Be more involved in how patients fill their prescriptions

As physicians, we often write prescriptions for our patients. Where, when, and how patients fill their prescriptions are usually outside of our realm of expertise. But should we be more involved?

On occasion, the cost of a medication and possible alternatives will be the subject of my conversation with a patient. I was surprised, however, when one of my patients complained about the price of an antidepressant that I had prescribed. My surprise was because the medicine has been available as a generic for almost a decade. Surely it wasn’t going to be expensive?

A quick check confirmed that it could be obtained without insurance for $4 a month from a large supermarket pharmacy. But my patient was paying five times as much, and because of two different doses, they were going to have to pay almost 10 times as much from their local pharmacy. Ever curious, I started by own investigation of the price of this prescription across several local pharmacies.

I stumbled across a 10-fold difference in the price of the prescription!

How could this make sense? Did my patient know this? I certainly had no idea about the vastly different prices at different locations. Since my little discovery, I have read reports of the highly variable pricing of medications between different pharmacies. These reports are often about highly specialized, newer medications and not a generic medicine that is one of the most commonly prescribed in medical practice.

I have now approached several of my patients and colleagues with this information, often being met by astonishment. Some people assume that their prescription at pharmacy A is going to be about the same as at pharmacy B, especially if they are in the same neighborhood. It seems that one should assume nothing and call around. This seems to pay off for many patients, with the savings multiplying for patients who take many medications. Having this information may be particularly useful for certain groups of patients, such as people with psychiatric prescriptions, who may be hesitant to shop around for their medications unless they are aware they may save money.

So here I am, having written thousands of prescriptions, but a relative novice in negotiating what my patients do with them afterwards. It appears that among physicians, I am by no means alone. The medications we prescribe are of little use if they are never filled or if patients are rationing them due to cost.

So what can patients do to obtain their prescriptions affordably?

  1. Call several different pharmacies and ask for their lowest price on a prescription.
  2. Consider a mail order pharmacy, or find out if a 90-day medication supply is less expensive.
  3. Ask the pharmacist for the full retail price of a medication. If you have health care insurance, then the retail price may actually be cheaper than your co-pay.
  4. Check if you can take a generic version of the medication you are prescribed; it might be less expensive than the brand name version.
  5. Ask the pharmacy if they have any special discounts; they may have special prices for students or older patients.

Arshya Vahabzadeh child  and adolescent psychiatry resident. This article originally appeared in The American Resident Project.

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  • Patient Kit

    It is shocking how big the difference can be at different pharmacies for the exact same medications. For example, more than $100 difference between Walgreens and Costco for the exact same med. But it’s even more shocking that many doctors apparently are clueless about this when they write Rxs for their patients. It would be great for docs to become aware of this and to routinely give their patients a patient education pamphlet about strategies for finding a good Rx price when they give patients an Rx. I bet it would improve patient compliance on actually filling Rxs and taking those meds as prescribed. This is a real world issue that both primary care and specialist docs should be aware of and make their patients aware of. It’s exactly the sort of thing that can be dealt with well in an education pamphlet or on doc’s websites.

  • guest

    This should really not be news to anyone who works with a non-affluent population. I routinely tell my patients that they should go to Walmart or Fry’s (the local grocery store chain) to take advantage of their $4/month generic prescription program, and I try to make sure to prescribe medications on that list if the patient is indigent and does not qualify for Medicaid. Also, I pull up and get discount coupons for patients.
    However, I work at a well-run public hospital where my patient load is capped at 10 and I have a full-time social worker handling a lot of the administrative work on my cases. I have the luxury to time to sit and talk with my patients and their families about these matters even though it is not “billable time” and my own office with my own computer and printer to easily access coupons.
    I suspect that the barriers to more doctors spending time on this matter has to do with limited time and other resources, rather than being totally clueless. All of us have our own medical needs and family medical needs for which we have to get prescriptions filled from time to time, so we should be aware of how difficult it can get. I personally spent about two hours yesterday on the phone and on email with a pharmacy, my insurance company and my HR rep trying to get a single prescription filled for one of my children.

    • Patient Kit

      Don’t most teaching hospitals see patients from a range of economic classes, including the uninsured working poor? The OP is a resident which is why I find it shocking that the doctors this resident encounters don’t seem to know about the complexities of retail drug pricing for their patients.

      I understand the time constraints on most docs. That’s why I suggested a pamphlet about strategies for finding the best price on your prescription be given to patients with their Rxs. I think most patients, armed with that info, would perform the search.

      On a side note, I still can’t sort out the numerous posters named “guest” on KMD. Once I realized you all aren’t one person, I’ve never known which “guest” I’m talking to at the moment.

      • EmilyAnon

        It gets really confusing when all the “guests” start talking to each other.

        • guest

          That’s why I try not to respond to anyone else named “guest.” I used to have a more readily identifiable screen name here but then people started “following” me and that makes me uncomfortable.

          • EmilyAnon

            You can go private by editing your profile on disqus.

          • Patient Kit

            You definitely have to go with what you’re comfortable with online, of course. But I just find it impossible to sort out your (multiple “guest”s) voices to get a sense of who I’m talking to. I know I could check profiles and previous posts but I don’t because I’m almost always posting on my phone on the fly (like now). It’s just frustrating because I’ve started to get a sense of other posters individual voices. Sometimes I love your posts and then other times I’m thinking “huh, is this the same guest?”. I guess the downside for you is that sometimes I think you said things that you didn’t. But the upside of that is that I don’t know who you are. So, if another “guest” says they are a Scientologist and don’t believe in psychology, it won’t matter if I think that’s you. LOL! I should probably just go swim some laps.

          • EmilyAnon

            Wouldn’t it be funny if all the “guests” were the same person taking opposite sides of an issue just to roil the pot.

        • Patient Kit

          I’m glad I’m not the only one confused by guests. Guest posts confuse me even when they aren’t responding to another guest. I dunno. Maybe with three major surgeries in the last couple of years, I’ve just had too much general anesthesia and painkillers. I’m probably just not as sharp as I used to be. :-p

    • querywoman

      Most of my own doctors know what’s on the $4/$10 list. I saw a list of those meds in the nurse practitioner’s examining room in my mother’s oncologist’s office.

  • maggiebea

    This gets even worse when you consider how many of us have been told – by doctors, pharmacists, and family members – that the only safe way to take multiple meds is to always get them at the same pharmacy, because that way the pharmacist can look out for drug interactions. If we start price-shopping every script, that safety will go out the window. Especially when a new med is prescribed by a new doctor, the doctor isn’t necessarily looking at interactions. (sigh)

  • AK

    I can only comment on the first part, because it’s where I have the most experience (Pharmacy intern, grocery chain). We can always tell patients the cash-paying price (i.e. the cost of their medications w/o insurance) for any quantity of any drug. The problem comes when it’s through their insurance, in which we would have to enter in the information from a prescription and bill it to their insurance company before we are told by the insurance what the patient’s co-pay will be.

    The differences in prices between pharmacies is the cash costs for each, but through their insurance it should be the same at each location (since the insurance is the one setting the co-pay at that point). Unless of course the insurance has a preferred pharmacy, or if your pharmacy isn’t in their network, or if the insurance prefers the patient to go through mail-order and charges higher at retail locations.

    I always tell my patients how much their insurance covers, or point it out on the handouts, and I don’t mind undoing prescriptions if patients decide to take it somewhere else. If we notice a drug that is a cheaper generic we’ll suggest the doctor write for 90 days next time, or just cash it out for the patient.

    I definitely agree with doctors knowing the costs behind the prescriptions however. Almost daily we get “my doctor told me it was $4″, and we have to professionally explain that not all drugs are $4 and that the doctors don’t work in the pharmacy and sometimes don’t realize the cost. Naproxen 500? Cheap as dirt. Naproxen 550? Well then there’s a problem.

  • Frugal Nurse

    I recently filled a prescription for an Epi-Pen (or pens, since they only come in packs of two now). Rather than have my physician send the prescription electronically to the pharmacy I typically used, I asked for a paper copy (the old fashioned way!). Then I was able to take time to look online and call around for the best price.

    I’m glad I did. Wow, Epi-pens are expensive!. I have an insurance plan with a HUGE deductible ($12,000), and have to pay out of pocket for prescription meds until the deductible is met. But even with the insurance discount, the cheapest Epi-pens I could find were $328.00 ($430 cash).

    Electronic prescriptions are super convenient, especially for the pharmacy that wants to retain customers, but that convenience can come at a high price.

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