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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