Professional Patient

Save Money on Meds: Generic Allegra (Fexofenadine HCl) Now Available

Great news today at the pharmacy. Once-expensive Allegra (fexofenadine HCl) is now available in generic form. By asking your doctor to prescribe the generic version, you can lower your out-of-pocket costs.

Barr and Teva Pharmaceuticals are offering the generic version of Allegra. They have earned the right to market the generic through legal action, as explained in a press release from Teva.

Getting the Most for Your Medication Money, Part IIb (more insurance strategies)

Even with health insurance/prescription drug coverage, medications can cost you a fortune. What's a savvy shopper to do?

In my previous posts, we discussed using generic drugs, older drugs, over the counter drugs, and buying fewer pills as ways  to save on prescription drug copays.

Today, I present three final strategies.

• Ordering drugs by mail.
• Choosing formulary drugs.
• Splitting pills.

Ordering  drugs by mail

Mail-order pharmacies have been around for about 10 years now. According to Fortune magazine, they account for $33.9 billion in sales, covering about 14% of the drug market.  (See full "Drug Wars" article; subscription required).

Mail-order pharmacies can help you cut your prescription copays by one-third. My insurance plan, UnitedHealthCare, offers me three months  of a drug for the price of two, if I order by mail.

If you want to try mail-order, here's how to get started.  Have your doctor write a prescription for 90 days of the medicine. Fill out the pharmacy-by-mail setup paperwork (call your benefits office or health plan if you've lost your paperwork). And sit back and wait for the drugs to come to your door. (Shipping is free.)

Mail-order has other benefits than cost -- easy online ordering of refills, no trips to the store, no need to buy medications every 30 days.  Great if you travel a lot, live far from a drugstore, have trouble getting out of your house, or just plain forget to renew your prescriptions every 30 days.

Choosing formulary drugs

It's very likely that your prescription drug plan has a formulary associated with it. A formulary is a list of preferred drugs that your insurance company will help you pay for. Formularies usually have "tiers" -- items in the bottom tier have the cheapest copay, and items in the highest tier have the highest copay. (Familydoctor.org has a good FAQ on formularies.)

For me, my lowest-tier drugs cost $15. My second-tier drugs cost $30. My  highest-tier drugs cost $45.  I can save $360 in copays per drug per year, just by sticking to drugs in the lowest tier.

Sometimes, drugs can move up or down in the tier structure. I used to purchase Allegra for a copay of $30; now that Claritin is available without a prescription, my Allegra costs $45. 

Changes like this are often cost-driven. The higher the cost of the prescription alternative (Allegra vs. Claritin), the more likely the insurance company will move the drug into a higher copay tier.

Pharmacy Benefit Management News, Winter 2003 issue, "Rx Reimbursement Brief," includes a stunning chart that shows that over-the-counter Claritin costs $.85 for an average  daily dose. Allegra 180 mg costs a pricey $2.26.  No wonder UHC wants to charge me more for Allegra now.

See a sample formulary: Aetna's formulary is available online. 

Splitting pills

As I explained in a previous post, pill splitting can help you double your prescription money.

More Resources

Vincent Iannelli, MD, offers an excellent online guide to buying prescription drugs that includes additional strategies for saving money on prescriptions.

Getting the Most for Your Medication Money, Part IIa (more insurance strategies)

Even with health insurance/prescription drug coverage, medications can cost you a fortune. What's a savvy shopper to do?

In my previous post, we discussed using generic drugs and/or older drugs to save on prescription drug copays.

Today, I present two more strategies:

Using over-the-counter drugs.
Buying fewer pills.

Later this week, I will post some additional strategies, such as

Ordering drugs by mail.

Choosing formulary drugs.

Splitting pills.

Over-the-counter drugs

Over-the-counter drugs are those that the Food and Drug Administration deems safe and effective for use without a prescription. They tend to cost much less than the retail price of prescription drugs, and may even cost less per dose than your insurance copay for a generic drug.

Some prescription drugs can become over-the-counter drugs after a few years on the market. The FDA Over-the-Counter Drugs information page reports that more than 700 products sold over the counter today were prescription-only medications 30 years ago.

Consider Claritin (desloratadine). Once, it was a pricey prescription drug. Now? It's available over the counter as Alavert and Claritin, both costing about $20 per 30 pills. Ditto for Prilosec; NPR reports that pricey prescription drug Nexium is just a new, patent-protected version of over-the-counter Prilosec.

View NPR transcript on the Business for Affordable Medicine Web site.

Listen to NPR report on NPR's Web site.

Fewer pills

You may not need a full 30-day supply of a medication. A few pills can sometimes cost you much less than your copay for a 30-day supply.

Case in point: My mother-in-law recently visited us (and our hairy cats). She was instantly allergic to the cats, but was only in town for 4 days. A 4-day supply of Zyrtec left her with a $9 expense. And she didn't have 26 extra pills to carry home with her, either.

If you think this approach might be appropriate for you, call your pharmacist and ask. Then get your doctor to write a prescription for the smaller number of pills.

Getting the Most for Your Medication Money, Part II (insurance strategies)

Even with health insurance/prescription drug coverage, medications can cost you a fortune. What's a savvy shopper to do?

To save money on prescription drug copays,  try the following:

• Request generic drugs.
• Consider older drugs over today's hottest thing.

Later this week, I will post some  additional strategies, such as

• Using over-the-counter drugs.
• Buying fewer pills.
• Ordering drugs by mail.
• Choosing formulary drugs.
• Splitting pills.

Request generic drugs

Generic drugs are perfectly good versions of the brand-name medications you have on your shelf.  As the Office of Generic drugs reports, generics are identical in form,  function, effectiveness, and safety. But boy do they cost a lot less.

In my prescription plan, I pay $15 per month for generic drugs, compared to $30 (or even $45) per month for brand-name drugs. In some plans, generics can cost as little as $5 per month.

Generic drugs can sometimes cost less than your prescription copay. You can ditch your insurance coverage and just pay retail price, if that's cheaper.

For example, let's say I need Valium (and boy do I ever!). I can simply pay the retail price of $7.99 for the generic version (diazepam). Which is much cheaper than paying my standard $15 drug copay for generic drugs.

Sadly, not all brand-name drugs have a generic counterpart. If your doctor prescribes something available only in brand name, ask if you can substitute some other, similar drug that has a generic version.

Consider older drugs over today's hottest thing

Consider arthritis treatments. Aspirin and Naprosyn have been around much longer than their cooler, contemporary counterparts, the COX-2 inhibitors (like Celebrex and Vioxx). They are cheaper choices because they are readily available over the counter, or in stronger prescription strength as generic drugs.

Older drugs can be safer choices, too. While the Journal of the American Medical Association has warned us about the dangers of  COX-2 drugs, Consumer Reports recently ranked naproxen as one of the safest and least expensive options for arthritis pain relief.

Getting the Most for Your Medication Money, Part Ia (more retail strategies)

MSNBC.com reports that pill-splitting can help you get the right dose of a drug, but for less money. Citing pricing from Drugstore.com, MSNBC.com shows that a month's prescription of Lipitor costs $96.99. Lipitor comes in two strengths (20 mg pills and 40 mg pills), and both the 20 mg pills and the 40 mg pills cost exactly the same amount.

Savvy patients double their money, so to speak, by splitting pills. Patients who need to take 20 mg a day are having their doctor write an Rx for the 40 mg pills. Then, at home, they split the pills in half, getting two months of medication for the same price as one month of 20 mg pills.

Drug companies do not endorse the practice--split pills may not deliver the precise dose required, and sustained-release pills do not work right when split. But major health care companies like UnitedHealthcare are now encouraging patients, working with their doctors, to split pills whenever possible.

Getting the Most for Your Medication Money, Part I (retail strategies)

Prescription drugs cost a fortune. I think we've all been shocked when we go to pick something up from the drugstore. How can medication cost so much?

My lone voice isn't going to get a big drug company to charge less for  meds. So rather than rant and rave, let's get practical: what can we do, here in the U.S., to save money on the retail price of prescription drugs?

Tools in this article:
Prescription drug tools for state residents
Medicare prescription drug tools
Prescription drug tools for everyone

Coming next week: Making the most of your prescription drug insurance benefit. Tips for saving money when you have prescription drug insurance.

Prescription drug tools for state residents:

Several states, including New Mexico, Ohio, and West Virginia, are helping residents find cheaper medications in-state. (No trips to Canada required).

Not in NM, OH, or WV? Check with your state's Attorney General's office to see if they have something similar.  (Find your state Attorney General's office on the National Fraud Information Canter's Online Resources Web page)

• The West Virgina drug information Web site currently shows that West Virginians can save up to $153.92 per month on Nexium (40 mg), just by shopping at a different pharmacy.
• The Ohio Attorney General's Prescription Information Web site shows that in the Cleveland region, you can save up to $19 per month on Celebrex (200 mg).
• The New Mexico Attorney General's Prescription Drug Web site shows that you can save up to $70.32 per month on brand-name antidepressant Wellbutrin (300 mg/day), or up to a whopping $166.52 if you switch from brand-name to generic.
  

Each site will cover a different number of medications (from 10 to 99) and participating pharmacies. Consider using any info. you find on these sites to get your local pharmacy to lower its price for your Rx drug. (Heck, car salesmen match prices. Why not pharmacists?)

Medicare prescription drug tools:

Medicare offers an online tool to help you determine which Medicare prescription card program will save you the most money. Visit their Prescription Drug and Other Assistance Programs Web site, and click on the QuickSearch tab. After you enter

• the name of your medication
• the strength of your medication (in mg)
• the number of pills of this medication you take per month,
• the retail price you pay for your medication, and
• your zip code,

the site will tell you how much money you could save if you enroll in one of the various Medicare discount drug card programs.

Prescription drug tools for everyone:

As reported by iHealth Beat, Consumer Reports has launched a new "best buy" drug tool. The Consumer Reports Best Buy Drugs Web site  is a free public education service from the nonprofit Consumers Union, publisher of Consumer Reports. The site identifies what it calls "best buy drugs," which

• are in the top tier of effectiveness for their drug category,
• have a safety record equal or better than other drugs in the category, and
• have an average retail price that is substantially lower than the most costly drug in the category.

The site presents this information in consumer guides on certain categories of drugs. Right now, it has  reports on NSAIDs (popular pain meds) and ACE inhibitors (for heart conditions). The site promises by early 2006 to cover most of the common prescription drugs in the U.S. today.  One drug category (out of 24 total) should be added to the site each month.

Important caveat: Medications are not one size fits all. A drug with a good Consumer Reports rating may not be any good for your body. Talk to your doctor about options. Don't get attached to the idea of taking one specific drug. There may be another one that's like it but works better for you.  

Knowing Your Medications

A smart friend admitted he was taking a new prescribed medication without knowing anything about it. He had no idea

• how the drug worked,
• what side effects it caused,
• who made the drug,
• what it looked like, or
• how it might interact with his other medications.

"My doctor said it would be fine," and that was good enough for him. But it shouldn't be enough for you.

The first line of defense, always? Seek the counsel of trained medical personnel--ask your doctor about the drug he/she wants you to take. Or, ask your pharmacist the next time you are picking up a medication or refill. (Don't rely on the printed information that comes with your medication--at my drug store, the inserts give no practical information whatsoever.)

There is also a wealth of information online.

To learn the basics about how to take a drug and what side effects to watch for, try

• MedlinePlus Drug Information:      http://www.nlm.nih.gov/medlineplus/druginformation.html
• WebMD Drugs and Supplements search:  http://my.webmd.com/medical_information/drug_and_herb/default.htm

To learn about potentially dangerous drug interactions, try

• Drugs.com interaction checker:  http://www.drugs.com/drug_interactions.html     
• RxList drug interactions and side effects listing: http://www.rxlist.com/cgi/generic/brand.htm

Wondering if your pharmacy gave you the right generic version of your medication? Try

• RxList's "Imprint Code Identification search":  http://www.rxlist.com/interact.htm     
• Drugs.com's pill  identification search:  http://drugs.com/pill_identification.html

For information about drug chemistry and action, including clinical pharmacology, try RxList's "Drug Monographs." Search by drug name at http://www.rxlist.com/.

To keep an eye on new clinical trials, drug alerts, and more, visit the FDA Center for Drug Evaluation and Research: http://www.fda.gov/cder/drug/default.htm

Armed with these reference sources (and perhaps the joy of Target's new drug packaging), we will all live healthier, safer lives.