Strategies to reduce costs at the pharmacy counter
The soaring cost of medications is not news to people with diabetes. But did you know that a number of factors can influence the price you pay for your diabetes drugs? The price of a medication can be extremely high and variable from one pharmacy to another, especially if you don’t have prescription insurance. Even if you have insurance, co-pays, deductibles and coverage gaps can still make it difficult to afford the medications you need to manage your diabetes. And it can be challenging to prioritize the high costs of necessary medications when other expenses arise.
Recent data from the National Health Interview Survey of Americans found that 15% of people with diabetes did not take their diabetes medication as prescribed due to the cost. Among this same survey group, almost 25% had to ask their healthcare provider for a lower-cost medication for diabetes.
Here are some ways you can work with your diabetes care provider and pharmacy to help lower the price you pay for your diabetes medications.
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Patient assistance programs
These are programs sponsored by pharmaceutical manufacturers to help those who cannot afford their medications. Many companies offer assistance with the medications they produce, but it is important to note that each company establishes its own rules and guidelines. For example, which medications are available and what requirements must be met to qualify for assistance will vary between programs. There is often an income qualification, and the program may only be available to those without insurance or with high out-of-pocket medication costs. All programs require paperwork to be submitted from both the patient and the prescribing healthcare provider. Talk with your provider, pharmacist and/or diabetes educator, who may be able to help you identify if you are a candidate for a patient assistance program.
Manufacturer co-pay cards
Co-pay cards are provided by the manufacturers of medications to either decrease the co-pay of a medication or provide a free initial prescription so you can try out the medication. Your healthcare providers may have the cards in their office and can provide them based on medications they have prescribed. Many co-pay cards are also available online, where you can sign up and print out a card to take to your pharmacy when the prescription is filled. Keep in mind that it is important to read the fine print. Look for the maximum amount the card will cover, the expiration date and the number of times you will be able to use the card. If you have government insurance, you may be excluded from using a co-pay card.
Pharmacy medication discount programs
Many pharmacies offer discounted prices on certain generic medications, which can include medications for diabetes, cholesterol disorders and high blood pressure. These discounts can be very helpful for reining in how much you spend at the pharmacy each month. Programs may vary at different pharmacies, so you may have to do some research to see what your local pharmacies offer. It is best to fill all of your prescriptions at one pharmacy so that the pharmacist can check for drug interactions, but if you are using multiple pharmacies to get discounts, you can provide the pharmacist with a list of all of your medications so he or she can safely fill your prescription.
Understanding your insurance options
Sometimes, the best way to save money on your medications is to better understand what medications your insurance prefers or, if possible, even choose a new insurance plan.
Look into your prescription insurance plan’s medication formulary, which will tell you what medications (both generic and brand name) are available at the lowest cost. You may be able to find an alternative medication that will work just as well for a lower price. Additionally, many insurance plans offer lower costs if patients fill prescriptions for a 90-day (three-month) supply or through the prescription insurance plan’s mail-order pharmacy. It is often difficult for your healthcare providers to access insurance formularies, so if you bring this information to your provider appointment, it can help you make better decisions for your care and perhaps your wallet as well.
Understanding what insurance plans are available to you can also help you better spend your healthcare dollars. This could include working with your human resources department to understand your insurance plan options at work. Looking into options like a Health Savings Account (HSA) or a Flexible Spending Account (FSA) may make your healthcare money go further.
If you have Medicare, be sure to compare the various Medicare Part D plans to find out which best covers the medications you need. Each year during the Medicare open enrollment window — usually toward the end of the year — you should review your plan to make sure it is still right for you. Those who have limited income on Medicare may also qualify for a program called Low Income Subsidy, also called “Extra Help,” which lowers the cost of Medicare prescription drug coverage. See the online application form to determine if you may qualify.
If you don’t currently have insurance, looking into options through the health insurance marketplace will help you determine if there is a good insurance option for you. This will allow you to compare plans available and can also help you to determine if you qualify for Medicaid in your state.
If the cost of your medications is more than you can afford, have a conversation with your healthcare provider. Changing the types of medications you are on, or considering a combination medication to decrease the number of co-pays you have to pay, may be other good options. Many times, the person prescribing your medication doesn’t actually know how much the medication will cost you at the pharmacy. Doing your homework to see if there are more affordable medication options to treat your diabetes may help you save some money and still meet your diabetes health goals.
If you are going through a challenging time and are unable to afford your medications, looking into resources in your area may be one of the best ways to help you get what you need. Health system patient assistance programs at local hospitals may be one option to help you get access to healthcare providers and medications. Many cities have charitable pharmacies and/or free clinics that provide care and medications to those in need. Local religious organizations, health departments and other charitable organizations may also be able to help meet your diabetes health needs when money is tight.
Don’t be shy — utilizing the available resources, as well as having frequent and honest conversations with your healthcare provider, are important steps to help you get access to the medications you need to stay healthy with diabetes.
Want to learn more about saving on your diabetes care? Read “How Your Healthcare Team Can Help You Save on Medications” and “Do’s and Don’t’s for Saving Money With Diabetes”