About 70 percent of American adults use at least one prescription drug, compared to just 55 percent five years ago. According to the research organization Civic Science. And nearly a quarter of adults take four or more prescription drugs, Civic Science says.
Americans spent approximately $380 billion on prescription drugs in 2021. Latest year for which statistics are available, According to the Bureau of Statistics, or about $1,432 per person, which is – by far – the highest amount in the developed world. This amount increased by almost 8% from the previous year.
Although governments in most countries impose strict controls on drug prices, in the United States market competition primarily determines prices. Last year, President Biden signed the Inflation Control Act, allowing Medicare, the nation's largest purchaser of prescription drugs, to negotiate prices directly with drug companies for certain high-priced drugs. With its great bargaining power, Medicare is expected to demand and deliver lower prices, which are scheduled to take effect in 2026.
In another attempt to lower the cost of prescription drugs, the Food and Drug Administration recently acted on a Biden administration executive order allowing Florida to import cheaper drugs from Canada for its Medicaid program. He said eight other states have laws allowing imports, but Massachusetts is not among them.
Currently, prescription drugs can be purchased at brick-and-mortar pharmacies, online pharmacies, mail order, or using “coupon cards” obtained online and presented at traditional pharmacies.
Here's what you need to know when buying prescription drugs.
What are the basics?
There are two types of medicines: original medicines and generic medicines. Pharmaceutical companies developing new drugs introduce them with capitalized brand names, such as the diabetes drug Ozempic, but some caregivers also prescribe them for weight loss. Pharmaceutical companies typically hold patents on drugs they develop for up to 20 years. The patent prevents competitors from selling the same ingredient under different names, allowing developers to recoup their investment.
What are generic drugs?
Once a patent expires, drug companies are free to sell generic versions of the drug that have exactly the same active ingredients as the original drug. For example, atorvastatin, which is used to treat high cholesterol to lower the risk of stroke and heart attack, is a common equivalent of the brand name Lipitor.
For consumers, generic drugs come at a significant discount, approximately 85% cheaper than the original branded drug. According to the Federal Drug Administration. If you are taking a brand-name drug, ask your prescriber if there is a generic drug available that could save you money.
Will insurance companies require members to use generic drugs?
Insurers typically offer significant incentives for generic drugs by structuring copay “tiers.” For example, my plan requires a copay of $10 for his 30 days of generic drugs, but as much as $65 for brand name drugs. In this way, insurance companies discourage the use of branded drugs when generic drugs become available.
Do all insurance companies cover all prescription drugs?
The majority of employer-based plans include a prescription drug component. (Medicare drug coverage(known as Part D) is optional and has an additional monthly cost. ) But insurance companies don't cover all drugs.
How do I find out which drugs my insurance company covers?
An insurance company's list of covered drugs is called an “official” or “preferred drug list,” and it details which drugs are covered in which tier (tier 1 drugs have the lowest co-pays). is). Some insurance companies require prior approval for some medications, and others require you to try a cheaper drug first before approving a more expensive one. My plan has three tiers: generic drug, preferred brand name, and non-preferred brand name. For a 30-day supply, my out-of-pocket costs are $10 for generic drugs (tier 1), $30 for preferred band names (tier 2), and $65 for non-preferred brand names (tier 3).
Is it cheaper to use a mail order pharmacy?
Yes, because your out-of-pocket costs can usually be lower. My plan allows me to order a 30-day, 60-day, or 90-day supply of generic prescription drugs for pickup at the pharmacy for $10 per 30-day supply. Therefore, my out-of-pocket cost for a supply of 90 pieces is $30. If you choose mail order, you will only receive a 90-day supply. Also, my mail-order co-pay is $25, which is a $5 savings compared to picking up generic drugs. The same applies to branded drugs. A 90-day supply of a tertiary drug costs $195, but the same supply via mail order costs $165, a savings of $30.
Are there any other considerations regarding mail order pharmaceuticals?
Some people prefer the convenience of home delivery of their prescription drugs. However, some people find it safer to have face-to-face contact with a caregiver at a traditional pharmacy, rather than relying on mail-in services for prescription medications that can be critical to their health.
Is there any reason why insurance can't be used for prescription drugs?
Yes, especially for those on high-deductible plans that are becoming increasingly popular among young people. High deductible health insuranceKnown as HDHP, there is a deductible of at least $1,500 for individuals and $3,000 for families. Higher deductibles mean lower premiums and can make sense for people who are in good health and have few medical needs.
How does it work without insurance?
Shop at online pharmacies like: cost plus pharmaceuticals, the company says it sells generic drugs strictly at the manufacturer's price plus 15 percent (plus pharmacy labor and shipping costs). Cost Plus Drugs does not accept insurance or sell brand name prescriptions. Enter the generic drug you want on the website, select the strength in milligrams and counts, and click to see the price. Last year, I paid $151.03, including a $100 deductible, for a generic prescription that I take every day. I pick up a prescription for him at a local pharmacy every two months (contains a 60-day supply). Cost Plus Drugs is offering the same thing for $92.40, which includes $5 shipping on every 60-day order.
another Amazon is the largest online pharmacywith insurance and free home delivery of prescriptions to Amazon Prime members.
What is a “coupon card”?
I I tried GoodRx. Once you fill in your 60-day prescription, a list of six nearby pharmacies will pop up, and if you click on CVS at the top of the list, you'll receive a coded “coupon” that will reduce the price of your prescription to $189.78. received. 1 year supply (compared to $151.03 with my insurance and $92.40 at Cost Plus Drugs).
I wish the prescription drug market was easier to navigate. My advice is to take the time to research online and try out different options.
Have a problem? Send consumer issues to [email protected] him @spmurphy Boston.
