If you are relatively healthy and do not take any prescriptions, you never ask how to save money on prescriptions. But if you take any costly medications, you want to know how to save money on prescriptions. And if you do not have insurance you really want to know how to save money on your prescriptions without health insurance.
Even with health insurance, many prescriptions are very expensive.
In this post I will share some idea that will help you save money on your prescriptions.
As you might expect, everyone wants to find affordable health insurance. But the most common health insurance question from people with medications is about copays for prescriptions. Sadly, the newest and most expensive prescriptions also have the highest copays. In some cases, these drugs remain unaffordable to the people who most them.
But let’s get back to the question at hand: how to save money on prescriptions.
Do I Have to Use My Health Insurance to Buy My Prescriptions?
In my article What Do You Need to Know If You Have a High Deductible Health Insurance Policy https://myhealthcare360.org/what-do-you-need-to-know-if-you-have-a-high-deductible-health-insurance-policy/) I talk about bypassing your health insurance policy. When buying medications it is often cheaper to be a cash-pay patient rather than use your health insurance. Even with copays, the cash-pay price may be less expensive.
Most health insurance policies today utilize a tiered copayment schedule for prescriptions. prescription drug formulary. It is not unusual for a policy to use a five-tiered drug formulary.
A Tier 1 medication is often free or has a very small copayment. In many cases, if there is a copayment, it is only five dollars. Still, prescription drugs are a costly component of a health insurance policy. To control cost many plans will implement a $25 copayment for generic drugs.
Whenever your prescription is a TIer 2 or higher, it is even more important to shop as a cash-pay patient.
If your medication falls into Tier 1 or 2 and you have copay, always check your local pharmacies before using your health insurance. Stores like Pubix Supermarkets may offer those drugs with no copay at all.
Here are just a few examples:
If you have health insurance but your medication falls into a Tier 4 or 5 and the cost is prohibitive, visit the manufacturer’s website. Many pharmaceutical companies offer copay assistance programs for their more costly drugs. In many cases, this can eliminate the entire cost to you.
How Can Paying Cash for a Prescription Be Cheaper Than My Copay?
When it comes to how to save money on your prescriptions, paying cash may be a key. There are several reasons why buying your medications as a cash-pay patient may result in lower costs than when using your health insurance copay.
One reason has to do with the way health insurance companies negotiate prices with the providers in their network. The pharmacy (and all other providers) know that the health insurance company will want a discount off of the retail price. The next time that you receive an Explanation of Benefits from your health insurance company, look at the details. You will see the following column headings: billed price / negotiated price / your savings. Since all medical providers know that the insurance company wants a “discount” they begin with an artificially high cost.
What is really weird is that one insurance company may have two or more different managed care networks. And within each network, the same drug may be in a different tier. So in one network, the prescription may be in tier 3 but in another, it is in tier 4. In addition, the discounts applied may be different in each network within the same health insurance company.
Another reason that the cash-pay price may be lower than the insurance company’s copay is something called a clawback. A clawback is the practice of insurance companies or prescription benefit managers using a copay that is higher than the actual cost of a drug. For example, you may have a $10 copay for Lisinopril, a common blood pressure prescription. But if you go to Blink Health (https://blinkhealth.com) you can purchase that same drug for $3.92. In the case where your copay is $10, the insurance company of the prescription benefit manager gets the $6.58 difference.
There have been several consumer lawsuits filed in an attempt to stop this practice. In 2019, the Governor of New Jersey signed legislation outlawing the practice of charging copays that are higher than the cash-pay price of the medication.
But in a 2020 lawsuit, a federal judge ruled in favor of the health insurance company and the prescription benefit manager. This ruling allows them to continue to charge copays that exceed the cash-pay price of a medication.
Financial Assistance for Expensive Medications
On the bright side, we have access to many new medications that can save lives and/or alleviate pain and suffering. Unfortunately, many medications are incredibly expensive. Even with health insurance some of these medications can be unaffordable.
Here is just one example of a prescription that can be invaluable but incredibly expensive, even with health insurance.
Vimovo is prescribed to people suffering from osteoarthritis and/or Rheumatoid Arthritis. While this medication can significantly reduce pain and inflammation, the cash-pay price is $2601 a month. One health insurance company that I work with has this drug in Tier 5. As a Tier 5 drug, the insured still must pay 30% of the cost or $780 a month. For too many people this is totally unaffordable.
The simplest answer to how to save money on your prescriptions without health insurance may be to seek out prescription financial assistance programs.
Some pharmaceutical companies offer their own financial assistance programs. So the first place to start your search is to go to the manufacturer’s website. Search for any applications for financial assistance.
When it comes to saving money on your prescriptions you should look into financial assistance programs. There are a number of websites that help you find any available financial assistance programs. Here are just a few:
The best tool that I have found can be accessed at The Medicine Assistance Tool https://medicineassistancetool.org/. This online resource allows you to input the name of your medication and any insurance you may have. Then you provide your address and income information and the system will help find available financial resources for you.
One last program that you need to know about is Prescription Hope. If you make less than $32,000 as an individual or $50,000 for a couple, Prescription Hope may be able to get your prescription cost down to $50 a month. If you are a family of three or more the income threshold increases. Go to https://prescriptionhope.com/
How to Save Money On Prescriptions
We are incredibly lucky to be alive in the twenty-first century. Today there are a lot of medications that can alleviate the pain associated with many chronic diseases. Plus, there are many medications that can delay the debilitation associated with many diseases such as Parkinson’s.
Unfortunately, many of those new medications also come with very high price tags. And even with health insurance, the copays for these prescriptions can be financially prohibitive.
Luckily, there are ways to make these expensive prescriptions affordable. You just need to know where to look.