thousands of patients and you can see why insurance premiums would have to go up.
- Your medication doesn’t work like the ad for it says it wouldSome expensive drugs might be worth the cost because they work. For example, Harvoni is a new drug that can cure Hepatitis C. The list price is about $100,000 for the treatment, but it cures Hepatitis C in more than 90 percent of patients who take it.Some drugs, though, cost a lot and are not effective. Jublia, for example, is a medicine that is advertised to treat toenail fungus. A full treatment can cost more than $24,000. But, it only cures 15 to 18 percent of people who use it. To make things worse, there are other treatments for toenail fungus that cost less than $200 and that cure double the number of people.
- You never considered using a generic optionAds put out by drug companies have convinced us that brand name drugs work better than generics. The fact is that the Food and Drug Administration requires generic options to have the same quality, strength, purity and stability as brand name drugs. They might have different flavors or dyes or other inactive ingredients. But those have nothing to do with how well they work.
What HealthPartners is doing to help members get the best medicine at the lowest cost
- We have a formularyThis is a list of drugs that your health plan covers because they are known to be safe, effective and the best value. We also give you access to a drug cost calculator that pulls in information from your formulary. You can use this tool to see if there are ways you can save money. For example, the pharmacy you go to may affect the cost of your prescriptions. Or, it may be cheaper to refill with a 3-month, rather than 1-month, supply.
- We negotiate with drug companiesHealthPartners covers prescriptions for nearly 1 million people. We use this buying power to negotiate lower prices with drug companies.
- We ask our members’ doctors to get an OK from us before prescribing some medicationsThis is called “prior authorization.” And it’s done to make sure that the drug is safe, effective and the most cost effective choice available. Overall, very few drugs require prior authorization. For HealthPartners, it’s less than one percent of all drugs prescribed to our members. This practice sometimes gets bad publicity. But in fact it can help doctors and patients by giving them information about safety risks or other alternatives that are less expensive.
Examples of high-priced drugs that usually don’t provide the best value
|Condition||High-priced drug||Price||Alternative medication||Price|
|Nerve pain||Horizant, Gralise, extended release||$500 per month||Gabapentin||$14 per month|
|Heartburn or reflux||Zegerid or omeprazole/sodium bicarbonate||$1500-$2700 per month||Omeprazole, lansoprazole, pantoprazole||$6 per month|
|Acne||Differin gel||$540 per month||Adapalene gel or Differin gel OTC||$171 per month for adapalene or $30 per month for Differin OTC|
|Pain||Anaprox||$330 per month||Naproxen generic||$13 per month|
|ADHD||Dexedrine, extended release||$4300 per month||Dextroamphetamine, extended release||$230 per month|
|Arthritis||Duexis (ibuprofen/famotidine)||$2700 per month||Ibuprofen||$15 per month|
|Asthma, cancer, multiple sclerosis, macular edema||Duexis (ibuprofen/famotidine)||$2700 per month||Ibuprofen||$15 per month|
|Asthma, cancer, multiple sclerosis, macular edema||Dexpak, Zonacort||$200-$700 per course||Dexamethasone||$6 per course|
|Migraines||Migranow kit (tablets and cream)||$3800 per kit||Sumatriptan tablets||$11 per prescription|
|Seasonal allergies||Ticalast spray pump||$4100 per kit||Fluticasone or azelastine nasal spray||$8 per month|
Check out our advocacy platform to learn what else HealthPartners is doing to promote more affordable care.