When you go to the pharmacy to fill a prescription and present your health insurance card, do you assume you’re getting the lowest price? If so, you may be paying too much.
Rising healthcare costs have made us all more conscientious of how we spend our healthcare dollars and checking the rising costs of prescription drugs is a good place to educate yourself on how to be a smart consumer. For instance, the cash price for many prescription drugs — especially generics — is often less than insurance co-pays. And, by double-checking pricing before purchasing medications, you’ll be glad you took a moment to shop around!
Read on for practical information on how to get the most from your prescription drug benefit and leverage prescription drug programs.
Why do prescription drugs cost so much?
According to a 2021 RAND study sponsored by the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, prescription drug prices in the United States are 2.56 times those seen in 32 other nations. Prescription drug spending in the Unites States accounted for more than 10% of all healthcare spending and, between 2000 and 2017, drug spending rose by 76%.
Brand-name drugs are the primary driver of the higher prescription drug prices in the United States. This is due to multiple factors, including testing (clinical trials) to meet stringent U.S. regulations and assure safety and exclusive distribution by only one manufacturer. Testing is expensive and manufacturers pass on some costs to consumers. Many of the most-expensive medications are those seen advertised on television. Advertising these medications on broadcast television and in print media is expensive and manufacturers pass on some of these advertising costs, as well.
Make the most of your prescription healthcare dollars with generic medications
The good news is that the RAND study found prices for unbranded generic drugs slightly lower in the United States than in most other nations. Unbranded generic drugs account for 84% of drugs sold in the United States by volume, yet only 12% of U.S. spending by volume.
At PHP we encourage members to find the lowest out of pocket cost for their prescription drugs by checking prices at phpni.com and confirming the availability of unbranded generic drugs which can offer huge cost savings.
If you are interested in a generic alternative, ask your doctor about options. When your doctor prescribes a medication, they may or may not have a preference for generic options. If they know YOUR preference is a generic option, they can make the best recommendation to replace a brand-name drug.
Generic medications are just as effective as brand-name drugs. According to the FDA, drug makers must prove that generic medications can be substituted for brand-name drugs and offer the same benefits as their brand-name counterparts. You can be assured that by taking a generic drug for a brand-name option, you’ll get the same effect.
Generic drugs have been around a long time, they have been studied and proven safe and effective, and they are usually much less expensive than brand name products.
Shop and compare pricing before purchasing a medication
Keep in mind that PHP negotiates upfront for the best pricing on prescriptions and includes these negotiated prices in our plans. Our goal is to make your plan and your prescriptions as affordable and accessible as possible.
If you are purchasing medication from a local or neighborhood pharmacy, check to see what opportunities you have for savings. Most pharmacies have their own discount pharmacy and/or membership plan that offers special savings and or accumulated discounts. Larger retail stores also have their own generics which are comparable to brand-name products.
For instance, Meijer and Kroger both offer pediatric, pain relief, digestive, and allergy relief medications in a store brand product. These medications offer the same benefits as national brand counterparts. Specific options for substitutions can be found on Meijer’s website with a convenient over-the-counter product comparison.
Costco and Sam’s Club discount warehouses also have in-house pharmacies and now offer mail-order or in-warehouse pick services. Through their high-volume they are able to offer significant savings on specific brands and products.
Getting vaccinated at a pharmacy or health center can eliminate the need for an office visit
People don’t consider vaccinations as a pharmacy benefit, but vaccinations are medications used to prevent illness and disease. Take advantage of vaccine options, to further your pharmacy benefits.
Many local pharmacies offer most recommended vaccines for adults, as well as some travel vaccines. If you plan on getting vaccinated at a pharmacy, consider calling ahead to:
- Find out if the pharmacy has the vaccine you need. This is an especially good idea if you need a travel-related vaccine.
- Ask what you will need to pay. Many vaccines are covered by health insurance. But if you don’t have insurance, try calling a few pharmacies and ask what they charge for vaccines. (prices can vary)
Federal pharmacy resources for COVID vaccinations
The Federal Retail Pharmacy Program for COVID-19 Vaccination is a collaboration between the federal government, states and territories, and 21 national pharmacy partners and independent pharmacy networks to increase access to COVID-19 vaccination across the United States.
Retail pharmacies participating in the program vary by state. If you are interested in getting vaccinated at a local pharmacy, check the pharmacy’s website to find out if the COVID-19 vaccine is available. You can also visit VaccineFinder.org or check the state health department website. Visit the federal website here to learn more.
Within Indiana, participants in the Federal Pharmacy Program include: Meijer, CVS Pharmacy, Rite Aid, Costco Wholesale, Kroger, Walgreens, and Walmart, Inc. (including Sam's Club).
Online pharmacy discount programs
Discount programs like GoodRx can help consumers save by helping to locate the best price for medications in their geographic region.
GoodRx is an online resource (and mobile app) that can locate pricing for medications in pharmacies close to you so you can compare prices and decide where to purchase your medication. GoodRx helps you find the lowest prices possible and does the comparison shopping for you.
To find the cheapest price for your medication close to you, visit GoodRx.com or use the mobile app and type in the drug name, strength, and dose.
You’ll receive a list of the lowest prices available at pharmacies near you, so you can pick your medication up at a convenient and cost-effective location. If you’ve been going to the same pharmacy for years, it’s important to check GoodRx before you leave the house because there may be better options at different locations.
How to transfer a prescription to a new pharmacy
If you’ve found a better price for your medication at a different pharmacy, don’t be reluctant to transfer the prescription. You may think transferring your prescription is a pain, but it’s easier than you think. Follow these three steps to make the process move more quickly.
- Contact the pharmacy where you want the prescription filled
With your permission and request, the new pharmacy can fill your prescription. Make sure to provide the name, strength, and doctor’s name that prescribed the medication. You can do this by phone, in person or online if the new pharmacy offers website transfer services.
- Provide your personal, health, and health insurance information
The new pharmacy will need basic information about you, like your first and last name, date of birth, address, and allergy information. Also your insurance plan number and member ID.
- Be patient
Remember, the “prescription” is written directions that authorizes you to receive a specific medication. When changing pharmacies, the instructions must be transferred before the new pharmacy can fill the order. Make sure you plan ahead for this delay. You should count on 1-3 days before you are able to pick up refills on your prescription to allow for this transfer. Some pharmacies offer “alerts” that tell you when your prescription is available for pickup.
Be a good healthcare consumer
Prescription medications can be costly depending on the type of drug, frequency of refills, and where you choose to purchase them. Use simple strategies to shop around, plan ahead, and find the best options for you and your pocket.
Take time to understand the basics of your health benefit plan, your deductible and what your out-of-pocket expenses are. Talk to your doctor about generic options, and shop around for the best price. As always, if PHP members have pharmacy or formulary-related questions, our on-staff pharmacist and assistants are available to answer your questions.
For PHP Members: How to access your pharmacy tools
At PHP we know prescriptions can be expensive, and we are here to help members get the most for every healthcare dollar spent. Follow the steps below to compare pricing online, and use tools available to PHP members.
- Login to your account at phpni.com and navigate to “pharmacy,” then “my pharmacy services.” From there click “continue” and go to the PHP/Express Scripts website. Choose the “prescriptions” dropdown and “price a medication.” Enter the drug name and strength and see what the prescription will cost using your PHP pharmacy benefit.
- With this information, visit GoodRx to compare pricing with the PHP price. Go to GoodRx.com and enter the drug name, strength, and quantity and compare the price to the PHP price. You can use GoodRx whether you have, or do not have insurance. Whenever GoodRx offers a better prescription price, use can use GoodRx’s recommendation instead.
If the GoodRx price (or another discount card) is lower, ask the pharmacist to submit the prescription to the discount card instead of submitting a claim to PHP.
- If you use GoodRx or another discount card, submit a receipt to get credit toward your deductible and out of pocket expenses. Go to phpni.com, “my pharmacy services,” and “continue” to the PHP/Express Scripts website. Have the pharmacy receipt in hand and select “benefits,” then “forms,” then, under request reimbursement, select the “Start a claim” button and follow the prompts. Be ready to upload a picture of your receipt during the process.
Sources:
Cost Reference: RAND
GoodRx Reference
