June 24, 2022 by John Fernandez
Lowering Prescription Drug Prices
As the cost of medications continues to rise and the debate over pharmaceuticals intensifies, patients are often faced with navigating options available through health insurance or trying to find lower prescription drug prices on their own if insurance doesn’t pay for them.
To help ease this burden, some large health systems like Baptist Health South Florida are leading initiatives to lower prescription drug prices as part of overall efforts to contain healthcare costs.
“It’s the latest tool we’ve added to our clinical decision support – evidence-based information about the cost of different medications for the physician to use to make decisions for his or her patient,” says Louis Gidel, Ph.D., M.D., a critical care physician (pulmonologist) and chief medical informatics and quality officer at Baptist Health South Florida.
The organization is in the beginning stages of a program that’s educating physicians about the cost of prescription drugs, including brand name and generic options. The plan is to design into the electronic medical system a mechanism that alerts doctors about alternatives to various prescription drugs, which in turn, allows them to tell their patients what different tiers of medication are available from which to choose.
“We’re targeting the top 15 most expensive drugs for common high-risk illnesses first to educate physicians — not only about quality of care but cost of care as well,” Dr. Gidel said. “The purpose is not to prevent them from prescribing one drug over another. We’re advocating ‘reasonable’ cost of care, and the patients appreciate having that option.”
In addition to getting information from the doctor’s office, there are other things patients can do to lower how much they pay for prescription drugs, including:
- Know what your insurance plan covers. Pay attention to co-payments listed for preferred generics, other generics, preferred brand-name drugs, other brand-name drugs and specialty medications, as they’re often termed in outlines of plan coverage.
- Work with your doctor or pharmacist to find out if a generic form of your medication, or a less-expensive brand-name alternative, is available. “A lot of the time a new medication is only marginally better than the generic,” Dr. Gidel said.
- Use pricing information available online to help make purchase decisions. To help with prescription drug price comparisons, Phil Moeller, journalist and author of popular books about Medicare, recommends the Plan Finder online tool. “The same drug can be included in different pricing tiers by different plans, so even if it looks like the prices for the drugs are the same, the amount you pay may differ,” he says. Consumer Reports also publishes a “Best Drugs for Less” comparison.
- If insurance doesn’t cover the medication you’re prescribed and there’s no generic option, ask the pharmacy if a drug discount card is available, or if you qualify for the drug company’s patient assistance program. You can also try negotiating with your insurance company for lower prescription drug prices if the medication is not on the preferred brand-name list.
- Look into some newer options, like online pharmacies, that offer online purchasing then pick up at a local pharmacy.
“No one can be an expert in all areas of today’s healthcare environment,” Dr. Gidel adds. “The tools we’re providing physicians allow for them, as subject matter experts, to provide the best choices for their patients.”