Saving money on medicines is important to just about everyone, even those who have prescription drug coverage. A study showed that when people who had a heart attack did not have to pay out-of-pocket for their medicines, they were more likely to get their prescriptions filled and take the medicines correctly, and they were less likely to have repeat serious heart problems . To avoid spending a lot of money on medicines, people sometimes try skipping doses or not refilling their prescriptions when they run out. In the long run, stopping medicines or skipping doses can cause serious health problems. People who cut back on medicines often end up being prescribed even more medicines because their doctors think that the medicines they prescribed were not enough (such as with blood pressure or cholesterol medicines) [2-5].
This article describes ways to make medicines more affordable. It is meant for people who live in the United States (US), but might also be useful to people in other countries.
What if I do not have health insurance? — If you live in the US and do not have health insurance, look into getting insured. The laws about health insurance in the US are changing, and it should be easier and more affordable to get insurance than before. What is more, in many states, more people are now eligible for lower cost insurance or Medicaid. Most insurance options include prescription coverage. For information about new options in health coverage, visit the healthcare.gov web site.
What if I have Medicare? — Medicare offers low cost prescription coverage called Part D. The ways of lowering drug costs in this article are useful even if you have or can get Part D coverage. (See 'What if I am eligible for Medicare Part D prescription coverage?' below.)
ASK FOR GENERICS
Generic medicines are copies of brand-name medicines that are generally less expensive. They contain the same active ingredient as the brand-name medicine and they are subject to the same government rules about strength, quality, and purity.
Using generic medicines will lower your cost in most cases whether you have prescription insurance or not. However, not all medicines are available in a generic form. Usually a medicine is first marketed as a brand-name only, but over time generics become available once the patent has expired.
How much can I save by buying generics? — On average, a 30-day supply of a "brand-name" prescription medicine costs about $150 a month without insurance coverage. An average prescription that is filled with a generic drug costs about $25 to $50 a month without insurance. The table (table 1) shows how some generic drug prices compare with the price of the brand-name version.
The prices on generic drugs vary a lot from one drug store to another now. To get good prices like those in the table (table 1) you may need to check with a few different drug stores. Many generic drugs cost as little as $4 per month from some drug stores. (See 'Always compare prices' below.)
How can I switch to generic medicines? — There are a few different ways you can use generic medicines:
●Brand name you take comes in generic form — If the brand-name medicine you take is also sold as a generic, you can usually take the generic version instead. Whenever your doctor prescribes a new medicine or refills a prescription, ask for the generic version. Talk to your doctor if you have any concerns about using the generic. In many cases, pharmacies will automatically give you the generic version of a brand-name medicine, if it is available.
●There is another medicine to treat your condition that is available in generic form — If the exact medicine your doctor prescribed does not come in a generic form, it is often possible to take another medicine that can treat your condition just as well that is sold as a generic.
For example, medicines commonly prescribed to treat osteoporosis called Actonel and Atelvia, are sold only by their brand names and are costly. If your doctor prescribes one of these, ask if you can take generic Fosamax (called alendronate) or generic Boniva (called ibandronate) instead. Generic alendronate and ibandronate sell for as little as $4 to $25 per month at "big" retail stores if you have no prescription coverage, and at a lower co-pay if you do have prescription coverage (table 1).
●The brand-name medicine you take comes in a different formulation that is available as a generic — Some medicines are sold as brand-only because they come with a newer formulation that is still under patent. For example, if you take a sleep medicine, such as Ambien CR, Edluar, or Intermezzo, ask your doctor if you can switch to generic Ambien (called zolpidem) which sells for as little as $10 per month at big retail stores for patients who do not have prescription coverage, and at a lower co-pay for those with prescription coverage.
●The brand-name medicine you take contains two or more medicines that are each available as a generic — Sometimes medicines are sold as brand-only because they are the only product that combines two or more ingredients into one pill. It may be possible to take the individual ingredients in separate pills as low-cost generics.
Any time your doctor replaces one medicine for another, make sure you learn what the new medicine looks like and which medicine it is replacing. People sometimes accidentally take the same medicine twice because the brand name and generic pills look different, and they think that they are taking two different medicines.
Why do generic medicines cost less than brand-name drugs? — When drug companies develop a new medicine, they spend a lot of money studying and testing it and this research takes time and is expensive. They also spend a lot of money on advertising. In exchange for that initial investment, United States (US) law allows drug companies to have a "patent" on their new medicines. Patents give drug companies the right to be the only ones to sell a medicine for the first several years it is available. Later, when the patent runs out, other companies can come out with generic copies of the medicine.
Makers of generic medicines can charge less because they do not have to pay for developing or advertising the medicines. Still, a generic medicine can only be made and sold in the US after the Food and Drug Administration (FDA) has carefully tested and approved the generic version. Once the FDA tests and approves a generic medicine, several companies can start making generic copies. At that point, the cost goes down even further, thanks to competition.
Are generic drugs as safe? — YES. FDA-approved generic medicines meet all of the same requirements for quality, strength, purity, and shelf life as brand-name medicines. Generic manufacturing plants in the US are subject to the same inspections and the same rigid testing as brand manufacturers.
You can find more information about the safety of generic drugs in the resources section of this topic. (See 'FDA information for consumers' below.)
Do generic drugs work as well as brand-name drugs? — YES. Each FDA-approved generic-equivalent drug has been carefully tested and shown to be equivalent to the brand-name version [6-8].
Sometimes switching from a brand to a generic or switching between different generic copies could cause problems for a small number of people with certain conditions. That could include people who have difficult-to-treat seizures or thyroid problems, or who take medicines to stop organ rejection after a transplant.
Always talk to your healthcare provider before changing your medicine, especially if you are treated for one of these conditions.
How do I find out if I can switch to a generic? — First, ask your doctor or pharmacist if any of the medicines you take are available as generics. Not all medicines come as generics. (You can also check if a brand-name medicine is sold as a generic at this government web site: www.accessdata.fda.gov/scripts/cder/ob/docs/querytn.cfm).
The table lists many commonly used medicines that are available as generic copies that cost much less than the brand versions (table 1).
Even if the medicine you take does not come in a generic form, there might be another medicine that can properly treat your condition that does come in a generic form.
If you are interested in switching to a generic, it is important to work with your doctor and make changes only with your doctor's approval. Generics can be a great cost-saving option, but any time you switch medicines, you have to do it carefully.
Will I save with generic medicines even if I have insurance? — YES. You can save by using generic medicines even if you have prescription drug coverage or a Medicare Part D prescription plan.
Nearly all insurance plans have lower co-pays for generic medicines than they do for brand-name medicines. The co-pay is the amount YOU pay out of pocket each time you fill a prescription when you have prescription drug coverage. Plus, many insurance companies require less paperwork to cover generic medicines.
But lower co-pays are not the only reason to switch to generics when you have insurance. Many insurances and Medicare Part D plans limit how much money they will spend on your medicines every year. If you go over that limit, you have to start paying for your medicines on your own. But, if your medicines cost less, you may never reach that limit all year, or at least reach it more slowly. If you reach the coverage limit and have to pay on your own, it will cost you less with generics than with brands. (See 'What if I am eligible for Medicare Part D prescription coverage?' below.)
Some insurance companies also require you to spend a certain amount of your own money on medicines first, before they will start paying for them. The amount you pay first is called a deductible or coverage gap. You can make the most of that deductible by using low-cost generic medicines.
ALWAYS COMPARE PRICES
These days there can be big differences in the price charged for the exact same drug depending on what drug store you are using and whether you ask for their savings program. Shopping around for a good price on your prescriptions can save you a lot of money especially for generics .
Find out which pharmacies or stores have the best price, and ask if there are discounts for buying a two- or three-month supply at one time. If you know you will be taking a medicine for a while, buying a two- or three-month supply can mean added savings.
"Big" retail stores and the pharmacy department at chain stores often have excellent prices on hundreds of generic medicines. Their prices can be as low as $4 for one month and $10 for three months.
These low prices can be less than your prescription co-pay if you have drug coverage.
You can check to see if the medicines you take are available at these low prices by asking for a brochure at the pharmacy in the store or by going online. You can find lists of discounted generic medicines for each store by entering the store's name and the words "prescription program" into Google or another search engine.
If the medicine you take is not on the list of low-cost generics at the "big" stores, print the list and bring it to your doctor at your next appointment. Then ask your doctor if your condition can be treated properly with a medicine that is on the low-cost list. This can save you thousands of dollars a year.
It is also worth checking and comparing prices at your local pharmacy. Some local pharmacies will "match" the best price you find elsewhere in the area, if you ask. Also ask if there is a discount club or card.
To make shopping around easier, you can usually get a price from a pharmacy over the telephone and sometimes on their web site.
You can find more information on how to get the best price on your prescriptions in the resources section of this topic. (See 'Help with comparing prices' below and 'Consumer Reports' below.)
BUYING NONPRESCRIPTION VERSIONS MIGHT SAVE YOU MONEY
Some medicines that your doctor can prescribe are also sold without a prescription. These are called "over-the-counter" (or OTC) drugs. They are also safe and effective and must be approved by the Food and Drug Administration (FDA). If the prescription medicine you take or a similar one is also sold without a prescription at a lower price, ask your doctor if you can take that instead.
Here are examples of ways to save money by using a nonprescription version:
●If you take Nexium, Prevacid, Dexilant, Protonix, or Aciphex for reflux or stomach problems, you might be able to switch to generic omeprazole or Prilosec OTC without a prescription and pay as little as $9 per month.
●If you take Xyzal or Clarinex for allergies, you might be able to switch to generic loratadine or OTC Claritin and pay as little as $7 per month.
●If you use a nasal spray for allergies such as Flonase, Nasonex, Omnaris, Beconase, or Qnasl you might be able to switch to OTC Nasacort Allergy 24 Hr and pay as little as $14 per month.
●If you take a prescription pain reliever like Celebrex, Mobic, or Voltaren, you might be able to switch to generic OTC naproxen and pay as little as $13 per month.
●If you take Detrol LA, Enablex, Sanctura, Toviaz, Vesicare, or Oxytrol patch to help with bladder control, you might be able to switch to OTC "Oxytrol for women" patch and pay as little as $20 per month.
Nonprescription medicines can be a different strength or be different from the prescription version in other ways, so do NOT switch to nonprescription versions without checking with your doctor first.
BEWARE OF "FREE" TRIAL OFFERS AND COUPONS ON BRAND-NAME DRUGS
These offers may sound good at first, but they do not provide a long-term solution because the drug company can stop the coupons or trial offer after you have been on the medicine for a while. In most cases where drug companies advertise a "free trial" or dollars off your insurance co-pay for their brand drug, there are similar medicines your doctor could prescribe that come as generics which will save you more money in the long run .
SPLITTING PILLS MAY SAVE YOU MONEY
If you have NO prescription drug coverage or your drug coverage has a limited dollar amount they will cover for prescriptions each year (called a coverage gap), splitting pills can lower your cost on some medicines.
Some prescription medicines cost the same no matter what strength the pill is. As a result, it is sometimes possible to get a prescription for double the strength you need and cut the pills in half. That way, you get your medicine at about half the cost [11,12].
For example, if you take Crestor to lower cholesterol and your dose is 10 milligrams per day, you could ask your doctor to change the prescription to Crestor 20 mg pills with NEW instructions to take HALF a pill per day. This will save you about $1000 a year if you have no prescription coverage.
If you DO have full prescription coverage, splitting pills is NOT likely to save you money on your usual co-pay.
Which pills are safe to split? — Many pills, including those used to treat high cholesterol, depression, high blood pressure, and diabetes, can be safely split in half by someone with good vision and good use of his or her hands. It is NOT safe to split ALL medicines. If you want to try pill splitting, FIRST ask your doctor or pharmacist if it is a good idea. Medicines that come in capsules or in pills that release medicine slowly should NOT be split.
What is the right way to split a pill? — Always use a pill splitter (figure 1). NEVER use a knife, which can smash your pills, and do not cut more than one or two pills at a time, as split pills can turn to powder if you shake them or store them.
If you split pills, ALWAYS review the new pill strength and new instructions with your doctor, nurse, or pharmacist to make sure you are getting the right amount of medicine.
You can find more information on splitting pills in the resources section of this topic. (See 'Consumer Reports' below.)
MAKE THE MOST OF YOUR INSURANCE
Take the time to learn about your prescription drug coverage to avoid expensive prescriptions. If you are eligible for Medicare Part D prescription coverage, there are ways to save money with that coverage too. (See 'What if I am eligible for Medicare Part D prescription coverage?' below.)
If you have a choice between different prescription plans, get the list of medicines that each of the plans covers (called the "formulary") and the different co-pay levels ("tiers"). Most insurance providers have a three-tier system like this:
●Tier 1 usually has the least expensive co-pay and includes mostly generic medicines.
●Tier 2 has a higher co-pay than Tier 1 and includes "preferred brand-name medicines." These are brand-name medicines that the insurance provider has approved because they are proven to work and be cost effective.
●Tier 3 has the highest co-pay and includes "nonpreferred" or nonformulary brand-name medicines that — according to the insurance provider — can usually be replaced with Tier 1 or Tier 2 medicines without any problems.
After you get the list of medicines that are covered by your insurance, check if any of the medicines you take are not covered or covered only with a high co-pay or in a limited way. For each of those medicines, ask your insurance company which covered medicines might work for you instead. Then give that information to your doctor.
Bring the list of covered medicines and their cost each time you visit a doctor. That way, if you need a new medicine, your doctor can prescribe one that is covered by your insurance at the lower Tier 1 or Tier 2 co-pay.
If any of your current medicines are not on the Tier 1 or Tier 2 list or are expensive, ask your doctor if any of the medicines on the list can replace them. However, your doctor may advise not switching your pills, for one of several reasons: a medicine similar to the substitute may have been tried before and not worked well for you, or you may be allergic to it, or it might not be the right choice to treat your particular condition.
Should I use the mail-order option? — If you have prescription drug coverage, most plans offer a mail-order option. This option will often save you money on medicines you take for three months or longer. Mail order is a good idea only after you know for sure that you will be taking a given medicine at a specific dose for at least three months.
The mail-order option with prescription drug coverage usually has a discounted co-pay for a 90-day supply of generic medicines and preferred brand medicines. To use this benefit of your insurance, you will need to register for the mail-order option for your plan. You will also need to ask your doctor to write you prescriptions that cover a 90-day supply with each refill.
What if I am eligible for Medicare Part D prescription coverage? — If you are eligible for Medicare, you can also enroll in a Medicare Part D prescription plan. There can be as many as 50 different Medicare Part D plans to choose from in your state, and each plan can offer a number of options that can be confusing.
A typical Medicare Part D plan costs from about $27 a month to more than $100 a month, depending on the specific coverage provided. The plans vary by many important details, including:
●How much you pay up front before the plan starts paying (called the deductible).
●The list of covered drugs (called the formulary).
●The co-pay amounts for generic and preferred brand drugs (called tiers).
●When you reach the coverage gap or "donut hole". (You reach the coverage gap after you and your plan spend a certain amount of money for covered drugs, then you have to pay more for your prescriptions up to a certain amount).
●The amount of drug coverage you will have if you reach the coverage gap. (Medicare Part D plans now provide some drug coverage if you reach the coverage gap).
It takes time to compare the different Medicare Part D prescription plans and their options, and it can be tough to decide which is best for your needs. Fortunately, reliable help is available. We recommend that you consult the sources listed below under Medicare Part D. (See 'Resources' below.)
MAKE SURE YOU NEED ALL THE MEDICINES YOU ARE ON
Some patients are prescribed more medicines than they really need. This seems to happen more often to older adults with multiple medical problems and to people of any age who see different types of doctors for different conditions.
In some cases, two different doctors prescribe two or more medicines that do the same thing. To avoid this problem, bring a list of all the medicines you take each time you visit any doctor. On your list, include the dose you use for each medicine, why you use it, how you take it, and the name and type of doctor who prescribed it. You should also include a list of any nonprescribed (over-the-counter [OTC]) medicine you take, such as arthritis medicines, vitamins, or herbal supplements. An example of such a list can be found at www.fda.gov/Drugs/ResourcesForYou/ucm079489.htm.
Ask all of your doctors to review your medicine list at each visit to make sure the list is up-to-date and has no errors. For example, your doctors should make sure the list does not include any incorrect doses or any medicines you should have stopped taking. Also check with your doctor that every medicine on your list is still needed and that you are taking it the right way.
It also helps to bring a bag containing ALL of your medicines with you to the doctor's office to have it checked.
GET HELP PAYING FOR THE MEDICINES YOU NEED
If you already looked into switching to generic medicines, splitting pills, and cutting costs in other ways, but you still cannot afford your medicines, you might be able to get help another way. There are state and federal programs that help people pay for their medicines. Plus, there are assistance programs sponsored by nonprofit organizations and by drug companies themselves. Whether you can get help from these programs will depend on things such as your income and how many people are in your family.
You can find information about these programs in the resources section of this topic. (See 'Resources' below.)
If you are cared for at a hospital or in a large medical practice, there should be a social worker or a pharmacist there who can help you find programs that might be able to help you.
BEWARE OF FOREIGN OR INTERNET-ONLY PHARMACIES
Pharmacies based in other countries and ones that exist only online sometimes offer what sound like really good deals. But be careful. Stay away from any pharmacy that offers to sell you prescription medicines without requiring a prescription from a doctor who has actually seen you. The Food and Drug Administration (FDA) has found that some internet and foreign pharmacies are not properly licensed and inspected. Plus, they may sell you medicines that are not right for you or that are expired or even fake [13-15]. You can find out if an internet pharmacy is licensed in the United States (US) by checking the FDA web site called "Know Your Online Pharmacy" listed in the resources section in this topic. (See 'FDA information for consumers' below.)
Pharmacies in Canada might be reliable, but the FDA has no oversight of their activities, so the agency cannot endorse the use of Canadian pharmacies.
There is no need to risk using an internet-only or foreign pharmacy just to get mail service. The mail-order choice for your prescription plan probably has an online order program. Also, most big chain stores and many local pharmacies now offer free mail-order service and let you order by phone or online at no extra charge.
●"Consumer Reports Best Buy Drugs" web site covers many topics on how to cut drug costs in both English and Spanish: http://www.consumerreports.org/health/best-buy-drugs/index.htm
●"Surprising ways to cut your drug costs" web site article provides the latest information on how to reduce drug costs even if you have insurance (August, 2013): http://www.consumerreports.org/cro/magazine/2013/09/how-to-cut-drug-costs-save-on-prescription-drugs-consumer-reports/index.htm
●"Same generic drug, many prices" article provides information about shopping around to reduce out-of-pocket drug costs (May, 2013): http://www.consumerreports.org/cro/magazine/2013/05/same-generic-drug-many-prices/index.htm
●"Shoppers guide to prescription drugs: Pill splitting" web site article gives helpful information about splitting pills to save money (2006): http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/money-saving-guides/english/PillSplitting-FINAL.pdf
Help with comparing prices — These web sites are helpful for comparing prices on prescription drugs.
●“GoodRx” web site compares prices on prescription drugs available at US registered pharmacies in your area: http://www.goodrx.com/.
●AARP’s “Drug Savings Tool” web site helps you determine if there are less expensive options you can discuss with your doctor: http://drugsavings.aarp.org/.
Help with understanding and choosing a Medicare Part D plan — These web sites are only for people on Medicare.
Medicare — This is the official government web site that lists the different drug plans Medicare offers. Here you can compare the plans offered in your state and view each plan's formulary (list of covered drugs).
●General site: www.medicare.gov
●Site with information on state help with drug payment (how to contact each program, who is eligible, and other details you should know): https://www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx
●What happens to your drug costs if you reach the Medicare Part D coverage gap: http://www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html
●How the Medicare Part D prescription coverage gap will be closed over the next several years: http://www.medicare.gov/Pubs/pdf/11493.pdf
●Phone: 1-800-MEDICARE (1-800-633-4227)
Medicare Rights Center — This is an independent nonprofit consumer advocacy group that helps people navigate the Medicare system. The group offers a hotline with counselors who can answer questions and help you make the most out of your Medicare coverage.
●Web site: www.medicarerights.org
Social Security Extra Help Program — Only for people with Medicare, this official government site has information about the Extra Help program. The Extra Help program helps people pay for the costs — monthly premiums, annual deductibles, and prescription co-payments — related to a Medicare prescription drug plan.
●Web site: www.ssa.gov/prescriptionhelp
●Web site with information about applying to the Extra Help program: www.ssa.gov/pubs/10525.html
SHIP: State Health Insurance Assistance Program — SHIP is a national program that offers counseling and help to people with Medicare and their families. This web site can help you find a counselor in your area who will meet with you one-on-one and talk to you about your Medicare options.
●Web site: www.shiptalk.org
Help paying for your medicine — These web sites provide information about different programs to help you pay for medicine.
Benefits Checkup (National Council on Aging) — This web site gives people lists of services and programs for which they can apply. The lists include programs to help pay for medicines, but also programs that do not have to do with healthcare directly. For example, this web site has information on finding housing, getting food stamps, and finding elder care. You can search for all types of programs at once, or target your search to find a specific kind of service.
●Web site: www.benefitscheckup.org
Needymeds — This is an independent nonprofit organization that provides information about patient assistance from drug companies and the government. The web site also offers people a discount card that they can use on prescriptions if they have no insurance or choose not to use their insurance. This card is especially useful in paying for medicines after you reach the Medicare "donut hole," and Medicare is no longer paying for your prescriptions.
●General web site: www.needymeds.org
●Web site with SHIP information: www.needymeds.org/indices/ship.htm
Partnership for Prescription Assistance — This program is run by drug companies and their trade group. It is only for people who do not have prescription drug coverage. The web site helps people find programs that will get them medicines for free or for a reduced cost.
●Web site: www.pparx.org
●Phone: 1-888-4PPA-NOW (1-888-477-2669)
Rx Assist — This web site lets you enter the name of a medicine or the name of a drug company to find programs that can help you get that medicine or medicines made by that company at a reduced cost. In many cases, the online applications for those programs are included.
●Web site: www.rxassist.org/patients
Rx Outreach — This web site offers medicines and diabetic-treatment supplies at a reduced cost to people who make less than a certain amount of money each year.
●Web site: www.rxoutreach.org
Learn more — These web sites provide extra information and tips to help you make smart choices and protect your rights when looking for healthcare.
FDA information for consumers
●Government web sites with information about safety and quality of generic drugs:
•"Generic Drugs: Same Medicine, Lower Cost": http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm340343.htm?source=govdelivery
•"Generic Drugs: Questions and Answers": www.fda.gov/Drugs/ResourcesForYou/Consumers/QuestionsAnswers/ucm100100.htm
●Government web sites with information about buying drugs online safely:
•"Know your Online Pharmacy": http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/BuyingMedicinesOvertheInternet/BeSafeRxKnowYourOnlinePharmacy/default.htm
•"Buying Prescription Medicine Online: A Consumer Safety Guide": http://www.fda.gov/Drugs/ResourcesForYou/ucm080588.htm
●Government web sites with information about the risks of foreign and internet pharmacies:
•"The Possible Dangers of Buying Medicines Over the Internet": http://www.fda.gov/forconsumers/consumerupdates/ucm048396.htm
•"Buying Medicine from Outside the United States": www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/buyingmedicinefromoutsidetheunitedstates/default.htm
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient information: Reducing the costs of medicines (The Basics)
Patient information: When you have multiple health problems (The Basics)
Patient information: Brand versus generic medicines (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
This topic currently has no corresponding Beyond the Basics content.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.