I work as a physician assistant at a rather large endocrine practice in San Diego County. We receive over 400 calls a day from our patients… that’s right, I said 400! Now, that’s a lot. I was not surprised to recently learn that over half of those calls are related to medication costs or/and insurance coverage. Finding the right medication at the right cost can be a long process, but did you know that we as patients can fast-track this?
I’ll let you guys in on a little secret… clinicians have no idea how much your medication will cost or whether or not it will be covered by your insurance. The only way for us to find out is to send your prescription to the pharmacy and see what they come back with. You can find out this information easily and in doing so, you may be able to get your medications faster and often for cheaper prices.
The first step to this process is obviously knowing which medication you are being prescribed. Ask your clinician or pharmacist for a list of alternative medications in the same drug class (you can also look this up online) you could take. Next, Google your insurance policy’s medication formulary and identify those medications. For price purposes, you want to find the medication that is on the lowest tier. The Fingertip Formulary app is also a great tool for identifying covered medications. This process can be useful even if the medication originally prescribed is covered. There may be a similar medication on a lower tier that will cost you less. This should be done for all medications, even insulin. I want to emphasize that finding this information is not your clinician’s job… this is yours! I think it’s important for us PWD to take charge and remember that we are the ones managing our disease.
Let’s talk about some other tips for finding the most cost-effective medications.
First, shop around! Copays can be different at different pharmacies and many companies offer discount coupons. The GoodRx app is very useful for locating the best medication price. Also, don’t ignore the small independent pharmacies — they will often offer medications at cheaper prices than the chains.
Second, sometimes it’s better to skip the insurance. This mostly applies to meds like antibiotics, but it’s worth a shot. Sometimes copays are higher than the price of the medication itself.
It is often less expensive to use a mail order pharmacy or club store pharmacy and it can be worth it to find out if you qualify for a patient assistance program. The Partnership for Patient Assistance Program website is a great place to see if you qualify, and it’s free.
I hope this helps and remember… you are in charge of your own health! Good luck!