Prescription medications are designed to improve our health and well-being; however, figuring out how to get them and pay for them can be difficult and confusing.
About half of adults say they are currently taking at least one prescribed medicine and about a quarter say they take four or more. Additionally, roughly 3 in 10 adults report not taking their medication as prescribed because of the price, which can be unhealthy and even dangerous.
Certain groups are much more likely to report difficulty affording medication, including those who take four or more prescription drugs, those with chronic conditions in their households, and those with an annual household income of less than $40,000.
PHP works to ensure our members receive the right medication at the right time for the best price. Take a look at some of the costs associated with prescription medicines, open legislation to help contain soaring costs, and some simple steps we can all take to avoid unnecessary expense or surprise pharmacy bills.
Factors affecting drug prices
Drug prices are influenced by a variety of factors. Pharmaceutical companies establish the cost or the “list price” of a drug, however, the price that consumers pay is influenced greatly by their health plan benefits. Insurance companies encourage the use of cost-saving measures, such as choosing generic medications when possible, by paying up to 100% of a generic drug cost but less of a brand name drug. This helps members become better consumers and it helps keep employer insurance premiums down.
PHP works to contain the expense of member pharmacy costs by working with pharmacy benefit managers (PBMs) who develop the insurance plan formulary—or designated drug list. (A drug formulary is a listing of prescription medications in different categories that determines how much you will pay for the medication.) The pharmacy benefit manager negotiates with pharmaceutical companies and works to achieve the best price possible for PHP members.
Drug pricing legislative proposals would help lower costs
The ever-rising cost of prescription drugs has been a political issue for years. There are currently several key proposals intended to help lower costs for consumers gaining momentum at the federal level. The Lower Drug Costs Now Act of 2019, would allow the U.S. Department of Health and Human Services to negotiate drug prices directly with pharmaceutical companies for Medicare beneficiaries and privately insured individuals. Several other legislative proposals would prevent drug companies from raising their prices at a rate faster than inflation and cap out-of-pocket payments for prescription drugs. These reforms could provide substantial and critical relief to millions of people and thousands of dollars in estimated monthly savings for some drugs.
Brand-name drugs push prices upward
Prescription drug prices in the United States are significantly higher than in other nations, with prices in the United States averaging 2.56 times those seen in 32 other nations, according to a RAND Corporation report.
The gap between prices in the United States and other countries is even larger for brand-name drugs, with U.S. prices averaging 3.44 times those in comparison nations.
The RAND study found that prices for unbranded generic drugs—which account for 84% of drugs sold in the United States by volume, but only 12% of U.S. spending—are slightly lower in the United States than in most other nations.
“Brand-name and specialty drugs are the primary driver of the higher prescription drug prices in the United States,” says Nick Sloffer, RPh, PHP pharmacy director. “The best thing consumers can do to help avoid these expensive prescriptions is to use their benefits wisely—shop around before purchasing medications and choose generics when available and appropriate.”
Three suggestions to get the most from your pharmacy benefits
Nick Sloffer, RPh, PHP Director of Pharmacy, offers three general suggestions for keeping prescriptions costs down:
1. Ask your health plan and/or your doctor for help with prescriptions
- Reach out to your insurance carrier’s customer service or pharmacy department for answers to questions about your health plan to see how much medications will cost before purchasing them.
- Also, ask your doctor to prescribe medication that meets your needs at the lowest cost, preferably generics, if they are available.
- Explore home-delivery options with your doctor and pharmacist. Your best value may come through mail delivery of a 90-day supply.
2. Schedule prescription renewals before they become urgent
- To avoid running out of a medication, pay attention to the supply you have on hand.
- Some medications require preauthorization and this will take extra time from your doctor and your health insurance plan. When possible, make these arrangements in advance.
- Contact your pharmacy several days before you run out of your medication to request a refill. Your pharmacist may need time to contact your doctor for approval. Your doctor may also want to evaluate your condition before authorizing a refill.
- Consider setting automatic refill reminders with your pharmacy to help make sure you aren’t caught unprepared.
- Have ample medication supply on hand for when you travel or before you switch to at-home delivery. Aim to have a month’s supply before transitioning to at-home delivery.
3. Use online tools to “shop and compare”
- With pharmacy benefits available online, you can check your health plan’s website for information on pharmacy benefits. Or, use a health plan’s app on your smart phone.
- PHP has online tools to help members with cost comparisons. You can check the drug and find the pharmacy location that offers the best price at phpni.com or on the PHP Go! mobile app.
- PHP’s website and mobile app also allow members to set up and refill home delivery orders, track prescription history, find network pharmacies, and compare medication prices from pharmacy to pharmacy—including comparisons to mail-order delivery.
