Tips to deal with rising medication prices

July 30--Working with Medicare, Medicaid, private insurance, various customer budgets and the ever-changing cost of medication, the pharmacy business is understandably complex.

But to a patient, the complicated process may be a primary stressor, especially when it comes to a person's financial situation.

Kim Nolte, a pharmacist at Apothecary Pharmacy, fills and verifies prescriptions while keeping in contact with doctors and working with Medicare-related processes. She says that the prices of various drugs and the co-pays associated with them can lead to some dangerous behavior on behalf of the patient, such as not taking the prescribed dosage or cutting pills in half as to prolong a prescription.

"That's what they do. They cut (pills) in half, they skip them, and some of them just walk away because they can't afford it," she says. "And they have to decide what's most important ... food, (shelter) or medicine?"

The prices of medication are set by companies and contracts and seem to be constantly shifting. Pharmacies, as well as Medicare and insurance programs, try to limit readmission into the hospital, as Medicare pays for many older residents' medicine while there. Nolte says that if people can stay on their medication, then they won't need to be in the hospital as much, preventing exposure to that type of environment.

She also says that drug prices and co-pays can change significantly, especially with generic drug companies merging and buying each other out, leading to major price hikes. And since every patient requires different medications, the system is not only complex but can lead to some financially crippling situations.

So if you're short on funds or have a fixed budget, what's the best way to pay for your medication? Nolte says the first step is simple: ask for help.

"I would ask your case manager, 'Can you give me an idea of how much this is going to cost?'" Nolte says.

She explains that talking with a doctor after being prescribed a new medication is paramount. Together with the hospital or clinic, the pharmacy can get a list of your medications and look for ways to save you money.

For example, many pharmacies nowadays are utilizing a three-month prescription plan, where some medications, especially for those dealing with chronic problems such as diabetes or thyroid issues, are provided for 90 days with just one co-pay. This leads to adherence, because if people have larger quantities of a particular medication, they're more likely to take it.

"We're finding too that we can give a 90-day supply at a good rate to the patients, and we're not filling three scripts ... and we can give them a better price. Instead of $7 times three months, we can give them a better price when it's all at once," Nolte says. "But for some people, if you have a lot of meds, you can't do that."

She also says pharmacy technicians will try to help customers by looking for better prices and calling their doctors to see what can be done for the betterment of the patient. Pharmacies also have access to local resources or groups that can offer assistance.

On the hospital side, patients can sometimes make use of a clinic's 340B plan, a contract that provides outpatient drugs at significantly reduced prices within the clinic. For example, insulin is very inexpensive on the contract as long as you have a Northwest Health Services or Mosaic care provider.

Some drug manufacturers also have coupons or patient services to provide financial help, though some coupons don't work if you're on Medicare or Medicaid.

"It's definitely about how you play the game," Nolte says of some of the more complex aspects of acquiring medication at discounted rates. "You have to follow the string to figure out where it goes."

But, of course, it's the patient's responsibility to reach out for help. If you're struggling financially, make it known, Nolte says. This is especially true of elderly patients who are on multiple medications, as the process can be overwhelming in more ways than one.

"A lot of older people are very proud, and they're not going to tell someone that they can't afford it," she says. "They don't want you to know they're having trouble with it, and until you figure it out, you can't help them."

Daniel Cobb can be reached at [email protected]. Follow him on Twitter: @NPNowCobb.

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