Unlike any other country in the world, the United States doesn't regulate medicine prices. The unchecked power of drug companies creates a burden that falls on consumers who struggle to afford life-saving treatments.
Medications are expensive due to the complex healthcare laws and regulations in the United States.
Using drug savings programs is an effective way to save on prescription medications without insurance.
Employer benefits, including FSA and HSA, are tax-free methods of saving for prescriptions.
Collaborate with your medical provider, local pharmacy, or pharmacist - they all want to help you get the treatment you need.
If you have insurance, call member services to ask about their coverage options for your health diagnosis.
Fortunately, there are several methods to save money on medications. Through working with savings programs, pharmacies, and providers, these medications can become more accessible.
Why are medications so expensive?
Global spending on prescription drugs tops one trillion dollars annually, and the cost of medication is only increasing. A 2020 study about medication spending speculates that this could be due to:
- Healthcare policy.
- Increased costs of drug development.
- Increasing elderly populations.
- Sicker patients.
Many factors go into the cost of medications, but the bottom line is: the price is passed onto the patient seeking care for their condition.
What medications are the most expensive?
Some medications are unaffordable, to the tune of tens of thousands of dollars. These may be in the form of oral medications, injectables, or intravenous drugs. Some of these medications include:
- Chemotherapy drugs.
- Medications for autoimmune diseases.
- New medications that are still undergoing clinical trials.
- Medications when being used “off-label” (meaning your doctor is prescribing it for a different reason than the manufacturer intended).
- Drugs for rare disorders.
Without insurance, it can make those medications completely inaccessible to most patients. Unaffordable medications decrease the likelihood of individuals adhering to their treatment plan. Even less expensive medications, like insulin or EpiPens, are life-saving medications that can cost over a hundred dollars out-of-pocket.
Five ways to save money on prescriptions
1. Use a savings program
According to Dr. Ben Aiken, family medicine physician and the VP of Health at Decent, savings programs are a great way to save money on prescriptions.
He explains how and why they are so effective:
Patients are more likely to fill prescriptions with savings programs. This means that pharmacies can generate more business by selling those medications and generating additional foot traffic in retail pharmacies.
Drug savings programs get a percentage of the payment each time a medication is filled. Since the savings programs are helping increase the rate of the medications sold, they get a cut of the profit.
Medication manufacturers get more medications sold. They increase sales without having to lower the price for everyone, only those that use the discount program.
2. Utilize a flexible spending account (FSA)
An FSA is a benefit offered by an employer that does not require that you have any health insurance. When setting up an FSA, you elect an amount of money from your salary to go into this account tax-free. This money can be spent on medications and medical treatment. Individuals can contribute up to $3,050 per year to an FSA.
If you have health insurance, you can sign up for a health savings account (HSA). Depending on your plan, money from an HSA can be rolled over into the following year and can be withdrawn as needed. If you are employed, check with your benefits program to see whether an FSA, HSA, or combination of both is best for you and your family.
3. Check the programs at your pharmacy
Some pharmacies offer delivery options for medications. Because the pharmacy can save money on overhead costs, like building costs and staffing, the delivery options can be a cheaper alternative.
Depending on the medication, you may also be able to buy it in bulk. Paying for medication a few months at a time can also save the pharmacy overhead costs and packaging expenses.
Check with your pharmacy to see what type of programs are offered that could potentially save you money.
4. Collaborate with providers and pharmacists
Your medical provider wants you to be able to afford your treatment regimen. If you’re having trouble affording your medications, reach out to your provider to let them know.
They will be able to educate you about what options are available for similar drugs or generic alternatives or connect you with community resources. Generic medications are known to cost less than brand-name medications.
If you experience sticker shock at the pharmacy counter, don’t be afraid to speak up and ask to speak with the pharmacist. They may be able to explain why a medication price increased, especially if you switched drug formulations or health plans.
Pharmacists are familiar with savings programs that may be available to you for your medication, and they may be able to help you.
5. Shop around
Dr. Aiken stated, “Each pharmacy charges its drug prices. This means that two pharmacies down the street from each other may charge entirely different prices”.
Because pharmacies want to keep their customers, they do strive to have competitive prices and price transparency. However, it might be worth it to call a few pharmacies in your area to see who is offering the best deal.
Is it difficult to get coverage with insurance?
Managing medication costs without insurance is challenging, but having insurance doesn’t guarantee affordability.
Here are a few things to check with your insurance before picking up a medication:
Check for prior authorizations
Some medications require prior authorization. Prior authorization means the medication must be approved by your insurance ahead of time to guarantee coverage.
Ask your medical provider if prior authorization is necessary so you can have the office submit documentation to the insurance company as soon as possible.
If your provider isn’t sure, or you want to ensure coverage, you can call the number for member services on your insurance card for more information.
Inquire about alternatives
Sometimes insurance companies refuse to cover a medication because there is an effective, lower-cost option.
Discuss the first-line treatments for your condition with your provider to make sure you have exhausted other cost-effective options.
This may include therapies, services, injections, other medications, or other formulations of the same medication. You can also ask the member services at your insurance company if they have a preferred first-line treatment for your diagnosis.
Apply for an appeal
Sometimes, prior authorizations are denied. If you experience a denial, ask your medical provider if they believe some alternative medications or treatments would be effective for you.
If your medical provider believes that the original request was medically necessary, follow the appeal process of your insurance to have your claim reconsidered and investigated.
If you have trouble affording your medication, know that you aren't alone. Without changes in healthcare legislation, medical treatment will continue to be expensive. Talk to your medical provider and pharmacy and search for savings programs online to find ways to make your treatment obtainable to you.
- National Library of Medicine. The high cost of prescription drugs: causes and solutions.
- AHA Journals. Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017.
- Healthcare.gov. Using a Flexible Spending Account (FSA).
- National Library of Medicine. Comparative effectiveness of generic and brand-name medication use: A database study of US health insurance claims.
- National Library of Medicine. Prior Authorization.