How to Put a Lid on Your Drug Costs in 2024
Jan 11, 2024
Tips for
controlling your drug spending if you’ve got a deductible that reset upon the
new year
The start of a new year means a fresh round of out-of-pocket costs
for people taking prescription drugs.Health-insurance
deductibles reset on Jan. 1. That means, if your deductible applies to your
prescription-drug costs, you could be on the hook for thousands of dollars
while you’re spending down the deductible and more favorable insurance coverage
kicks in. (Of course, you might still be on the hook for any copays and
coinsurance.)
If you’re uninsured, you’ll face the challenge of paying the full
cost of a medicine throughout the year.
Here are steps you can take—some of which are new this year—to
help control your prescription-drug costs:
New law, new savings
The Inflation
Reduction Act of 2022 contained some of the most sweeping drug-price
provisions ever enacted.
One of the earliest provisions to take effect, in 2023, was a $35
monthly cap on insulin costs for people on Medicare. Administrators of
Medicare Part D drug plans were required to arrange for the caps to be applied
automatically at the point of sale at a pharmacy or mail-order service. You
should contact your plan if you didn’t benefit from the
cap. (The cost cap doesn’t apply to people with private insurance.)
The
law also expanded the list of vaccines that seniors enrolled in Medicare Part D
can receive at no cost. More information is
available here.
Beginning
in January 2024, there will be an effective annual cap on out-of-pocket costs
of about $3,300 for brand-name prescription drugs in Medicare Part D plans. The
out-of-pocket cap falls to $2,000 in 2025, a big help for people taking
expensive drugs. Previously, there was no cap on out-of-pocket spending, and
some patients were on
the hook for several thousands of dollars a year. More information is
available here.
New insulin prices
In
addition to the IRA’s $35 monthly cost cap in Medicare, insulin manufacturers
last year announced list
price cuts and out-of-pocket cost caps for common insulins. Some of
the cuts took effect in 2023, but others are taking effect in January
2024.
If you
take insulin for diabetes, find out if you can benefit from these price cuts.
You can check the websites of the three main insulin manufacturers—Eli Lilly, Novo Nordisk and Sanofi
—to see if the price of your insulin is being cut. Ask your
doctor or insurance plan if there is a cheaper insulin than the one you’re
taking. T1International, an advocacy group for diabetes patients, also has
information about the insulin
price cuts here.
Swap drugs
Many
drugs have a lower-cost, generic equivalent to the brand-name drug that you’ve
been prescribed. There’s also a newer category of drugs called biosimilars,
which are close copies of brand-name biologic drugs such as Humira, the
high-selling drug for autoimmune diseases.
Ask
your doctor, pharmacist or health plan if taking a generic or biosimilar could
save you money. Keep in mind the medicines’ names are different from the brand
names.
Here
is the growing list of approved biosimilars.
It’s
also worth asking if there’s a less-expensive drug that isn’t a direct copy or
biosimilar of the prescribed drug but is in the same category and could be
equally effective. Or you might be able to take an over-the-counter, nonprescription
version of a drug, if the dosage is appropriate.
“It
always makes sense to talk to your doctor and say, ‘I’m really struggling to
pay, are there lower-cost alternatives that may deliver similar results?’ ”
said Juliette Cubanski, deputy director of the program on Medicare policy at
KFF, a nonprofit health-policy research firm.
While
you’re talking with your doctor, review your prescriptions if you have more
than one, and see whether you could stop taking one or more of the drugs.
Shop around
Prices
for the same drug can vary widely depending on where you buy it.
For
generics, check out the growing number of online discount prescription
services. The Mark Cuban Cost Plus Drug Co. offers
generic drugs at 15% markup plus pharmacy and shipping fees by cutting
out pharmacy middlemen and negotiating directly with manufacturers.
Amazon.com offers various pharmacy services including one that provides
eligible medications for $5 a month, found
here.
Another
online service, GoodRx, lets you compare prices for the same drug at
several bricks-and-mortar pharmacies near you, and provides coupons that can
lower the cost. A prescription for a generic version of the widely used
cholesterol-lowering pill Lipitor, for example, costs up to $21.47 at one chain
pharmacy in Peoria, Ill., while the same prescription costs $11.04 at a
grocery-store pharmacy in the same town, according to GoodRx’s website.
“Medications can differ in price from pharmacy to pharmacy, and
that’s something that a lot of people aren’t aware of,” said Dr. Karla
Robinson, medical editor at GoodRx.
Try Canada?
It
might also be worthwhile seeing if you can get your prescription at a lower
cost in Canada. Drug importation is only allowed under limited circumstances
under federal law, but both the Trump and Biden administrations
have pursued policies to loosen restrictions.
The
agency says it may be allowable if the product doesn’t represent an
unreasonable risk, if it is for personal use and the quantity is limited, among
other criteria. Read about the Food and Drug Administration’s policy
here.
If you do decide to either drive into Canada to buy a medicine or
order it online from a discount pharmacy, be sure to verify that the Canadian
pharmacy is legitimate. The Canadian government has
information here about how to do that, including searching a list of safe
pharmacies that is operated by the National Association of Boards of
Pharmacy.
Skip your insurance
Don’t
assume insurance gives you the best deal. Sometimes just paying cash for a generic
prescription is cheaper than paying the required out-of-pocket cost under your
health plan. Ask your pharmacy whether it would be cheaper to pay cash, outside
of your insurance plan.
Some
retailers offer prescription savings programs, such as Walgreens,
where patients can get special discounts on the cash prices of some drugs for a
$20 annual membership, outside of a person’s insurance coverage. Walmart sells
some generic drugs for $4 cash a month, and no membership or insurance is
required.
A
downside is that spending outside of your insurance plan won’t count toward
reaching your plan’s deductible, when better insurance coverage kicks in. You
might have to make some calculations to figure out which approach saves you
money over the course of the year.
Seek financial assistance
Many
drug companies offer patients financial assistance with copays, or provide
drugs free to people meeting income criteria. The copay assistance can reduce
your share to $5 or $10 a month, even if your health plan’s required
out-of-pocket costs are much higher.
Go to
the manufacturer’s website to see what copay assistance they offer. Or you can
search your medication on websites that aggregate information about various
manufacturers’ programs. The industry trade group PhRMA offers one,
as does RxAssist.
The caveat is that manufacturers’ copay-assistance programs are
generally off limits if you’re on Medicare or other government programs,
because the assistance might run afoul of federal anti-kickback laws.
If you
are on Medicare, you instead might seek copay grants from third-party
foundations. Usually your income must be below a certain threshold.
One of
the largest, the PAN Foundation, operates an online
tool to help people find a copay-assistance fund that specializes in
their disease, including funds that other foundations operate. The foundations
receive funding from drugmakers, but they are supposed to make the decisions
about grants regardless of which drug they take.
“We
don’t want people making unfortunate decisions around having to split pills in
half or choose between food on the table and taking medicines,” said Amy Niles,
chief advocacy and engagement officer for the PAN Foundation.
In
addition, some states help low-income older adults pay for prescriptions.
Pennsylvania, for instance, uses proceeds from its lottery games to provide
low-cost prescriptions to the elderly. You can find information about what
your state offers here.
If you’re a veteran, use VA benefits
The
U.S. Department of Veterans Affairs provides healthcare and drug benefits for eligible
military veterans. For some members whose illness is connected to their
service, there is zero cost. Other eligible veterans pay monthly copays of $5
to $11 for their prescriptions. The VA will help patients pay copays in certain
cases.
The VA
is able to provide drugs at low cost partly because federal law requires
certain discounts and allows the VA to further negotiate prices with
manufacturers. Information about applying for benefits can
be found here.
Source: Wall
Street Journal