Surprising ways to cut your drug costs

Many Americans, even those who have insurance coverage, spend more than they need to on prescription medications. Those who regularly take a prescription drug spent an average of $758 a year, according to our 2012 Consumer ­Reports Best Buy Drugs annual prescription-­drug poll.

Overall, people who currently take prescription drugs take an average of four medications, and 14 percent say they take seven or more. And to pay for all of those drugs, some cut back on other household expenses, spending less on entertainment and dining out, groceries, or clothing. Here’s how to keep more money in your pocket and still get effective and safe treatments for what ails you.

For certain common conditions—heartburn, insomnia, seasonal allergies, migraine headaches, joint pain—a treatment you already have in your medicine cabinet might work as well as a prescription drug. Why? Many over-the-counter (OTC) drugs were once prescription-only, such as the allergy medications Allegra (fexofenadine and generic) and Claritin (loratadine and generic) and treatments for heartburn, such as Prilosec OTC (omeprazole and generic) and Prevacid 24HR (lansoprazole and generic). Those OTC drugs might be less expensive than prescription drugs for the same condition, and many are now available as low-cost generic store brands. In other cases, when the condition is infrequent, such as a mild migraine or the occasional insomnia, our analysis shows that some OTC remedies may work at least as well as certain prescription drugs and save you the expense of a visit to the doctor. See the chart below.

Some over-the-counter remedies should be used only after a trip to the doctor. Others don’t work well enough to justify the risk of side effects. Here are two examples:

Overactive bladder. You’ll probably start seeing ads for a new product: the Oxytrol patch. Previously a prescription-only drug, it will become available this fall as an over-the-counter product for women with that condition. As with all drugs in its class, Oxytrol (oxybutynin) is only moderately effective at relieving symptoms and can cause dry mouth and constipation. Our analysis of the evidence showed that the prescription patch caused skin reactions at the site of application in about one of every four people who used it. And 11 percent of the time people stop using it because of that complication. (The Rx and OTC patches contain the same dose of medication.) 

Our medical advisers caution against treating yourself for an overactive bladder without first seeing a physician for a diagnosis. The symptoms, which include incontinence and a frequent need to urinate, can stem from other conditions, including an infection and tumors, and medications for other conditions, such as those for high blood pressure.

If you have mild symptoms, try lifestyle changes, such as cutting back on caffeinated and alcoholic beverages, drinking less between dinner and bedtime, and doing Kegel exercises to strengthen the pelvic muscles that help control urination.

If those don’t help, medication might be called for. But the Oxytrol patch might not be the best place to start. Our CR Best Buy Drug recommendations include prescription tolterodine (Detrol or generic) and its extended-release version (Detrol LA). They have a lower rate of side effects than other medications in their class, but you still have to watch out for dry mouth, constipation, blurred vision, and dizziness.

Multiple-symptom cold remedies. Colds can make you miserable in many ways, so it’s certainly tempting to reach for a multisymptom cold reliever. But the product might not provide the relief you seek and could cause side effects.

For example, only a single active ingredient in Vicks DayQuil Cold & Flu might actually do you much good: the pain reliever acetaminophen, which can help lower fever, reduce sore throat, and ease body aches. The other two ingredients—the cough suppressant dextromethorphan and the decongestant phenylephrine—don’t work that well. Some multisymptom cold relievers, such as Alka-Seltzer Plus Cold & Cough, contain an older-style antihistamine that can help dry a runny nose. (“Nighttime” versions contain an antihistamine that causes drowsiness.) But the side effects, including dry eyes and mouth, and fluid retention, might make it not worth the bother—or worth the money.

Instead, you’re better off listening to Mom about getting rest and drinking plenty of fluids. Consider taking two teaspoons of honey to help ease a cough. Take medication only if you really need it, and even then take only products that target your particular symptoms.

Hundreds of commonly used generic medications can be purchased for as little as $10 for a three-month supply at major chain drugstores, big-box stores, and club stores in the U.S. Although program details vary and some require an annual membership, our analysis shows that many people don’t take advantage of the programs. Here’s an example: You can pay $4 for a month’s worth of the generic antidepressant fluoxetine (Prozac), 20 milligrams, at Sam’s Club, Target, or Walmart. But many people pay an average retail price of $31 without getting the discount. Insurance companies can pay even higher rates (see the chart below), which can increase future premiums.

Even drugs usually covered by your insurance might be less expensive if you pay cash instead. Our secret shoppers recently found a month’s supply of 20 milligrams of the generic version of the antidepressant Lexapro (escitalopram) for an average of $7 at Costco. That’s a savings of $3 a month if your generic-drug co-pay is $10.

Before you buy, check out discount prices

When you’re hunting for over-the-counter drugs, make sure you cast a wide net. People who design product displays for stores intentionally place products to boost sales and maximize profits. Knowing the tricks of the trade can help you zero in on the best deals. Here’s where to look:

End-of-aisle displays. Stores often use that space to feature items that are highly promoted, new, seasonal, or on sale. It’s where you might find discounted antihistamines during allergy season.

To the right of the name brands. Retailers might help you find a better deal by putting store brands in an easy-to-spot location. They can save you as much as 73 percent off the name-brand price, according to our secret shoppers.

On the lower shelves. The “bull’s-eye” location on the top shelves frequently contains best sellers, fast-moving products, and often higher prices. Look beneath that area for greater savings.

Under a clearance or sale sign. But buyer beware. Those signs could be enticing you to buy a name brand that might not actually be “on sale.” And even products on sale can be more expensive than a store-brand equivalent.

Next to a related item. You might find cold remedies next to the tissues, for example. So-called shopping-basket fillers can be good deals, but they also appeal to impulsive buyers and discourage comparison shopping. Don’t put the product in your basket unless you really need it and you know that the price is right.

On your phone. Consider using your smart phone while in the store to look up ingredients and product alternatives or to comparison shop.

The Affordable Care Act includes several provisions that can cut your drug costs now and in the future:

Coverage for young adults. All health plans must now allow young adults to remain on their parents’ health plans until they turn 26, so they can continue to receive coverage for prescription medication.

Cheaper drugs for Medicare Part D. Seniors with Part D plans who reach a total drug cost of $2,970 in 2013, also known as the doughnut hole, have to start paying prescription-drug expenses themselves. But now once they reach it, they’ll get a 52.5 percent discount when buying most brand-name drugs and a 21 percent discount on generic drugs covered by Part D.

As of March 2013, more than 6.3 million older adults and people with disabilities had saved $6.1 billion in prescription costs since the law was passed. The doughnut hole will continue to shrink until it disappears in 2020.

Free preventive care. New private plans will cover and eliminate cost-sharing (co-payments, co-insurance, and deductibles) for proven preventive measures. For women, they include breast-feeding supplies and contraception, as well as mammograms and cervical-cancer screenings. For everyone, routine vaccines are covered, and depending on your age, colorectal-­cancer screenings. Health plans provided by religious organizations that object to birth control must still offer the coverage, but the cost will be borne entirely by their insurance company.

Higher limits. Annual limits on coverage, including drug coverage, in job-related and individual plans are now restricted to a minimum of $2 million. But that will be completely phased out in January 2014. Health insurers can’t set lifetime limits on your coverage or cancel if you get sick.

Almost every drug plan has a list of covered drugs called a formulary. Drugs that aren’t on the formulary have the highest out-of-pocket costs to consumers or simply aren’t covered at all. Employers used to revise their formularies every year, but many have started to update them every few months, which can lead to sticker shock at the pharmacy counter if your drug is no longer covered.

“Up to 10 percent of consumers nationwide learn, at one time or another, that a drug they’ve been prescribed is no longer covered,” says Stephen W. Schondelmeyer, Pharm.D., Ph.D., a professor of pharmaceutical economics at the University of Minnesota College of Pharmacy. Medicare Part D and Advantage plans usually must notify you 60 days in advance if a drug you’re taking might not be covered any longer, but commercial plans might not tell you. “Many people don’t know it’s a possibility until it happens,” Schondelmeyer says.

If you find yourself in that predicament, you have a few options before paying the full retail price. First talk to your doctor about prescribing a different drug that’s on the formulary. If that’s not possible or your doctor says it’s not a good idea, have him or her petition your insurance company to cover the drug. If the health plan denies your request, file an appeal.

You can also enlist the help of your pharmacist. “We can work with patients to choose a different drug that’s affordable, find a generic substitute, or go through the prior-authorization process to petition the plan,” says Tim Davis, Pharm.D., a pharmacist and owner of Beaver Health Mart Pharmacy in Beaver, Pa.

Our secret shoppers recently called more than 200 pharmacies in the U.S. to get prices for five common medications. Our analysis showed that in some cases, callers were not given the lowest available price. When shoppers called a few stores back and asked for the cheapest price possible, they got a better deal. For example, a Walgreens in Clive, Iowa, first gave us a price for a month’s supply of 75-milligram generic clopidogrel (Plavix) of $190. When we called back to ask for the lowest possible price, we were told that if we signed up for the pharmacy’s discount program at $20 a year for an individual ($35 for a family), the price would be $50.

Some commercial and Medicare Part D plans have negotiated deep discounts with mail-order and retail pharmacies. Check to see whether your plan has a preferred pharmacy or allows you to order by mail. For example, people with Humana’s Walmart-­Preferred Rx Plan can fill prescriptions for select generic high-blood-pressure drugs for only a penny at more than 4,000 preferred pharmacies, including Neighborhood Market, Sam’s Club, Walmart, and Walmart Express. Other generics cost as little as $1 a month (after deductible).

Certain Medicare plans offer similar savings. People who have a Medicare Advantage plan with Part D coverage through United Healthcare can fill some prescriptions for as little as $2 at Kroger, Target, and many other pharmacies. Aetna has partnered with CVS pharmacies to offer a special Medicare Prescription Drug Plan: $2 co-pay for preferred generic prescriptions and a $5 co-pay for nonpreferred generics. Other pharmacies are available in the network, although higher costs may apply.

And if you take a generic drug regularly for a long-term condition such as diabetes or elevated cholesterol, you might get an even better deal through mail order. The Humana plan described above has co-pays as low as $0 (after deductible) on generic drugs ordered by mail. Be sure to look closely at the details of your coverage plan.

For certain conditions, such as high blood pressure, high cholesterol, and arthritis, your insurer might cover only front-line, less-expensive treatments at first to see whether they help before turning to pricey options. That’s often called step therapy. For example, doctors might start you on generic diuretics as an initial treatment for high blood pressure. Diuretics can cost as little as a few dollars for a month’s supply and are a better initial choice than expensive name-brand drugs, such as Coreg (carvedilol) and Cardizem (diltiazem), that can run more than $100 per month.

Likewise, to treat rheumatoid arthritis, the first drug of choice is often generic methotrexate. At a monthly cost of $21, it is significantly less expensive than other medications, such as Enbrel (etanercept) and Humira (adalimumab), which can cost more than $2,000 per month—but you might need one of those if methotrexate does not provide enough relief.

Step therapy can also involve first trying lifestyle changes, which not only can save you money but also might have the added benefit of improving your overall health, even to the point where you might not need to take a medication. Case in point: If you have high cholesterol or high blood pressure, making changes such as getting regular exercise, losing weight if needed, and quitting smoking can help reduce your blood pressure and cholesterol to a healthy level and lower your risk of heart problems. And the cost of adopting those changes is considerably less expensive than the pricier name-brand medications used to treat those conditions.

You should also talk to your doctor about nondrug treatments that are safer and might work just as well as medications. For example, acupuncture, exercise, massage, spinal manipulation, and relaxation training are usually better first choices for back pain than muscle relaxants and painkillers.

And once a year it’s a good idea to do a “brown-bag review” with your primary physician, where you bring in everything you take—prescription and over-­the-­counter drugs as well as any vitamins, supplements, and herbals—to make sure that it’s still appropriate. Taking fewer drugs will not only save you money but also will reduce your risk of side effects and potentially dangerous interactions.

Americans who currently use prescription drugs take an average of four regularly; those 65 and older average five drugs, according to our national telephone poll. The more medications you take, the more likely you are to get one you don’t need. People wind up taking unnecessary drugs for several reasons. A medicine could have been improperly prescribed or could duplicate another drug being taken. Or the disorder the drug was prescribed for might be resolved, or evidence no longer supports its use.

The powerful effects of lifestyle changes 

The table below shows how much you can lower your systolic (upper number) blood pressure level by making the recommended changes. People who make multiple changes can expect even greater reductions.

This article originally appeared in the September 2013 issue of Consumer Reports magazine. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Consumer Reports has no relationship with any advertisers or sponsors on this website. Copyright © 2007-2013 Consumers Union of U.S.