Where Have All the Cheap Drugs Gone?

Parents tell their sons and daughters that they remember when medicines were really inexpensive. But anyone who has recently visited the pharmacy to fill prescriptions realizes that those days are long gone. My own drugs have become pricier, and the deductibles and copayments for the medicines are higher. How can we get affordable drugs for our illnesses?

Even generic pills have increased in cost. Augmentin antibiotic pills, commonly used for infections, which cost about $400 for brand-name medicine, still cost $80 to $120 for generics. Inhalers, blood pressure medicines, anti-diabetic drugs and cholesterol-lowering medicines have all become more expensive.

If you need injected medicines, you are likely paying more. For arthritis, medications are remarkably effective at reducing pain, improving mobility and function, and improving quality of life, but at high cost. Phil Mickelson's golf success despite his psoriatic arthritis is an example of how effective these drugs (such as etanercept) can be.

In the treatment of cancer, we have made enormous progress, with reduced cancer deaths. But the cost of anti-cancer drugs has ballooned to many thousands of dollars per month. The average costs of such medications has doubled to $10,000 per month in the last decade, and 11 of 12 drugs approved in 2012 cost over $100,000 per year.

The effect of the Affordable Care Act on drug costs is good news and bad news. As for the good news, the reduction of the donut hole of personable responsibility for drug fees is lowering costs for Medicare patients. But the bad news is that, compared with last year, the deductible amount on health plans (which only sometimes includes drug expenses) has increased by 43 percent on average for bronze plans, to $5,031, and total out-of-pocket costs have increased to $6,350 for individuals, and up to $12,700 for families. Since the average household income is a median of only $53,046, health care is rapidly becoming unaffordable for many families, and the cost of drugs has become a big burden on family finances. Health insurance, once thought to be a protection against personal bankruptcy, now may no longer have that role for many people.

Other countries are also trying to deal with the high cost of medications. In England, access to expensive drugs is often denied based largely on cost (but also on only marginal improvement from some medicines). In India, the courts and government allow generic equivalents of drugs, still protected elsewhere by patents, to be produced and sold, often at only one tenth of the price of the brand-name drugs. India's solution is not allowed in the United States, where courts protect patent holders. But an English-type approach might actually be adopted in America by the Independent Payment Advisory Board, created by the Affordable Care Act, to reduce escalating Medicare costs.

What can you do to find affordable medications? Here is a long list of my tips:

• When your doctor is prescribing medicine for you, ask what the cost of those drugs will be and if a generic drug is available that will work as well. Generics are less expensive than brand-name proprietary medicines.
• When you are going to fill the prescription, compare prices at your usual pharmacy, and also with other in-store pharmacies and even online pharmacies. In my experience with my patients, you could save up to 75 percent by comparative shopping.
• Check with the pharmacy to be certain if your prescription is a brand-name drug or a generic, and if it is on the regular formulary (cheaper and more available) or if it is now considered a specialty pharmacy drug (which is not only more expensive but may require pre-authorization due to the high cost).
• If your medication is too expensive, ask your doctor if a less-expensive medicine can be prescribed instead.
• Also ask your physician if she/he has free samples available for you.
• Since pharmaceutical manufacturers know their drugs are very expensive, many of the companies provide patients with discount cards, which can reduce your out-of-pocket costs. Some also have free drugs available for patients if their incomes are limited (but those limits can be as high as $100,000 income annually!). Ask at your doctor's office if they have discount cards. If they do not know about any discount programs, contact the drug manufacturer or ask the pharmacist.
• If you are on Medicare and are receiving an expensive medicine, ask your doctor, your pharmacist, or the drug company if there is a foundation that can reduce your copayments for the treatment. Then apply for a grant from the foundation (this is very easy, and if you need help, check with your doctor's office staff).
• When it is time to re-enroll in a Medicare Part D program, shop carefully on the Medicare.gov website, where you can list all your medications and determine the best value plan. Remember, each plan is still allowed to change costs of drugs at any time, so a good choice right now might not be the best later in the year. Companies can also change the tier status of drugs (higher tiers have larger copayments and prices) at any time.
• If your medications are still too expensive, price shop on the Internet from Canadian or other foreign online pharmacies. To understand details, pros and cons of ordering drugs in this manner, see the chapter "Finding Affordable Medications" in my book Surviving American Medicine.
• If your doctor is planning to use injected therapies, such as anti-arthritic drugs, immune-modulating therapy or chemotherapy, discuss with your doctor what the costs will be, what your copayments will be, and whether there are less-expensive or less-toxic therapies with similar outcomes and disease control.

Is this too much work for you to have to do? Well, when you are going to buy a home, a car, or even a major appliance such as a video system, you usually spend a little time researching so that you don't get the wrong house, auto or TV. But more important than buying those is getting the wrong medication, or one you cannot afford. Start being a smart shopper for drugs and treatments by asking for the right help and information from your doctor, pharmacist and insurance company. Use your team to win the game of finding affordable medications.