Let’s talk about prescription drugs. You know, the ones that treat debilitating diseases and harmful conditions — but often are unaffordable. Unfortunately, the prognosis for medications in 2017 is even worse. Prescription prices for Americans younger than 65 are projected to jump almost 12% in 2017. And older Americans won’t fare much better. Their drug costs are projected to rise almost 10%. But wages are only expected to rise 2.5% in 2017.
The more we dig into the details of prescription drug prices, the more outlandish it becomes. Let’s take a closer look at 11 ways you’re being ripped off at the pharmacy — and three ways you can take action.
1. You’re still overpaying for name-brand medications
Consumer Reports found 4 in 10 people said their doctors sometimes or never recommend generics over brand-name drugs. You’re falling for a name and paying the price. But with generic prescriptions on the rise, you should look to see whether your name-brand prescription has a generic counterpart that is just as wonderful and effective.
Next: Pharmacies can charge higher prices since you and your insurance company pick up the tab.
2. You’re forgetting about competition
Drug prices are not regulated. As patents expire, prices drop as competitors enter the scene. Medications that used to cost pharmacies $400 for 100 pills now could cost $10. Selling them to you is a different story. We’ve gotten so used to buying medication with insurance that pharmacies just continue to charge the same copay while making a substantial profit on cheaper products.
Next: You might want to make a visit to Walmart after all.
3. You’re ignoring Walmart
Walmart is doing what others won’t. It undercuts competition, simply by using less markup. Medication prices are the same for all pharmacies who buy them. It’s just that few are willing to do what Walmart does and slash prices for consumers. For example, the lowest retail price advertised on GoodRx for 30 500 mg capsules of Amoxicillin is $4, listed at Walmart.
For those of you who typically avoid Walmart, Costco is another outlet known for seriously cheap drugs.
4. Your doctors are uneducated
As consumers, we assume our doctors are all-knowing, often taking their recommendations to the bank without question. But some prescription drugs have serious implications, and our health is at the mercy of others. In 2012, the Food and Drug Administration mandated that manufacturers offer educational courses regarding long-acting opioid drugs (such as methadone and oxycodone) to help doctors better prescribe them. However, the three-hour online training course was not mandatory. And, according to Bloomberg, only 38,000 out of the 320,000 active opioid prescribers signed up to take the class.
5. You’re accepting unnecessary medication
Regardless of a doctor’s education, we continue with blind agreement, heading to the pharmacy after receiving a prescription. But what we don’t know is doctors are prescribing medications more freely than ever. A study found at least 30% of antibiotic prescriptions written in outpatient settings are unnecessary. And for acute respiratory conditions, almost half of antibiotic prescriptions are excessive, according to the study.
We’ve all walked into the doctor’s office convinced we’re on our death bed with a disease only pills can cure. This is frustrating for a doctor whose rest-and-recuperation explanations fall on deaf ears. Sometimes it’s easier — and quicker — to prescribe medication to patients than to explain why they don’t need it.
6. You’re throwing away money on meaningless drugs
Your overmedicated self might be paying to address an illness that’s better cured naturally. Certain bacterial infections do require antibiotics, but some things go away on their own. Chat with your doctor about what’s really needed before accepting that prescription slip. Commonly prescribed drugs, such as those claiming to cure low testosterone, actually do more harm than good. Television commercials might convince men of its miracle abilities, but it also increases your risk for heart attacks and strokes.
7. You’re choosing unregulated herbal remedies
With an increased interest on natural and herbal remedies, many pharmacies are making these products available right on the counter, hoping for an impulse buy. This is worrisome for two reasons. First, the FDA does not regulate these herbs as food or drugs. Manufacturers, instead, must sell these as dietary supplements and the FDA is only responsible for monitoring safety once the remedy hits the counter.
Second, many pharmacists are uninformed about the drug details and various risks associated when combining them with your regular prescription. Some herbal remedies respond badly to ingredients found in your drugs. So though pharmacists can advise on use of herbal remedies, they’re probably not considering any potentially harmful side effects either.
8. You’re being dooped by ‘clawbacks’
Benefits managers, those who negotiate manufacturer drug prices for pharmacies, might seem like a valuable resource at first. They can pin companies against each other to score the lowest prices. But an article by Bloomberg shows they’re actually reaping substantial monetary benefits at your expense using a term known as “clawbacks.”
For example, you pay a nice and low $10 copay previously agreed upon by the benefits manager and insurance company. The pharmacy will get reimbursed for the price of the drug, say $2, and make a small profit of maybe $4. Then, the benefits manager “claws back” the remaining $4 with the patient never knowing there was a cheaper price. Consider that $4 take a cost of doing business with the manager.
People have caught on, filing lawsuits against companies, including Humana and United Health Group. But it gets worse.
9. Your pharmacists are sworn to secrecy
Yes, many pharmacists are aware of the “clawback” method, but they are unable to alert customers to the drug’s true price. Even in cases where paying out of pocket would be less than your designated copay, pharmacists are bound by contracts made to the pharmacy benefits manager to stay silent. In turn, consumers continue to buy prescription drug coverage for assistance when the reality is it doesn’t always hold up.
Frustrating, right? Take comfort in knowing this is not going unnoticed. In addition to the lawsuits filed against the aforementioned drug companies, states are stepping in. A 2016 Louisiana Senate bill would allow pharmacists to educate customers on how to get the cheapest price for drugs. In 2015, an Arkansas law prohibited managers and pharmacies from overcharging customers more than the pharmacy would be paid — something that immediately prompted another lawsuit.
10. Your common medications are most expensive
More than likely, you know someone who has a prescription for asthma, high blood pressure, or irregular heart rhythm. These types of medications top the list of drugs that have seen price increases in the past several years. But that’s a concern only consumers share. Manufacturers know most won’t walk out of the store without their drugs, so they continue to raise prices. In fact, 81% of people will pay the bill, regardless of their sticker shock.
11. You’re paying out of pocket
Again, because drugs prices aren’t regulated, pharmacies can choose their rates. Businesses have bottom lines that need to be met. So if one pharmacy sees a lot of patients with high coverage, it will need to focus on customers who typically pay more for drugs to foot the remaining bills — such as those on Medicare and the working poor. In these instances, people who need to pay out of pocket for their drugs will pay more than normal. Some Americans have no other options, and that’s understandable. But before you pay out of pocket because you think it’s a lower alternative, ask for confirmation.
Next up are ways to help you save on prescription drugs …
So that was the bad news. Now that you’re aware of 11 potential ways you’re being ripped off at the pharmacy, it’s time to put that knowledge to good use and do something about it. Here are three ways you can save on prescription drug prices.
Secret shoppers for Consumer Reports found independent pharmacies often offer extremely low drug prices, cheaper than larger chain retailers. What’s advertised in one location is not always true across town. When prices are too high at one store, check out area retailers, and ask for a better price. In addition, metropolitan pharmacies are often costlier than those located in rural or suburban areas. So a quick drive beyond the city limits might be worthwhile.
As with most things these days, shopping online can give you back more of that precious time and money. Use websites, such as GoodRx, to compare prices before heading to the pharmacy. Or just order prescribed medications online. But be careful of scams and rogue sites that aren’t listed as reputable sellers. Look for a logo with the initials VIPPS — Verified Internet Pharmacy Practice Sites — to ensure credibility.
Ask more questions
The more you know the less you’ll pay. Considering what we now know about overprescribing doctors and generic alternatives, don’t be afraid to question your doctor about medication choices. Ask up front about the price, insurance coverage, and whether the medications are absolutely necessary.
Urge your doctor to treat you like a person and truly consider what he or she is prescribing. Asking questions and being proactive will help ensure a doctor is doing research on what medicine is best for you and your situation, instead of writing yet another prescription that works for the masses. You want to be healthy, and you want to have money — and it’s not too much to ask for both. You don’t have to choose.
Follow Lauren on Twitter @la_hamer.