Impact Health Sharing 9 min read

A Look at Prescription Drug Prices

How to keep the price of prescription medication low

Receiving a prescription from your doctor is a guarantee nearly every time you go for a visit—especially if you are under the weather.

 

Prescription medication helps us feel better by alleviating the symptoms with which we are afflicted, relief that often cannot by remedied by over-the-counter medications. While receiving a prescription is often part of the process of visiting a healthcare provider, many Americans are surprised by the skyrocketing prices of many prescription medications.

 

So how does one counteract both the symptoms of sickness and price-gouging from pharmaceutical companies?

 

Allina Health, a large Minnesota hospital network, is just one of an expanding number of health systems and insurers that provide real-time drug-pricing information to doctors. This system allows physicians to help patients avoid “sticker shock” when they go to pay for their prescription medication.

 

Embedded in physicians’ electronic health records and prescribing systems, the drug-pricing tool shows how much patients will pay out-of-pocket based on their insurance provider and the pharmacy they choose. Additionally, it allows the prescribing physician to find a cheaper alternative when possible, as well as starting the process of drug authorization, should the insurer require that.

 

You’ve likely seen commercials or even read news stories about people not being able to afford their medications. In some instances, people are rationing out their medication, leading to a worsening of symptoms, increase in subsequent health care costs and sometimes death.

 

Experts say that prescription pricing tools can help consumers, who face higher deductibles and climbing copayments, to learn about cheaper options before leaving the doctor’s office. However, studies show that physicians are slow to adopting the new technology due to fears of getting into long discussions about drug costs. According to Humana, less than 10% of its network doctors are using its drug-pricing tool, which was released in 2015.

 

There are also limitations to the tool. For example, drug cost negotiations between insurers and pharmaceutical companies are often highly competitive and secretive, and the tools often don’t provide data for every patient. 

 

The federal government is pushing a remedy for the situation. Sen. Martha McSally (R-Arizona) pressed a top Trump administration health official about why so many patients don’t have access to information about prescription drug prices when they visit their doctor.

 

“This is America,” McSally said. “Why can’t we have this tool available now? The data is out there; the information is out there. What is going to make it happen?”

 

The Centers for Medicare & Medicate Services received a boost in technology earlier this summer, when the organization mandated that all Medicare drug plans embed such a tool in their doctors’ electronic prescribing system, which is set to begin in 2021.

 

Additionally, the National Council for Prescription Drug Programs, a nonprofit organization that helps set guidelines for the pharmacy industry, has embarked on an effort to create standards for a drug-pricing tool. Experts predict that by 2020, doctors across the country will be able to use the same drug-pricing tool to look up all their patients’ drug costs, regardless of the insurer.

 

Despite there not being such a standard currently in place, there is an incentive for healthcare providers in providing a cost-saving service to their patients – it can save them money, as well.

 

For instance, Allina gets a set fee from some insurers to care for all of a patient’s health needs. Therefore, the doctors and health system benefit when they can reduce costs and improve patients’ adherence to taking medication.

 

Dr. David Ingham, a family doctor from Edina, Minn., said that when he prescribes a more expensive mediation, he and doctors part of his network share a smaller portion of revenue from the insurance contract. He specifically noted that the tool helped him prescribe inhalers to his patients diagnosed with asthma.

 

“I pulled up one medication I normally use, and it said it would be $240 out-of-pocket,” Dr. Ingham explained, “but it suggested an alternative for $20 that was pharmacologically equivalent. I sheepishly asked the patient which we should choose.”

 

There are also a number of other tools available to consumers to help lessen the strain of prescription medication. ScriptHero.com allows people to add medications and see cost options.

 

For example, in a search for Adderall XR, used to treat Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder, Script Hero showed generic options and forms of which to take the medication, while also allowing visitors to select the prescription strength. Once all specifications are made, site visitors enter their location. Then, you are directed to a new page featuring local pharmacies and the range of prices.

 

In our search, a CVS Pharmacy provided the lowest cost for Dextroamphetamine-Amphet ER, 30 milligrams, the generic equivalent of Adderall XR, at just $40.53 for a 30-day supply. The highest cost was at Wal-Mart Pharmacy, which came it at a whopping $130.84. That’s a staggering difference of $90.31. If someone seeking this medication went to the CVS Pharmacy seeking this medication instead of Wal-Mart Pharmacy, they would be able to pay not only a cheaper price, but be able to pay for an additional three months worth of that very same medication before reaching the amount Wal-Mart Pharmacy was charging. 

 

One of the more well known drug-pricing tools is GoodRx, whose slogan is “Stop paying too much for your prescriptions. The company has a mobile app and discount card available to consumers.

 

When visiting the website, people can compare prices and print free coupons; consumers can also choose to send coupons to their phones by email or text message. Those who utilize GoodRx’s system may be able to save as much as 80% on their medication.

 

In a search for Lexapro, which is used to treat depression and certain types of anxiety, GoodRx boasted that its lowest price of the most common generic version of the drug is available for $2.40, a whopping 97% off the average retail price of $98.15. 

 

Like Script Hero, GoodRx allows site visitors the change to select generic or name-brand drugs, prescription strength and number of tablets.

 

Lastly, many drug companies provide coupons and discount codes to help save consumers money. These coupons and discount codes are often multi-use. 

 

Learn how prescriptions are shared in Impact membership here.

 

 

COMMENTS