How to Beat the Rising Cost of Prescription Drugs

If a drug you take suddenly becomes more expensive, make sure the new price is, in fact, accurate. For example, if you’ve changed jobs, make sure the pharmacy has the right insurance information. Or it’s possible your pharmacy may have lost your details, says Brandy Letson, PharmD, co-owner of Cashiers Valley Pharmacy in Cashiers, N.C. In either event, the pharmacy “won’t locate your insurance coverage properly and you’ll get charged the full price,” she says. After checking that, confirm that the pharmacy has the right info about your drug, Letson says. “Sometimes doctors send prescriptions for a larger quantity of drug than you want, or at a higher dosage, which could raise the cost.” Price still high? The cause may be one of the situations detailed below. Check out our solutions for each.

Maybe you’ve changed jobs and the insurer doesn’t cover your drug. Or your insurer changed its formulary, the list of drugs it covers. This can happen at the start of each plan year, usually January for Medicare Part D. But it can happen any month with other plans.

While the insurer must notify you of formulary changes, the alert can be easy to miss or hard to understand, says Stephen W. Schondelmeyer, PhD, a professor at the University of Minnesota and director of the PRIME Institute, which researches economic and policy issues regarding pharmaceuticals. Formulary changes often involve price increases or the drug being dropped altogether.

Say you get a new prescription and when you go to a pharmacy to fill it you have to cover only a low-cost copay. Understandably, you assume your insurer fully covers the drug. But when you attempt to refill the prescription a month later, you’re charged full price. Why? “Often, insurers provide a 30-day courtesy fill even if they don’t cover the drug,” Letson says. “Then, in the second month, the courtesy is over.”

Solution: Ask your insurer about similar drugs. If it agrees to fill a prescription only once, it’s probably because there’s an alternative that works as well, is safe, and is less expensive, Schondelmeyer says. So ask whether a less expensive generic or alternative can be prescribed instead. Pro tip: Nip the problem in the bud—when your provider first writes a prescription—by asking whether your insurer will cover it.

A formulary change can mean a drug that used to cost a fixed $10 or $15 copay now costs 20 percent, 30 percent, or more of its full cost. This is called coinsurance, and you may be asked to pay it for more expensive brand-name meds or high-cost generics, Schondelmeyer says. And because coinsurance is based on a drug’s full cost, if that increases, your out-of-pocket share will go up, too.

Solution: If you have employer insurance and take a branded medication for which you pay coinsurance, consider applying for a manufacturer copay coupon. That covers copays as well as coinsurance.

Manufacturers offer these because they want you to use their medication. The coupon will cover all or most of your costs, usually for about a year or a set number of prescriptions. To find a copay program, ask your pharmacist, go to the drug manufacturer’s website, or go to needymeds.org, a nonprofit that tracks drug discount programs.

Copay cards and other discount programs offered by branded drugmakers can be major cost-savers, but they’re not a forever fix, says Vanderbilt’s Dusetzina. They may limit how many prescriptions you can fill in a year. Once you reach that, you’re back on the hook for the amount the insurer charges you. Or there may also be a dollar limit to how much the manufacturer will cover, Dusetzina says. Either way, you could be stuck facing a rather big bill.

Solution: Contact the manufacturer. Assuming there’s no other less expensive and better-covered drug that works as well to treat your condition, call the drug company’s copay program to see whether there are other payment options or an exception can be made. Often companies have some leeway to cover your costs in the short term or until a new plan year begins, says Rich Sagall, MD, president of NeedyMeds.

If that’s a no-go and your insurance plan is through an employer that operates its own plan (that is, is self-insured), contact your HR department and appeal for a higher rate of reimbursement. If that doesn’t work, consider applying for a Patient Assistance Program from the drug manufacturer by going to needymeds.org and looking up your drug’s discount and assistance programs.

You’re probably familiar with paying deductibles for doctor visits. But you may have a separate deductible for prescription drugs, Dusetzina says. Or you may have to meet your plan’s full deductible before your plan’s drug coverage kicks in. In either case, the average deductible for an individual on an employer plan last year (including for drugs) hovered around $1,763, according to the Kaiser Family Foundation, a nonprofit health research and policy group. For Medicare Part D plans, the maximum deductible in 2023 is $505.

Solution: Consider paying cash. Counterintuitively, some drugs can be more expensive when you use insurance to pay for them, Dusetzina says. And some, including hundreds of low-cost generics, can be purchased inexpensively if you pay for them with cash.

For example, Walmart’s discount program offers a month’s supply of generic drugs for $4, or $10 for a 90-day supply. You can also find online discounts at healthwarehouse.com, costco.com, and costplusdrugs.com. Your local independent pharmacy could also meet or beat a price you find online or at a big chain store. To find out, ask your pharmacist for the lowest possible price it can offer, Letson says.

You could also try to turn in your receipt for prescription purchases to your insurer as an out-of-network cost so that it counts toward your drug or combined medical and drug deductible. In California, for example, plans may accept a receipt for medication and count it toward your deductible.

Called step therapy, your insurer may ask you to try a lower-cost alternative medication before it covers a pricey, brand-name drug. It can be problematic if the request happens midway during your coverage year, and you already know that other drugs don’t work as well for you. “Your new employer’s insurance won’t have your previous medical records that show you’ve been more successful on the med they don’t want to cover,” Letson says.

Solution: Ask your doctor to apply for prior authorization. Your doctor will ask the insurer to reconsider the decision, and if it does, you’ll be charged a copay or coinsurance. If not approved, you’ll be on the hook for the full amount.

In that case, ask your pharmacist to look for coupons or apply for a manufacturer’s Patient Assistance Program. Once reserved for low-income people, many manufacturers have loosened their eligibility requirements and some have set income caps over $100,000.

You can protect yourself from drug price increases. Here are ways you can save big bucks.

Buy in bulk. If you’re positive you’ll be taking the same drug at the same dose for a while, you can realize some eye-popping savings by filling prescriptions for several months at a time. At Amazon Pharmacy, we found a six-month prescription of 20-mg generic Lipitor (atorvastatin) for $32.90, compared with $9.50 for a single month’s supply—a $24 savings. Get a year’s worth at an H-E-B grocery store in Texas for $23 using a GoodRx coupon.

Consider an online pharmacy subscription service if you take several generics. Two options: ScriptCo and GoodRx. At both, you pay an annual fee and get free or low-cost common generic meds, sometimes just pennies per pill. This could be an option if you take multiple generic drugs. For that same generic Lipitor, after paying a $140 annual membership fee at ScriptCo, you’d be charged $6.57 for a year’s worth. For a $10-a-month Gold membership at GoodRx, a year’s worth of the same drug would cost $22.43 at RiteAid. You’ll also have access to telehealth visits ($19 each) for prescription renewals.

On Medicare Part D? See whether you qualify for Extra Help in 2024. A third of all enrollees in Medicare Part D get some sort of assistance, according to figures from the Kaiser Family Foundation, and with the Inflation Reduction Act, up to 300,000 additional people will be eligible for the assistance. To qualify for the program, called “Extra Help,” your annual income can’t exceed $21,870 for an individual or $29,580 for a married couple. (Even if your annual income is higher, you may still be able to get some help.) Also, the value of your savings, investments, and real estate (other than your home) can’t exceed $16,660 for an individual or $33,240 for a married couple living together. If you fit the bill, you could get Medicare Part D free or at a reduced cost. Find out whether you qualify at ssa.gov/extrahelp or call 800-772-1213.

Ask for a rebate from the drug company. In addition to traditional drug copay coupons and patient assistance programs, consider calling the drug manufacturer to see whether it’s willing to offer you a rebate. Some manufacturers may do this if you ask, says Sagall of NeedyMeds.