80 percent of prescriptions in the U.S. are for generic medications. Generics are supposed to be less expensive alternatives to brand name drugs. However, prices for certain generics are rapidly increasing. 50 percent of generic medications increased in price in the last year and 10 percent more than doubled in cost during the same time period. Among them are thyroid replacement hormone, doxycycline, digoxin and other heart medications, tetracycline, albuterol (pill form), and certain medications for blood pressure and high cholesterol.
I thought generics were supposed to offer a lower-cost alternative to brand name medications. Pharmacists are reporting seeing generics priced similarly to the brand name of the same medication.
Something is wrong here. Apparently Vermont Senator Bernie Sanders and Maryland’s Elijah Cummings were concerned enough to investigate why generic drug prices are soaring. A hearing of the Senate Subcommittee on Primary Health and Aging was called to probe for answers and incite action.
In addition, many brand name medications for asthma, COPD, diabetes, as well as heart medications, cancer treatments, hormones and nasal sprays, will no longer be covered by health insurance plans in 2015. Brand name medications are cost prohibitive. Now, certain generics are too, and patients are being forced by health insurance companies to accept less expensive alternatives to the medications their doctors have prescribed or not take them at all.
This is not what our medical providers want. Doctors are handicapped enough already by health insurance denials. Even preauthorizations for prescription medications are now often turned down.
Take my husband, Jamie, who was given samples of Celebrex for pain. When those ran out, he tried to fill the prescription for the same drug. Our health insurance company, HealthNet, turned that down even after a pre-authorization was done by his doctor’s office. He was offered meloxicam instead, which is not nearly as effective as Celebrex in reducing his pain. He limps along.
Our pharmacist explained that until Jamie has tried two more alternative prescription anti-inflammatories, HealthNet will not approve Celebrex. The generic for Celebrex is not yet available. Our pharmacist also said that even when the generic is available that it might be almost as expensive as the brand. That could mean that HealthNet will not approve that either.
Unless your health plan’s drug formulary covers your medication, you might be out of luck. A drug formulary is a list of prescription drugs, both generic and brand, that are preferred by your health plan.
If you’re shopping for health plans now during open open enrollment (November through February, 2015) you might ask if the medications you take regularly are covered. No one wants to be surprised by an unexpected medical cost.
Tips to help you
1. When shopping for health insurance plans, ask if your regular medications are covered by the plan.
2. Mail order pharmacies tend to be less expensive than retail pharmacies. 90-day prescriptions tend to be less expensive than monthly refills.
3. Some pharmacies will give you discounts on certain medications. Ask your pharmacist.
4. Ask your medical provider for samples. This is only useful for time-limited treatment. All samples are brand name medications.
5. Ask your doctor for a higher dosage of your medication and split it in half. For example: You are supposed to take a 10mg tab. Ask for a 20mg tab. Check with your doctor and pharmacist before splitting pills. It’s only safe for certain types of tablets.
6. Drug manufacturers will sometimes offer discounts for brand medications. Go to the medication name website and type in discount. There will be an explanation of the discount you can receive and under what conditions.
8. Ask your pharmacist for help with reducing the cost of your medication.
Martine Ehrenclou is a patient advocate. She is the author of Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive and The Take-Charge Patient.