If you’re taking prescription drugs regularly, these strategies can help you save money
Prescription medications can be life changing and expensive. Americans spend nearly $1,400 a year on prescriptions and over-the-counter (OTC) drugs.* That’s too much for many of us. A recent poll found that 18 million Americans were unable to pay for at least one prescription in the last three months.* That challenge was almost twice as common among households making less than $24,000 a year.
Now for the good news. There are plenty of ways you can be smart and savvy about your drug costs, says Paula J. Eichenbrenner. She’s the executive director of the AMCP Foundation, which helps patients get medications at affordable prices. “Health care is complex. Especially when you’re overwhelmed with bills or helping a family member figure out a new diagnosis,” Eichenbrenner says. Here are tips that can help make your prescription costs a little easier to swallow.
Aetna® care teams can help you find a doctor, schedule appointments, manage a condition, access the right benefits and more. It’s a personal benefit designed for Aetna Dual Eligible Special Needs Plan members.
“When you buy pills at a pharmacy, you’re paying for two things: the pill and the pharmacy to fill the pill, which is a base charge,” says David Belk, MD. He’s a consumer advocate at True Cost of Health Care. “This is why there’s an advantage to buying in bulk, so you don’t pay that base charge as often.”
Many health plans offer three-month refills of prescription drugs. For instance, Aetna® Special Needs Plan or SNP members can get some covered prescription drugs in up to 3 month supplies.
Brand-name drugs are considerably more expensive than their generic versions. Even if there’s only one generic available, it can cost as much as 30 percent less than the brand-name version.* You might be surprised at how affordable some generics are.
“Generic drugs often cost 90 to 95 percent less than the brand-name versions,” Dr. Belk says. Many cost only about as much as a bottle of aspirin. And don’t worry, Dr. Belk says, they work just as well. Generics must meet the U.S. Food and Drug Administration standards. These include that the generic versions of medications work in the same way and deliver the same benefits as the brand-name ones.*
Health plans contract with a network of pharmacies to provide prescription drugs to plan members. Choosing an in-network pharmacy will help make sure that your medication is covered. Aetna members can search their secure member website (or call their care team) to find an in-network pharmacy.
Not all pharmacies (even in-network ones) charge the same amount for prescription drugs. “Just like anything else you purchase, you can compare prices at different places,” says Eichenbrenner. So before you fill a prescription that’s not covered by your plan, or if you have a deductible and haven’t met it, you can call your pharmacy and others in the area to ask what they charge for a medication.
Ask your pharmacist for advice on how to save money. Often, they’ll know about rebates or coupons that can lower those drug prices. Or they may be able to suggest a generic medication as a substitute for more expensive brand-name drugs.
It’s a good idea to have a doctor, nurse or pharmacist go through all the medications you take. That’s to make sure they’re working well together. (Health plans with Medicare drug coverage like Aetna SNPs offer Medication Therapy Management for members who meet certain requirements at no added cost.)
Sometimes a provider or pharmacist may be able to point out cheaper generic options. They might even find that two drugs are canceling each other out. Or they may see that you’ve doubled up on a treatment. Getting rid of overlaps can streamline your medication regimen and save you money.
“It’s a good idea to bring a list of your medications, or better yet all of your medication bottles in a bag, to each doctor’s appointment,” Dr. Belk suggests. Bring both prescription and OTC drugs, as well as any supplements you’re taking.
Before you fill a new prescription, make sure it’s included in your plan’s drug formulary. That’s the list of medications covered by your health insurance. If it isn’t on the list, you may be able to switch medications — or switch plans.
“Not all drugs are covered by Medicare plans. And beneficiaries should contact the plan to confirm drug coverage,” says Ann Kayrish. She’s the senior program manager for Medicare at the National Council on Aging. “D-SNP enrollees have the option to change plans several times during the year if they determine a plan is not covering their drug costs or meeting their health care needs.”
When you first start a new medication, it might make sense to get only a small number of pills. This is in case you and your doctor decide it’s not right for you. That way you’re not paying for a full month (or more) of a drug you don’t end up using.
Enrollees in SNP plans are eligible for the federal Low Income Subsidy (LIS) program, also known as Extra Help. This program ensures that in 2024 you will pay no more than $4.50 as a copay for generic drugs. And you will pay no more than $11.20 as a copay for brand-name drugs.
Try to find out the LIS/Extra Help copay amount for each prescription drug you take. Then compare it with your insurance plan’s copay amounts. Enrollees in the LIS program always pay the lower cost of the two.
Another option: Contact the Patient Access Network (PAN) Foundation.* It’s dedicated to helping people get the medications and treatments they need by assisting with out-of-pocket costs. Eligibility is based on your prescriptions or health condition.
If you’re not eligible, the PAN Foundation will suggest other resources.
If you qualify for both Medicare and Medicaid, you may be eligible for an Aetna® Dual Eligible Special Needs Plan (D-SNP).
If you're 65 or older and have an eligible chronic condition, you may qualify for an Aetna® Chronic Condition Special Needs Plan (C-SNP). CSNPs are currently available in select counties within IL and PA.
You may be eligible for an Institutional Special Needs Plan if you’ve lived (or plan to live) in a participating facility for 90+ days and you have Medicare Part A (hospital insurance) and Part B (medical insurance).
*FOR SPEND PER YEAR SOURCE: Organisation for Economic Co-operation and Development. Pharmaceutical spending. 2021. Accessed July 5, 2023.
* FOR 18 MILLION SOURCE: Gallup. In U.S., an estimated 18 million can’t pay for needed drugs. September 21, 2021. Accessed July 5, 2023. back
*FOR 30 PERCENT LESS SOURCE: U.S. Food & Drug Administration. Generic drug facts. November 1, 2021. Accessed July 5, 2023. back
*FOR PAN FOUNDATION SOURCE: PAN Foundation. About us. Accessed July 5, 2023.
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