Dr. Tom Ferguson authored numerous works on medical self-care.
PHOTO: RICHARD ALLEN
The amount of money that people could—but don't—save on drugs boggles the mind! Many folks conscientiously comparison-shop for such items as cars, washing machines, and groceries, and, as a result, save maybe 10% or 20% at most on these goods. But it's not uncommon to find people paying 500% or even 1,000% more than necessary for prescription drugs! By applying just a little basic knowledge and consumer awareness, anyone can save money on prescriptions. In fact, individuals who take one or more medications every day—for such chronic conditions as high blood pressure or arthritis—could conceivably save hundreds of dollars a year.
Prescriptions and Your Rights
The first step toward controlling pharmaceutical expenses is to realize that drug purchase decisions can and should be made with the bottom line in mind. The typical patient unquestioningly agrees to the first medication the doctor suggests, obediently gets the prescription filled at the nearest pharmacy, and then uncomplainingly swallows the prescribed drug…and the accompanying bill.
Seldom do clients ask their doctors in advance what the cost of their prescriptions will be. And—no matter how high the tab at the pharmacy—few people ever say, "Hold on! That's too much!" or ask for a less expensive substitute. Yet both measures are perfectly within your rights as a consumer.
Doctors and Drug Costs
Many doctors have never once considered price when deciding on an appropriate drug to administer, since they've had little or no training in writing cost-effective prescriptions. If anything, they're biased toward the high-priced brand-name drugs—and no wonder: Pharmaceutical companies spend over a billion dollars each year advertising their expensive products to physicians!
From the moment they receive their first black bags (free gifts from drug companies), doctors are subject to unrelenting promotion. They get deluged with attractive full color advertisements for brand-name drugs every time they open a professional journal. At medical meetings—many of which are sponsored by drug companies—physicians are surrounded by displays and salespeople, and they're frequently visited in their offices by drug company representatives (called "detail men") whose job is to get the doctors to purchase their firms' products.
Of course, the expense of all this promotion inevitably finds its way to the consumer, in the price you pay for prescription medications. And since little is being done within the medical profession to make physicians more cost conscious, it's largely up to you to remind your doctor of the importance of saving money. Let's examine exactly how you can take a more active role in determining the price of your health care.
Ask your physician about non-drug treatments. Suppose, for example, that you've just been diagnosed as having slightly elevated blood pressure. You and your doctor might decide that, before trying some medication, you should see if you can bring your pressure down with a combination of salt restriction, exercise, relaxation training, weight loss, and not smoking. After a two- or three-month trial of these measures, you can then consider together whether or not you need to add a corrective drug to your anti-hypertensive regimen. Or, if your chief complaint is anxiety and insomnia, you and your doctor might decide that the best first step would be for you to stop drinking coffee and to take a warm bath before bed each night. If that doesn't work, then it may be time to consider an appropriate sleeping pill.
Even if you have a problem for which no acceptable non-drug treatment is available and your doctor suggests a prescription remedy, there are still several possible money-saving measures to explore. For instance, ask your doctor, "Is there a less expensive (but equally effective) generic form of this medication?" If, for example, you have a mild case of hypertension, you and your physician might agree that drug treatment is necessary. He or she could write you a prescription for a brand-name drug which in this case might be Hydrodiuril, the trade name for hydrochlorothiazide manufactured by Eli Lilly and Company. On the other hand, the prescription could specify the generic form of the drug, hydrochlorothiazide. (All drugs have a generic name, and may or may not have a brand name as well.) Generic drugs are, of course, chemically identical to the brand-name products, but pharmaceutical houses have raised the point that—because of different filling agents and packaging processes—two different forms of the same substance may not have the same clinical effect. For this reason, some doctors have hesitated to prescribe generic drugs.
Now, however, the Food and Drug Administration (FDA) has published a listing of generic drugs, by manufacturer, with ratings telling whether or not the company has submitted studies showing that its product meets the FDA's standards for activity within the body. Your doctor, then, can write a prescription for the generic form of the drug, specifying a manufacturer whose product has been FDA-approved, so that both of you can be sure of the drug's effectiveness, while you save money, too.
Some medications, though, aren't available in generic form. When a new drug is developed, the producer is granted a patent on the manufacture of that substance, and then has an exclusive license to make and sell the drug for a period of 17 years. If you need to take one of these brand-name only products, your best bet for saving money is to comparison-shop by phone. Chances are that the price of a given prescription varies widely in your area.
Another money-saving solution, especially for those who know they'll be taking the same medication for a period of months or years, is to buy from a discount pharmacy.
Here's another key question you can ask your doctor if you have a condition for which drug treatment seems necessary: Is there a less expensive alternative drug that I could take instead?
Frequently, doctors choose one medication in favor of another simply because they think it'll be more convenient for you to take. For example, the brand-name drug Tagamet is frequently prescribed for ulcers. It is effective and convenient (you take one pill two to four times a day), but it's also expensive. Liquid antacids, on the other hand, are a bit more bothersome—you need to take them up to seven times daily, and some people don't like their taste—but they can be very effective in the treatment of ulcers, and many are quite inexpensive.
Doctors sometimes also shy away from certain perfectly good drugs because they may produce minor, mildly annoying side effects in some patients. But if you don't happen to get (or mind) a particular side effect from a given drug, it may prove to be an excellent and less expensive treatment for your problem.
The Bottom Line
It's most critical for people on fixed incomes or limited budgets to save money on prescriptions, and that includes more and more of us these days. It may well be worth putting up with a non-hazardous side effect or a less convenient medication if you can save $40 to $80 per month. In fact, if you regularly take several prescription drugs and consequently have high medical bills, savings on prescription costs can make a vital difference in your ability to buy food or pay the rent…factors that may ultimately be more important determinants of both emotional and physical health than any drug!
Pharmacologist Joe Graedon, who co-wrote this issue's column with Dr. Ferguson, is a contributing editor for Medical Self-Care magazine and the author of two excellent consumer guides to prescription and nonprescription drugs: The People's Pharmacy and The People's Pharmacy 2. Both are published by Avon Books and can be found at most libraries and bookstores.
Dr. Tom Ferguson was the founder and editor of a quarterly journal titled Medical Self-Care, which ran from 1975 to 1989, as well as Medical Self-Care: Access to Health Tools (Summit Books, 1980).