10 Insider Tips for Dosing Your Drug Dollars

The economic downturn has left even more people struggling to pay for

their prescription medications. If you’re having trouble, you’re not alone. In fact, almost 40 million of us – especially women – are affected. Here is a round-up of valuable, accurate advice for how to make your drug dollars go further, as well as new, essential medical information to help you dose your drug dollars more safely.

1)  Pride Goeth Before the Overcharge: Swallow whatever lingering discomfort you may have about discussing price with either your doctor or your pharmacist. You will probably be pleasantly surprised with the result, since the one doctor who is not aware of cost as a major issue is probably practicing medicine under a rock. In a desert. Or possibly in Hollywood – either way, we’re talking total fantasyland here. So how do you start this uncomfortable discussion, especially if it’s never been an issue before? Think of cost as a side-effect (and a common, painful one too). Here’s a tip – don’t wait to ask about drug cost until after the prescription is written. Your doctor might be a little grumpy (and possibly resistant to changing the drug) because he/she will have to re-do the prescription(s). Instead, ask up front when the “you may need a medicine/change your dose/get refills” discussion starts.

2) Passive = Price-gouged. Be bold when it comes time to get your prescription filled. Pharmacies of all kinds are some of the last hold-outs of secretive pricing. If you don’t ask up front (preferably by phone, calling numerous pharmacies) you may, like Doc Gurley, be standing at the Pick Up Your Prescription line with a million irritable people behind you as the pharmacy assistant leans forward and says, “That’ll be $1,067.24.” Yeowza! Who needs to add a financial heart-attack to your health problems? Calling, and/or asking in advance about the price will also save you the slight embarrassment of asking for your prescription back so you can take it somewhere else.

3) Can You Do The Splits? Taking a bigger dose pill and cutting it in half can save you some big bucks. However, this option is not safe or effective for all medicines. Any drug that is time-released, for example, is probably not a good choice for splitting, because it can destroy the time-release coating. Studies have also shown that, even with a pill splitter (anyone who’s splitting pills should own one!), there can be variations in the size of pill fragments. For many drugs, a 20% difference in size after splitting may not be a big deal, but for some categories of drugs – like heart medicines and antibiotics, those differences can be sometimes dangerous. If you are thinking of splitting, be sure to ask your doctor about it – especially if you’re splitting the last of your pills to make them go farther. It may be dangerous for you to do so, or there may be a better, cheaper way to address the issue. So, you may be thinking, who would split pills?  For some pills, splitting is a real winner, cost-wise. It’s so cost-saving, for example, that some systems automatically suggest the larger Viagra dose (plus pill-splitter) – thereby saving the patient approximately $10 a pop (so to speak). Bottom line: Ask your doctor before splitting willy-nilly. If it’ll work for you, bingo!

4) Brand Hype is Usually Hocus: Numerous studies have confirmed the effectiveness of generics. Being a brand-snob can cost you, big-time. If the options are to a) skip your medicine, or b) go generic, it’s time to give the generic options a whirl. The emerging categories of drugs where generics seem more variable are psych meds, and pain meds. In both cases, if you give the generics a try, and you don’t feel like you’re getting the same result, talk to your healthcare provider about dose-adjustments, which might improve the situation for you while still reducing costs.

5) Know Your Purchase Options: For more tips on getting a good price, check out this timeless Liz Pulliam Weston article, Thirteen Ways To Save On Prescriptions. Many studies (and Ms. Weston) have pointed out the dramatically decreased prices for the exact same brand medication in Canada and Mexico. However, as Ms. Weston notes, it’s extremely important to make sure that, if you’re going the overseas route, the pharmacy is licensed and certified. Even with these safeguards in place, the FDA frowns on the usage of overseas medication purchasing. The risks are certainly greater, so if you do choose to do this, pick the most credentialed (and probably slightly more expensive) option – one which will certainly require a written prescription from your doctor. If you find a source that doesn’t require a prescription, you may be taking something completely ineffective, or, even worse, deadly. All of Ms. Weston’s discount advice gets a resounding Doc Gurley Two-Stethoscopes-Up nod of approval, with one exception: the approach to safely saving money on a one-time prescription is very different from  the approaches you can take for an on-going medicine. For example, it is, generally, a really bad idea to try to get a mail-order antibiotic, since taking your medicine right away (in this scenario) can mean a huge difference to your health. Getting well faster will save you money in the long-run, even if your prescription from a local pharmacy costs more. So what can you do to save on a one-time drug?

6) One-Off Winners: Trying to save money when it comes to one-time prescriptions can be very different from the strategies you use for on-going prescriptions. Often, one-time prescriptions are for antibiotics. A little-known secret in medicine is that, when it comes to antibiotics, the number of days you need to take them can be, well, (there’s no other way to put this) rather arbitrary. There’s even an insider slang-phrase for this, called the “ID multiple.” An “ID multiple” means the relatively random number of days you take a drug for an infectious disease – usually 3, 5, 7 or 10 days. After you’ve swallowed your pride about discussing costs with your doc, you may enjoy having a discussion about how many days you really need to take an antibiotic – will 3 days do it (for an uncomplicated urinary tract infection in a woman?) or do you need 21 days (for a urinary tract infection that’s spread to the kidneys?) or how about 10 days (because your last drug failed and now you’re resistant?). As you can imagine, the number of days of drug usage can make a big difference in price. There are also powerful arguments for taking as little of any medication as you can get away with, however… WARNING: don’t attempt this stunt at home! This high-risk maneuver should only be performed with professional assistance. Why is that? Well, there’s no better way to give yourself a nasty, uber-resistant infection than to take only part of your pills, or – worse yet – stop when you feel better (but aren’t yet cured) and then re-start them when you feel worse again. Or (God help us) borrowing someone else’s pills (see #8 below, Hoarding for Dollars). When it comes to antibiotics, the goal here is to ask how few days makes sense, and to have a plan for what you should do if you finish your pills and then your symptoms recur (which usually involves another, different drug…). But if fewer days makes clinical sense, and your doctor’s just writing a prescription for 7-10 days from habit, it’s a great idea to ask about fewer days and go home with a plan for follow-up. Some of the same concepts hold true for one-time, post-procedure pain medications, where you might want to ask for two smaller prescriptions instead of one prescription for a larger amount, just in case you only need a few days’ worth. Keep in mind that pharmacists cannot alter or reduce narcotic prescriptions, so asking a pharmacy to give you only half of a big prescription won’t work. Also keep in mind that stopping pain pills, then restarting them, can give you a nasty case of break-through pain that’s tough to chase away – so you want to decide if you need to fill your second pain-pill prescription before your first runs completely out.

7) Samples – Should You?: Samples are free drug pills that are given to doctors’ offices by drug company representatives in order to encourage prescriptions of certain drugs. A doctor may offer a patient a sample for a variety of reasons. In the best case example, the sample may actually be enough for an entire treatment (such as a very short course of antibiotics for a urinary tract infection or a sexually-transmitted disease). Hey, what’s cheaper than free? Keep in mind, however, that drug companies are no fools when it comes to profit. The types of drugs that get offered as samples are usually ones that are for chronic conditions. The hope is that once you start them, you stay on them for ages. Rarely are free samples the best, the cheapest, or the drugs most likely to be voted once-is-enough. If your doctor offers you a sample, especially for an on-going condition like high-blood-pressure, you want to ask if this is the best drug for you, long-term. Otherwise you could end up being penny-wise and dollar-foolish by taking a short-term freebie, but paying much more in the long-run.

8) Hoarding For Dollars: It’s a little-discussed fact of life. Pretty much everyone across this country hoards pills – for lots of reasons. Maybe you’ve heard (rightly so) that you shouldn’t flush left-over pills because they end up in our water. But sticking $368 worth of antibiotics in the trashcan deeply offends your wallet. Is there any answer to our silent epidemic of drug-clutter? First, if you can’t make yourself throw pills away, be sure all prescription meds are locked up securely – especially narcotics. The overdosed death of someone you love (or their visiting teen friend) can never be forgotten. Second, taking or giving meds without professional instruction is usually a really bad idea. Nasty little secret drug interactions or the fact that you can get a worse outcome if you take the wrong pill (or the fact that none of the tests to diagnose your problem will now work after you’ve taken even one pill) are some of the many reasons why these little round blobs are prescription meds. But here’s the deal: why not take the bottle of left-over pills to your doctor, and, after your evaluation/plan, ask if these pills will work for you? Keep in mind, you may want to do this, even with “expired” pills. What? you may be thinking. Well, another little-discussed fact is that most pills are still quite effective after they have “expired.” Take a wild guess who gets to decide an expiration date? The drug company that makes the pill – that’s who. Studies have shown that many pills are every bit as effective after 5 years – with some important exceptions (all liquid types of medication, many herbal-based drugs, for example, among others). Just make sure you get your doctor’s input, and don’t start taking any prescription pill before you’ve been seen. If you’re sick enough to need a prescription medication, you’re sick enough to deserve a thorough, competent evaluation and care plan.

9) Prevent The Cash Hemorrhage: Prevention, prevention, prevention – it’s a great way to save the big bucks. Any time your doctor hands you a prescription, whether it’s for a bigger dose, another long-term med, or a one-time problem, we should all be asking “what can I do to prevent this from happening again?” Many times the answer is, well, nothing. Bad luck happens, and, if anything, too much of healthcare is focused on a blame game. But you might, still, be surprised by some possibilities. For example, if you’re a sexually active woman and you’ve got a urinary tract infection, studies have shown that you may be able to prevent future UTIs by getting up after sex to pee and, at the same time, taking a 500mg vitamin C with a big glass of water. But check with your doctor first. Examples like this abound in medicine. Maybe using your inhaled steroids more regularly, or getting a non-smoking roommate, can really help reduce the number of albuterol prescriptions you must fill at the new, price-rigged cost. It’s hard for many of us to make sustained changes to our habits – but learning that you could literally save $289 a month on blood pressure pills might help motivate you to power-walk regularly – especially if you actually take $75 of the money you save and do something nice (and non-caloric) for yourself each month as a reward. These approaches won’t work for every diagnosis or person, but it’s worth asking your healthcare provider. Prevention is always better, and cheaper for your health.

10) Being “Bad”: Sometimes it’s a choice. Sometimes it’s not. When you’re out of money, you stop taking your pills. In the past, these patients (by which I mean you and me) got referred to as “non-compliant” or other medical euphemisms for, frankly, being bad. However, nowadays, many people who are stretched as far as they can get, financially (and some even farther) are deliberately being “bad.” High costs may actually make us less likely to suck down a pill each day. Is skipping or stopping pills a viable option? Here’s the issue – for some diseases or drugs, this approach can actually kill you. Stopping your expensive ($15 a pill) seizure medicine can result in a (possibly uncontrollable) seizure. Some high-blood-pressure pills, when stopped abruptly (clonidine and beta-blockers, to name two) can cause your blood pressure and/or heart rate to skyrocket, which can actually cause a stroke or heart attack – just the opposite, in fact, of preventing one. Going on and off antibiotics can give you a CDC-level resistant germ. So when you’re out of money, what’s a person to do (other than weep with frustration)? First, always, always talk to your healthcare provider about the issue. Sometimes a cheaper option is out there. Sometimes there’s another pill you could be on that is much less likely to actually kill you if you stop taking it suddenly (yeah!). Finally, an honest discussion about running out of money can be the ticket to getting your doctor to seriously prune your prescriptions down to the bare essentials – which may, in the long run, be better for both your budget and your health.

Have you got some tips for dosing your drug dollars? Got a question? Post them in the comments section below!