Two ways to get cheaper prescription medications
There are certain conversations that I have every day.
Every day, I talk about the price of prescription medication. It is inevitable. This is something that impacts almost all of us. More than 75% of Americans think prescription medications are unaffordable. 30% of Americans don’t take needed medications because of the expense. This means they have untreated medical conditions like high blood pressure and diabetes. There are stories about this every day. The cost of essential medications like insulin. And how much drug prices have increased over the past many years.
Medications are more expensive in the US than they are in other countries. The average American spends more than twice what citizens of other countries spend on prescription medication. This doesn’t mean making medications in the US is more expensive. It is more a function of our system. Expensive prescription medications impact my medical care every day. The medicines with fewer side effects and higher efficacy aren’t affordable. Insurance companies mandate using suboptimal medications that are cheaper but have side effects like permanent memory loss. It is a frustrating game that patients and physicians are losing.
Our existing system
We have created a convoluted and bloated system. Insurance companies currently outsource the management of prescription medications to pharmacy benefit managers (PBMs). There are 3 PBMs in the US that control more than 80% of the market. These are CVS Caremark, Express Scripts, and OptumRx. These organizations operate and distribute prescription medications to patients and pharmacies. They also negotiate and process insurance claims and rebates. And while this may sound reasonable, how they do their job isn’t really clear. But data shows that these third parties have the highest gross profit in our drug supply chain.
There has been a big push recently to learn more about the details of their operations. So much so that the Federal Trade Commission has launched an investigation into how PBMs operate. They are specifically looking at:
- The fees charged to unaffiliated pharmacies (usually small, local pharmacies)
- Methods used to steer patients to PBM-owned pharmacies (usually chain pharmacies)
- Administrative restrictions like prior authorizations
- Impact of fees and rebates on formulary design (this is super-complicated and differs for different pharmacies and health plans)
- Cost of prescription medications
All of this is great news. There is no reason not to ensure the system is as efficient and economical as possible (and we all know it is not now). I can’t tell you how much time my office spends getting prior authorizations. Prior authorization is when a medical provider must get approval from the health insurance company before a treatment, procedure, or medication. And while this has long been the case for surgery, it is standard before starting a medication.
And this is busy work. It is time-consuming, expensive, and does not improve the quality of care. I have to do this even if I think the medication is inferior and not the best choice. It almost takes a full-time employee to handle medication pre-authorizations. It is a very bureaucratic process, and patients often feel like it takes forever. Sometimes it just feels like the insurance companies are stalling, hoping we will get tired of trying to do the right thing.
So, while we wait for changes in our existing system, is there anything to do to get my prescription medications cheaper?
Good Rx
Good Rx (https://www.goodrx.com/) is a disruptor in all the good ways. It is accepted at more the 70,000 pharmacies in the US and is a free price comparison resource. It helps you access coupons for the lowest-priced name-brand and generic medications. You have to have a prescription, and it works whether or not you have insurance. Good Rx works with PBMs. They make most of their money through advertising on their website and a percentage fee for every time their coupon is used at the pharmacy.
Many patients save considerable amounts of money with GoodRx. Like most things in medicine, it all depends on your insurance plan. But local pharmacies (not chains like Walgreens or CVS) can lose money with Good Rx because of their relationships and deals with the PBMs. GoodRx was the first company to operate in this fashion, and some new competitors are springing up like Capital Rx, NowRX, and Waltz Health.
Costplus Drugs
Mark Cuban Costplus Drugs (https://costplusdrugs.com/) supplies only generic medications, and it functions without PBMs.
This company charges you the cost of the drug +15%. There’s an additional 3$ fee for the pharmacy partner to prepare the medication. And then 5$ in shipping costs. And that’s it. For many medicines, this is much cheaper than going through your insurance company. The only negative is that it saves your insurance company money and doesn’t go towards your deductible. You must have a prescription, and your provider can send it directly to the company.
Right now, Costplus Drugs carry more than 200 medications. Some drug manufacturers are leary to work with them because of feared repercussions from the established industry. This limits the medications that they carry, but they are working on this and adding new medications all the time. But some essential medications, like insulin, are not currently available through this site.
As an example, Costplus drugs currently carries three incontinence medications, oxybutynin (price $4.50 compared to a retail price of $22.80), solifenacin (worth $5.10 compared to a retail price of $337.50), and tolteradine ER ( price $25.80 compared to a retail price of $221.70). Comparing the price to a retail price does not tell you how much you will save since it is not the price your insurance company will charge you. But if your prescription prices are high, you should check out their site. There isn’t a catch. Mark Cuban funded this company, which is his gift to the world. The goal is to help combat our crazy prescription prices. The company is not designed to maximize profit. And this makes me love Mark Cuban.
So, if you are part of the 25% of Americans who aren’t worried about the cost of prescription medications, this does not apply to you.
But if you feel like your costs are too high, she should check out these two sites. GoodRx might be a great option for you if you want to use your insurance coverage. You’ll know you are getting the lowest cost (and sometimes different branches of the same chain will have different prices). And if this is too expensive, check out Costplus Drugs. I think it is a game-changer. And while I wish our existing system worked better and we didn’t have to skirt around it, this will help many of us in the meantime.
https://www.statista.com/statistics/239976/us-prescription-market-share-of-top-pharmacy-benefit-managers/
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