April 15, 2015

Saving on Drug Costs: Pros and Cons of Discount Programs

Surfing the web, I came across a link to "7 Tips for Saving Money on Prescription Drugs" featured on Next Avenue, the PBS website created for people 50+.

Author Bart Astor, an expert on life transitions for seniors, relayed a personal anecdote about his health insurer's refusal to pay for an expensive drug prescription. Why wouldn't his carrier pony up? He didn't have the specific disease the drug is supposed to treat.

Astor says his subsequent effort to resolve this issue uncovered a potential "happy ending for all of you who are stuck paying for an expensive drug without the benefit of having prescription drug coverage or if you're one of those with a prescription drug insurance doughnut hole."

Drug Discount Programs
A pharmacist at Costco suggested he check for coupons available online that offer discounts up to 70%. Astor then Googled his drug's name and the word "coupon" and got many links. He clicked on internetdrugcoupons.com and found that the company provided a free pharmacy discount card good for every FDA-approved drug. He ordered the card.

When he took it to his local CVS, the pharmacist told him that the drug would cost $432, about 70% less than the regular price of $1,600.

The pharmacist also said she often tells patients to check for coupons online, and to ask their doctors for free samples.

Astor then created his list of seven tips to save money on prescription drugs. Tip number two: "Ask your doctor for free samples." Tip number four? "COUPON!"

Others Advise Differently
I thought Astor's seven tips would make a helpful blog post. But first -- since I wasn't familiar with online coupons -- I wanted to do a little more research.

I visited internetdrugcoupons.com, the site Astor found useful. I entered the name of my most expensive drug, Azilect. Two coupon options popped up:
  1. A manufacturer's coupon, which would require I pay only $15 per pill, an alleged savings of up to $75, depending on my insurance. 
  2. An internet coupon, which offered to 50% discount from the retail price. The coupon indicated it was accepted at all the big chains, but it couldn't be combined with insurance and was intended to cover "only those drugs not covered by your plan."
Next, I visited a favorite site for drug information: Consumer Reports Best Buy Drugs. Here's what I learned there: To combat higher co-pays on brand-name medication, drug manufacturers have offered more discount coupons and programs in recent years  -- and more consumers are using them. A recent poll found that among those regularly taking a medication, some 16% had used manufacturers' coupons in the last year to save on medication costs.

But the programs, according to Consumer Reports, are often designed to first capture your interest, then retain or expand the company's market share by offering initial low costs. Once the program ends or you're no longer eligible, you'll have to pay the original price. CR recommends:
Skip the coupons and freebies. The offers can be enticing, but they're usually not for drugs that are the best first choice. That's also true for most free drug samples, because after the sample runs out and it's time to fill the prescription, you could be stuck taking an expensive drug
Conflicting Advice from the Same Source
In a separate report -- "6 Ways to Save on the Drugs You Need" -- Consumer Reports' "Best Buy Drugs" offers a different spin on discounts and coupons. Tip number two is "Check out discount programs." That article include these comments:
Chain drugstores, supermarkets, big-box retailers, and pharmacies at warehouse clubs all offer "$4 generic drug" discount programs. Prices can be as low as $10 for three-month supply of medicine.
Most chains offer added perks, such as savings and flu shots. Kmart's Pharmacy Prescription Savings Club gives discounts of 5 to 20% on brand-name drugs. Walgreens' Prescription Savings Club members also get a 10% bonus back onto their card for purchasing storebrand products and photofinishing services.
Program details vary, so it's important to shop around.
Big Pharma's Drug Assistance Programs
The April 2015 issue of the Harvard Health Letter leads off with an article titled "Best tips to stay on your medication and stay healthy." It offers this advice on drug discount programs:
If a drug cost is too high for you, talk to your doctor or pharmacist about more affordable options, such as generic drugs. A number of large chain stores (Walmart, Target, Kroger) offer 30- and 90-day supplies of dozens of generic drugs for as low as $4 and $10.  If you must stick to a brand-name drug, shop around for prices, and see if you qualify for prescription assistance programs through the drug's manufacturer. One useful website is GoodRx.com, which offers the opportunity to comparison shop for drug prices, as well as links to coupons.
A more extensive report on the drug companies' patient assistance programs (PAPs) appeared in another favorite drug newsletter -- Worst Pills, Best Pills. Its March 2015 report indicated that these programs appear to be charitable since they offset drug costs for eligible patients, often on generous terms. But it questions whether these programs are helpful in improving overall drug access and affordability.

The article reports that there are currently 475 PAPs. These programs cover over 2,500 drugs and have provided prescription support for about nine million patients since the programs' launch nine years ago. Still, many of the 41 million+ Americans without health insurance reap no benefit from these programs. In addition, the $4 billion per year that the American pharmaceutical industry spends on these programs represents a small percentage of its $347 billion in annual sales.

Despite the benefits that the PAPs offer to some needy patients, the newsletter indicates that these programs create adverse effects on health care expenditures. By removing the cost barrier for covered medications -- often expensive specialty drugs -- PAPs steer patients toward these drugs, even when other equally effective, less costly alternatives are available.

If patients eventually obtain better prescription drug insurance coverage, they will likely request continued treatment with unnecessarily expensive medications. Even if a patients decide to switch to a less expensive drug not covered by a PAP, she may then need additional doctor visits -- and tests -- to become stabilized on the new drug. Physicians who treat patients on PAPs may also become accustomed to prescribing expensive PAP products rather than less expensive alternatives, like generics.

Bottom Line
After reviewing this somewhat conflicting advice from others, here's where I end up:
  • Everybody agrees you should always ask your doctor if a lower-cost generic is available.
  • If the prescribed drug is costly, you should ask your doctor about the availability of lower-cost alternative meds that are just as effective.
  • The Prescription Assistance Programs aren't likely to do me much good. Usually you cannot get a PAP if your health insurance covers the drug. To qualify for many PAPs, your household income must be less than $20,000 for one person, $28,000 for a couple, and $40,000 for a family of four.
  • However, there are some PAP's for higher income people. You may qualify if you do not have drug coverage and you need expensive drugs.
  • The drug coupon programs might help with costly prescription medications. I've requested the pharmacy discount card from internetdrugcoupons.com, and I'll see if it helps bring down the cost for my Azilect when it's up for renewal. Unfortunately, no generic or lower-cost alternative is available for this big-cost Parkinson's med.
I'll review other tips for reducing the cost of prescription medications in a future post.


Pat Swords said...

Thanks for the research and summary, John. I've found the Walgreens discount card to be helpful for my 93 year old mom as she has no drug plan, but the card is not available for recipients of Medicare drug plans. I was surprised that she qualified as she does have Medicare parts A and B, but I guess since she doesn't have D, she is able to take advantage of the program.

Bart Astor said...

Thanks for the mention and kind words. I know coupons are not successful for everyone, but as you noted, they are for some. And it was for me. There are other, similar websites, such as Scriptrelief.com that are good so be sure to check several. Keep following my own blog at bartastor.com and also Next Avenue.
Bart Astor