Prepared Patient: When Rx Cost-Cutting Threatens Your Health

As the economy sours and health care costs soar, cost-cutting measures are creeping into the medicine cabinet. We split pills in half or take the drugs every other day to stretch our doses. We stop filling the prescriptions for our most expensive drugs. We seek out herbal remedies and over-the-counter medicines as prescription substitutes. We buy prescriptions from online pharmacies with questionable credentials.

As patients pay more for their prescription drugs—whether it’s through higher insurance co-pays or shouldering the full costs—many people decide to opt out of taking the drugs altogether.

But there are safer ways to cut costs than skimping on—or skipping—the medicines you need. Getting your pharmacist involved, asking for generics, seeking out patient assistant programs and working with your physician to eliminate drugs you don’t need can keep money in your pocket without harming your health.

Dropping a prescription can be a risky move: More emergency room visits, severe and uncontrolled asthma attacks, and an upswing in heart attacks and strokes are just some of the poor health outcomes that have been associated with skipping a prescription due to its cost.

Patients who take medicines for chronic conditions are often the ones to drop the drugs when they become too expensive. For a disease like high blood pressure where the symptoms are not obvious, skipping the drug may seem like no big deal, according to Rebecca Snead, executive vice president of the National Alliance of State Pharmacy Associations.

People “often say, ‘I don’t feel any different than I felt yesterday,’” Snead says.

But, “We don’t want someone who can’t afford a medicine to become someone who can’t afford bypass surgery,” warns John Michael O’Brien, a prescriptions cost expert at College of Notre Dame of Maryland.

That’s exactly what happened with to Karen Merrill, who has heart disease. She felt worse when she stopped taking her prescriptions for a while after her heart attack, “and I ended up back in surgery for a bypass,” she said.

When patients decide to stop taking a prescription or otherwise alter their doses without informing their doctors, they may put themselves at risk for overdose or harmful medicine interactions.

“A doctor may think a patient is taking a drug when he really isn’t, and may prescribe another drug when it appears that the first drug isn’t working,” says Michelle Fritsch, a pharmacist and chair of the clinical and administrative sciences department at the College of Notre Dame.

Savings Plan

But maybe your insurance doesn’t quite stretch to cover a brand-name antidepressant, or maybe you are stuck in Medicare’s Part D “doughnut hole,” waiting for your annual cap on prescription coverage to roll over. Maybe you have no insurance and no cash to spend at the pharmacy. How should you handle the costs?

The first step, says O’Brien, should be a talk with your pharmacist—not necessarily with your doctor. Some surveys suggest that physicians can be uncomfortable talking about a patient’s finances, and those who do bring up prescription costs may not know much about co-pays or overall drug costs.

“It is hard for prescribers to keep track of existing meds and health plans and what they cover and don’t cover,” says Snead, “but people are acutely aware of drug prices because they often pay the out-of-pocket costs.”

“Every time you fill a prescription, talk to your pharmacist about lowering your drug costs,” O’Brien advises. “Your pharmacist can explain your options and help your doctor choose a medicine that meets your needs.

On the other hand, “I don’t know about you, but I know I would have a hard time standing in line with my pharmacist and saying, ‘I can’t afford this,’” says Merrill, who now works with the American Heart Association as a survivor-advocate.

In many cases, insurance companies reach out to pharmacies directly to notify them about less costly options in a class of cholesterol drugs, for instance, or a new generic version of a drug. “And if a generic is available for a drug you’ve been prescribed, you should take it,” O’Brien says.

People who think generic drugs “are like generic toilet paper” can rest assured that the Food and Drug Administration certifies generic medications as having the same dose, strength, safety and efficacy as their brand-name counterparts, Fritsch says.

Free prescription drugs are available for people who can’t afford their medicines through patient assistance programs or PAPs.

Janet Walton, deputy program director at RxAssist, says it’s not always the uninsured or the poor who are seeking help: “People who are underinsured are calling—there are not a lot of options of things they can do to lower their prescription costs.”

The biggest stumbling block for those applying to a PAP “are the forms,” Walton admits.

Merrill sets aside money in a special health savings account to pay for her prescriptions throughout the year, “but come November, December, I’m in my doctor’s office begging for free samples,” she says.

“Samples aren’t a replacement for continuity of care,” says O’Brien, who notes that irregular use of samples can make it difficult for pharmacists to catch drug interactions. Doctor office samples also tend to be expensive brand-name drugs, not generics, “so if you start on a brand-name drug, you’ll soon get a prescription for a brand-name drug.”

Snead and others advise against buying cheaper prescription drugs from Canada, Mexico, and other foreign markets. “The incidence of counterfeit drugs is rising exponentially,” Snead warns. Your online pharmacy may be stamped with a maple leaf flag, “but how do you know that the Web site is really in Canada?” she asked.

Speak Up—and Cut Back

“One of the questions that I’ve trained my 77-year old mom to ask is, ‘if I get a new medication, which one of these other medications can I stop taking?’” Snead says.

O’Brien and Snead both recommend a yearly review of all medicines, in consultation with your doctor and pharmacist, to look for drugs that don’t appear to be working the way they should, drugs that overlap in their actions and drugs that may conflict with other medications.

By Becky Ham, Science Writer, Health Behavior News Service