It’s no secret that one of the greatest financial challenges in the US today is the rising cost of healthcare. Simply covering all of your basic medical costs can bankrupt some families. This can be especially difficult if you rely on certain prescription pills and medications for chronic medical conditions. According to the Wall Street Journal, the price of prescription medicine rose 12% last year; the largest annual increase in over a decade. So how does one manage one’s health affordably in the 21st Century? Do we eschew the system of Western medicine entirely? Unfortunately, alternative supplements and treatments can be expensive as well since the large percentage of them aren’t covered by any sort of program or insurance. Thankfully, there are a variety of options with extensive online information to seek financial help when you are relying on conventional pills and medicines for acute and/or chronic conditions.
The first line of cost savings to keep in mind is that generic prescriptions often cost much less than name-brand prescriptions. For example, Coumadin is the standard prescribed blood thinner for post-surgical patients and those who’ve suffered blood clots, but the generic version Warfarin is significantly cheaper and the same exact drug chemically speaking (Federal laws insure that). The US GAO found in 2012 that, on average, the cost of generic meds is 75% less than the equivalent brand-name versions. Over the last 10 years, generics have saved the US healthcare system $1.2 trillion. Check with your doctor to see if your condition qualifies you for generic medications. You can also search the database at [email protected] to see if your medication has a generic equivalent; the general rule of thumb is that a medication needs to be on the market for 20 years before its patent expires and generic equivalents can be produced.
If you’re over 65 or disabled, you most likely qualify for a Medicare Part D prescription plan. We could write several articles just on the number of different plans available (20-40 in each state, and they vary from state to state) and the byzantine method of applying for them complete with calendar sign-up rules and financial penalties for late-signups (including higher premiums), but you are probably better off just going to the Medicare Rights Center and navigating their simple website and/or contacting them to find out what programs are available to you in your state.
Even those on Medicare can find themselves struggling to cover out-of-pocket prescription expenses, however. The Social Security Administration offers the Extra Help Program for up to $4000 a year for Medicare recipients living in the US who qualify due to income and limited resources.
If you are completely uninsured — usually from being self-employed and/or working part-time jobs with no benefits — it is imperative at the flip of the calendar year to investigate the Obamacare health care options at healthcare.gov or, if your state runs its own exchange, at the appropriate exchange website (here is a list). Your eligibility and benefits available will vary widely from state to state, but this is the first and best option in most states to find affordable health coverage that will almost always include prescription drug coverage. The cut off for signing up for Obamacare insurance for the year is February 15th, so make sure you investigate this option earlier rather than later. It’s also worth investigating on your own if you qualify for Medicaid due to income; this is also a program based on income, but if you do qualify all or most of your prescription drug benefits will be covered.
However, if Obamacare insurance is out of your grasp financially due to your income or the intricacies of your state, there are a number of other government programs available. If you serve or have served in the military, check your VA Benefits and the TRICARE website. For everyone else, check with your state government. Both Medicare and NeedyMeds have listings of all the different state-sponsored prescription programs available, and also a listing of free clinics nationwide. Most free clinics have onsite pharmacies that rely on free samples and pharmaceutical company assistance programs. The US Department of Health and Human Services also has a searchable database of community health centers which are regulated by the federal government and provide care including free/low-cost prescriptions.
It may be tempting to order prescription meds from an online Canadian pharmacy or some such international seller, but please be aware that this is still currently illegal under US law.
Most drug manufacturers also have their own programs to help save on prescription meds. These programs require application, offer eligibility based on income, and range from full coverage to cost-saving coupons. You will need to figure out which of the larger umbrella companies manufactures your particular medicine and can apply in most cases online at the links below. Or, to make things easier, The Partnership For Prescription Assistance has a searchable database to link you with the right drug company based on your drug name (and also provides assistance with finding state prescription programs based on need).
- Johnson & Johnson – JJ Patient Assistance Fund
- Pfizer – Pfizer X Pathways
- Sanofi Aventis – Sanofi Patient Connection
- Glaxo Smith Kline – GSK For You
- Merck – Merck Helps
- Novartis – Patient Assistance Now
- Roche/Genentech – Patient Access
- AbbVie – AbbVie PAF
- AstraZeneca – Affording Your Medicines
- Bayer – Bayer Prescription Assistance (PPA website)
- Eli Lilly – Lilly Tru Assist
- Bristol-Myers-Squibb – BMS Patient Assistance
If your medicine is not manufactured by one of the “Big 12” above, a simple Google search for the company name and “prescription assistance” should point you in the right direction.
All the major US pharmacies have prescription drug saving programs. These programs are not insurance; they are discounts for an annual fee. But sometimes these programs can save you more money than purchasing the drug through your insurance so they are well worth investigating. Have the pharmacist check for you when you are purchasing your medicine as to whether an in-store program can save you more money. Walgreens has a Prescription Savings Club where, for a modest annual fee of $20 ($35 for a family), you can possibly save hundreds. CVS has a similar program for $15 per person, the Health Savings Pass, as does Rite Aid (Rx Savings Program). Walmart offers a number of $4 generic prescriptions and its own Humana Medicare Part D prescription insurance (you have to be an existing Medicare member, though). Target has its own Savings Program, and pretty much every national and regional supermarket chain with a pharmacy has some kind of prescription savings program. Check with the individual pharmacies for more information.
Many organizations offer some kind of prescription drug benefit through membership. Almost every local Chamber of Commerce in the US has some kind of discount card available either to members or to local residents. Community organizations like the Shriners and the Rotary Club either offer ways to purchase insurance or prescription discount cards for their members Basically, if it’s a community organization and you pay a membership fee, check to see if a prescription discount card and/or program to get insurance is available.
There are also a number of different websites specializing in prescription assistance. GoodRx and PharmacyChecker offer comparison shopping tools where you can compare prices at different pharmacies on and offline, plus a myriad of other discount possibilities. LowestMed has an app for your smartphone for the same comparison-shopping purpose.
In addition, Alliance Direct Benefits from the Alliance for Affordable Services offers its association Members three different prescription assistance options. Members access to the MedPro Program which offers income-based prescription support, and a mail service pharmacy offering discounts on 90-day maintenance meds and hassle-free prescription orders delivered straight to your door. Additionally, Members who sign up for the optional Health Superpack option receive the Association Rx Discount Card which offers savings of up to 65% at over 60,000 pharmacies nationwide.