‘How this writer shopped around and discovered a valuable secret’
My health insurer recently refused to pay for one of my prescription drugs because I don’t have the specific disease the drug is supposed to treat. Instead, I have some other condition that also happens to be remedied by the pill. If you think this decision makes sense, then you’re a perfect candidate to work for an insurance company.
The drug is expensive, about $30 per pill, and most people with my condition need about 56 pills (four weeks’ worth). That brings the cost to over $1,600. If the insurer had approved, my copay would have been $40. So when it denied my coverage it was a lot of money.
Ah, but the story doesn’t end there, and, actually, there’s a happy ending. In fact, there’s a potential happy ending for all of you who are stuck paying for an expensive drug without the benefit of having prescription drug coverage or if you’re one of those with a prescription drug insurance donut hole.
Call the Drug Maker
Most of you have seen the pharmaceutical ads on TV or in print that say something to the effect of, “If you need assistance paying for this medicine, [fill in the drug company] will help.”
So when my coverage was denied, I called the maker of the prescribed drug and asked what kind of help it could provide. I anticipated the company saying it would take a percentage off if I could prove I was low-income and couldn’t afford the full price. That’s not what it said at all.
The rep said the drug company would try to intervene with my insurer to help convince it that mine is a coverable condition. Remember, it’s in a pharmaceutical maker’s interest to convince insurers that its drug can be used for multiple conditions. While the appeal was playing out — likely to last months — the drug maker agreed to provide up to three months worth of the pill at no charge to me. That, too, would take some time — a couple of weeks to get the drug to me — which wasn’t going to help me when I needed it, which was right away. Still, I thought I’d pursue that path.
Tips to Save on Prescription Drugs
1. Unless the doctor makes it a point to prescribe the brand name, buy the generic. In almost all cases, the active ingredients are the same and should save you a bundle, even if your insurance covers you. Copays for generic drugs are usually less than for the name brand.
2. Ask your doctor for free samples. Most doctors have samples of branded drugs from pharmaceutical companies and while that may not be the full complement you need, it will reduce the number you have to purchase. (For the downside of free samples, see Why Free Drug Samples Can Cost You Too Much.)
3. If larger doses of the drugs are available and the pill comes in tablet form, get your doctor to prescribe the larger dose. Then, cut the pills in half (or in quarters, as appropriate). Make sure the particular tablet can be cut with an inexpensive pill cutter available at most drugstores. But note that there are some pills that cannot be cut or are too small to cut. Your pharmacist can advise you accordingly.
5. Get comparative prices, especially from the big box stores (such as Costco and Walmart).
6. Consider using a mail-order pharmacy service. But be sure to check out the particular pharmacy thoroughly. And although Canadian pharmacies are generally reputable, steer clear of companies from other countries.
7. Call the customer service department at the pharmaceutical company that makes the drug. Many companies offer discounts or free samples, especially for people who are low-income or simply on a fixed income, as many of us are who are retired. Some companies will appeal to your insurer on your behalf to cover the drug.