Saving Money on Prescription Drugs (FS-2024-0712)

Often when we receive a prescription, we assume the medication prescribed is the best option. But there may be less costly alternatives. One example of this is the difference between "name-brand" and "generic" drugs. Name brand drugs are usually associated with the specific company which originally developed that particular drug and holds the patent on it. But once that patent expires, different companies may have a similar, non-branded version, called a generic. A well-known example of this would be acetaminophen, which is also available under the brand name Tylenol. In Maryland and some other states, pharmacists are required by law to fill a prescription with a generic unless the doctor specifies that a brand name is required or there is no generic available. In general, generics are less expensive. So, if you're feeling like the cost of your medication is too high, ask your pharmacist whether the drug is name brand or generic.

In some situations, healthcare providers prescribe a name brand for a reason, so make sure you talk with your doctor before switching to generic. Because healthcare providers may not know how much you will end up paying for your medications, don’t assume they know how expensive your medication might be. If the cost isn't working with your budget, reach out to your healthcare provider. There may be other medications they could prescribe that are more affordable. They may also be able to help you access free samples or assistance programs. See tip #4 for more details.

Typically, we go to a pharmacy and pay our prescription copay for any medications we are prescribed. We also tend to assume this is the lowest price available, since we are using our health insurance coverage. However, there is a complex network of people who determine the prices for prescription drugs and other healthcare services. One of the ways prices are set is through reimbursement contracts with the providers. These contracts set the price for money owed to the pharmacy through your insurance provider. You have the option to pay for your medications without going through insurance, which is called paying the "cash price." The cash price is the retail rate of medications that are not billed through insurance. This option is available in Maryland and other states that do not charge a penalty for being uninsured. For many commonly prescribed drugs, the cash price could be lower than the copay for the same medications. To find out more about the cash price of your prescriptions and the availability of this in your state, you'll need to talk with a pharmacist. Since some pharmacists cannot share this information unless it is specifically requested, you may need to specifically ask, "What is the cash price for this medication?"

There are several prescription discount programs that can help reduce your drug costs. Because the programs work in a few different ways, make sure you understand the program before enrolling. For example, some pharmacies offer store or medication copay discount cards. These programs are store-specific and may have a small annual fee but may result in a lower purchase price. Other programs offer coupons or discount memberships which may provide lower prices for various prescriptions. A popular one of these programs is called GoodRx. Each program operates differently, but typically, you go to the program's website and type in the name of your prescription. Talk to your pharmacy to determine if they work with these programs. It is important to remember that these coupons are based on the cash price at various pharmacies, when you are not using your insurance. They may or may not be cheaper than your prescription copay. Be sure to compare prices and participating pharmacies before using the coupons. You'll want to consider whether you are willing to travel to different pharmacies to get the lowest price or stick with your preferred pharmacy. Finally, the coupons can change. If you are using a coupon from one of these programs, check regularly to make sure it is still valid.

A different option is using an online pharmacy. One of the most well-known is Cost Plus Drugs. Online pharmacies may or may not allow you to go through your health insurance. If you want to use your health insurance, you'll need to talk with your insurance company and see if the online pharmacy is an in-network pharmacy for your prescription plan. If they are not part of your plan's network, it can still be useful to check their price on your prescriptions as it can be less expensive than some prescription copays. You will also need to check to see if your medication is on the list of what they offer because online pharmacies may not offer all medications.

Online pharmacies typically ship medications to you at home, so make sure you check how much shipping will cost as well.

Many drug manufacturers offer patient assistance programs for name brand drugs, which offset the cost of more expensive medications. Assistance and coverage may vary from one company to another, depending on the medication, your income, and your insurance coverage. To find out if the manufacturer of a specific drug offers discounts, look on the bottle or on accompanying paperwork from the pharmacy for the manufacturer’s name or the drug brand name. Once you know this information, contact them by phone or through the company or drug’s website, see the “Key Website Search Terms” box for common terms to aid your search. You can also talk with your healthcare provider to see if there are any free samples available. Finally, you can check to see if your grocery store or pharmacy offers a loyalty or discount card. Although it may or may not directly reduce the cost of your medications, it may offer you savings on other products you typically purchase at those same stores. Some are free, but some may require you to pay for a membership. It is a good idea to compare the cost of membership to any potential savings to see if it would save you money in the long run.

You may also be able to access medications at a lower price through participation in research programs. Clinical trials are research studies designed to test the effectiveness and safety of a variety of medical treatments. People agree to take part in clinical trials for many reasons. In addition to helping others by participating in the development of new interventions, participants can receive specialized care while gaining access to ground-breaking treatments for difficult-to-treat medical conditions. If you are interested in learning more, a great place to start is the searchable registry through ClinicalTrials.gov, a service of the U.S.Government. This database provides information about both private and publicly supported trials that are recruiting, and you can search by location, medical condition, and interventions.

Learn more about programs available in your state. In Maryland, a free discount program called Maryland Rx Card provides drug discounts at participating pharmacies. Although it is not a state-run program, it is open to Marylanders and has no eligibility requirements. Visit the Maryland Rx Card website at www.marylandrxcard.com to print, text, or email yourself a discount card. Other prescription drug savings cards are available throughout the State of Maryland. Your health care provider or pharmacist may be able to direct you to these, and you can also search the 211 Maryland database at http://www.search.211md.org to find other programs. If you live outside of Maryland, you can look for similar programs in your state.

Finally, it is important to understand how using these alternative programs relate to your regular health insurance. When paying the cash price or using a discount program, you are often paying for them outside of your health or prescription insurance. This means that the money you pay for these prescriptions will not help you reach your prescription plan's deductible. If you have a prescription deductible, it is important to know its amount and to know that you must meet that deductible in the future before your prescription plan pays for other medications. Having prescription insurance is still important because unexpected illnesses can happen and having that insurance will likely reduce the cost of any additional medications you may need. Prescription insurance can be confusing, but using these strategies can help you get the care you need while still keeping your costs low. If you still have questions or need more information about health insurance, you can find further resources at https://extension.umd.edu/programs/family-consumer-sciences/healthinsurance- literacy/.

You can use this tool to compare out-of-pocket costs for medications through different discount programs, prescription insurance, and cash price.

Remember, you can also talk with your doctor about considering other medications that might be less expensive. Write the name of any medications you would like to discuss with them here:

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• Affordable Care Act. Maryland Health Connection. (2020, September 25). https://www.marylandhealthconnection.gov/glossaryslug/affordable-careact/
• Cost Plus Drugs. https://costplusdrugs.com/
• Good Rx. https://www.goodrx.com/
• Harvard Health Publishing. (2021, February 12). Do Generic Drugs Compromise on Quality?. Harvard Health. https://www.health.harvard.edu/ staying-healthy/do-generic-drugs-compromise-on-quality
• MD 211: help with essential health and human services: https://211md.org/
• U.S. Centers for Medicare & Medicaid Services. (n.d.). Getting Prescription Medications. HealthCare.gov. https://www.healthcare.gov/using-marketplace-coverage/prescription-medications/