The Rx Games: How to Win at the Pharmacy

Written by Ronny Bachrach

It's that *fun* time of year when deductibles restart, and potential new/changes in your insurance are now a stark reality. It's bleak. Seasonal affective disorder isn't the only thing kicking everyone's butt.

You thought you did your research on keeping your existing plan or opting for a new one, crossing all the Ts and dotting all the Is. But somehow, you’re taken by surprise at resetting pharmacy deductibles, medications that have changed tiers, and new pharmacies’ prices that are different from old ones.

Woof – as if the monthly premiums weren't bad enough. It often feels like you have the no-win choice of either selecting a plan with great pharmacy benefits and super high monthly payments and/or deductibles, or reasonable deductibles and payments with somewhat lousy pharmacy coverage.

If that sounds like you, here are some questions to consider.

Are you taking a generic? Can you?

While the medications are deemed "the same thing," our bodies don't always respond to generics the same way we do brand-name ones. Are you willing to experiment with different generics? Is there another brand name that might be cheaper or fall into a lower drug tier?

Have you called around to different pharmacies?

This is a big one, and while it’s rather unpleasant to do the legwork, it’s worth it. While your insurance dictates the out-of-pocket cost for your medication, pharmacies, on occasion, can and do apply manufacturer discounts that said pharmacies might not even know they offer. As evidenced by my six-phone-call saga, pharmacy employees often aren't even aware that these discounts are happening. It's a helpful (albeit time-consuming) process to price out meds at different locations.

Does the manufacturer directly offer help?

Another thing you can do is to check the manufacturer’s website to see if they have any payment assistance programs. In one case, I was able to reduce the cost of my insulin by $400 per 45-day supply. I just had to register with the manufacturer and bring a BIN number (a six-digit number that insurers use to process electronic pharmacy claims) into the pharmacy to apply the discount. In another case, I found that a particular medication had an automatic discount applied at check-out if I was willing to go to one of the insurer's approved pharmacies.

Have you explored all available discount avenues?

I also checked to make sure that the medications weren’t being offered at Mark Cuban’s new discount pharmacy, Cost Plus Drugs. It looks like there’s a limited offering of medications but at very reasonable costs. Checking websites like GoodRx is also a good way to ensure you are paying the lowest possible price. You can also check with your insurance if they have a pharmacy partner where you can get larger supplies of your medicine at a reduced cost. Lastly, I would check with your physician’s office for additional resources and any cost savings suggestions they may have.

Navigating prescription costs is just one way Cancer Sherpa is here to help. Contact us for support today.