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Patient education: Reducing the costs of medicines (Beyond the Basics)

Jonathan M Zand, PharmD BCPS
Becky Briesacher, PhD
Section Editor
Mark D Aronson, MD
Deputy Editor
Jonathan M Zand, PharmD BCPS
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The high prices charged for many prescription drugs has become a major concern in the United States, forcing as many as one in four people to go without their medicines [1]. Drug prices in the United States are increasing much faster than other prices, so finding ways to get needed medicines safely and affordably is now more important than ever to most patients, even those who have prescription coverage [2]. As an example, a study showed that when people who had a heart attack did not have to pay a lot for their medicines after being discharged from the hospital, they were more likely to get their prescriptions filled and take their medicines correctly, and they were less likely to have repeat serious heart problems [3].

When medicines cost too much, people sometimes try skipping doses or not refilling their prescriptions when they run out. It can be harmful to start and stop some medicines and 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) [4-10].

This article describes ways to make medicines more affordable. It is meant for people who live in the United States, but it might also be useful to people in other countries.

What if I do not have health insurance? — If you live in the United States and do not have health insurance, look into getting insured. The laws about health insurance in the United States have changed, and for many people it is easier and more affordable to get insurance than before. In many states, more people are now eligible for lower-cost insurance or Medicaid. Most insurance options include prescription coverage. For information about options in health coverage, visit the healthcare.gov website.

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.)


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.

Studies show that people who take generic medicines are more likely to stay on them than more costly brand-name medicines [8,11,12]. Additionally, guidelines for clinicians recommend that they prescribe generic medicines for their patients, if possible, rather than more expensive brand-name medicines [12].

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 USD $250 a month without insurance coverage. An average prescription that is filled with a generic drug costs about $25 a month without insurance [13,14]. 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, a medicine commonly prescribed to treat migraine headaches, called Relpax, is sold only by its brand name and is costly. If your doctor prescribes a brand-name migraine medicine, ask if you can take generic Imitrex (called sumatriptan) or another generic antimigraine medication instead (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 brand-name sleep medicine, such as Edluar or Intermezzo, ask your doctor if you can switch to generic Ambien (called zolpidem) which sells for as little as $10 per month and at a lower co-pay for those with prescription coverage.

Some medications are sold as brand-name only because they contain two or more medications in one pill [15]. It may be possible to take the individual medications in separate pills as low-cost generics.

Some popular prescription medicines are now available at a lower cost without a prescription For example, if you take Nexium or Prilosec, lower-cost non-prescription versions can be a good option. (See 'Buying nonprescription versions may save you money' below.)

If there is no low-cost generic medicine that is appropriate for you, ask if there is a lower-cost brand medicine. (See 'Find out if you can use a lower-cost brand medicine' below.)

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 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 United States after the US 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 United States 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 [16-18].

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 website: http://www.fda.gov/Drugs/InformationOnDrugs/ucm129662.htm.)

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.


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 [19].

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 more 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 USD $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. You can also search on your computer or via a smartphone app by looking up “goodRx” which is a website which compares local prices and provides discount coupons [20].

If you take several medicines and want to buy them from different pharmacies, let your doctor know and be sure to always give each pharmacy a full list of your current medicines so they can check for drug interactions.

You can find more information on how to get the best price on your prescriptions in the resources section of this topic. (See 'How to find the lowest prescription prices' below and 'Consumer Reports' below.)


If you cannot switch to a generic medicine, often there is more than one brand-name medicine that can be used to treat your condition.

For example, if you are on insulin for diabetes and your insulin costs too much, ask your doctor about changing insulin types. Often, using a different insulin type can save you money. "Regular" insulin (brand names: Humulin R, Novolin R) and "NPH" insulin (brand names: Humulin N, Novolin N) cost about one-half of what other insulins cost [21,22].


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 US 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 prescription Nexium, Prilosec, Prevacid, Dexilant, Protonix, or Aciphex for reflux or stomach problems, you might be able to switch to Nexium 24HR or Prilosec OTC or generic omeprazole without a prescription and pay as little as USD $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 $4 per month.

If you use a prescription nasal spray for allergies, such as Flonase, Nasonex, Omnaris, Beconase, or Qnasl, you might be able to switch to an OTC nasal spray and pay as little as $14 per month. Available OTC nasal sprays include Flonase Allergy Relief, Nasacort Allergy 24 Hr, and Rhinocort Allergy.

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.

More information about nonprescription medicine choices are in a table (table 1).

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.


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 [23,24].


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 [25-27].

For example, if you take rosuvastatin (brand name: Crestor) to lower cholesterol and your dose is 10 milligrams per day, you could ask your doctor to change the prescription to rosuvastatin 20 mg pills with NEW instructions to take HALF a pill per day. This will save you about USD $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.)


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 USD $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.)


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 non-prescribed (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.


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.


Pharmacies based in other countries and ones that exist only online sometimes offer what sound like really good prices. 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 US 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, have expired, or are fake [28-31].

If you decide that an internet pharmacy is a good choice for saving on your prescriptions, look for one that is licensed to operate in your area and has been certified by the National Association of Boards of Pharmacy [20].

You can find out if an internet pharmacy is licensed in the United States by checking the FDA website called "Know Your Online Pharmacy" listed in the resources section in this topic. (See 'FDA information for consumers' below.)

The National Association of Boards of Pharmacy certifies internet pharmacies as licensed and operated according to appropriate quality standards. These websites can be identified by the oval blue seal that reads “VIPPS,” which means “verified internet pharmacy practice site.” A link to a list of VIPPS websites is provided in the resources section. (See 'National Association of Boards of Pharmacy' 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. In fact, many pharmacies that claim on their website to be located in Canada are actually based in other parts of the world.

There is no need to risk using a 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

"Consumer Reports Best Buy Drugs" website covers many topics on how to cut drug costs in both English and Spanish: http://www.consumerreports.org/health/best-buy-drugs/index.htm

“Save Money on Meds: 6 Tips for Finding the Best Prescription Drug Prices” (January 06, 2016) http://www.consumerreports.org/drugs/6-tips-for-finding-the-best-prescription-drug-prices/

"Same generic drug, many prices" – How to locate the lowest prices on generic medicines (May, 2013): http://www.consumerreports.org/cro/magazine/2013/05/same-generic-drug-many-prices/index.htm

"Shoppers guide to prescription drugs: Pill splitting" website article gives helpful information about splitting pills to save money (2015): http://article.images.consumerreports.org/prod/content/dam/cro/news_articles/health/PDFs/Consumer_Reports_Splitting_pills_2-pager.pdf

How to find the lowest prescription prices — These websites are helpful for comparing prices on prescription drugs.

“Save Money on Meds: 6 Tips for Finding the Best Prescription Drug Prices” (January 06, 2016) http://www.consumerreports.org/drugs/6-tips-for-finding-the-best-prescription-drug-prices/

"GoodRx" website compares prices on prescription drugs available at United States-registered pharmacies in your area: http://www.goodrx.com/

AARP's "Drug Savings Tool" website 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 websites are only for people on Medicare.

Medicare — This is the official government website 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: https://www.medicare.gov/Pubs/pdf/11493-Coverage-Gap.pdf

How to lower your out-of-pocket costs if you reach the Medicare Part D coverage gap: https://www.medicare.gov/part-d/costs/coverage-gap/ways-to-lower-drug-costs.html

How the Medicare Part D prescription coverage gap will be closed over the next several years: https://www.medicare.gov/Pubs/pdf/11493-Coverage-Gap.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.

Website: www.medicarerights.org

Phone: 1-800-333-4114

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.

Website: www.ssa.gov/prescriptionhelp

Website 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 website 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.

Website: shipnpr.acl.gov

Help paying for your medicine — These websites provide information about different programs to help you pay for medicine.

Benefits Checkup (National Council on Aging) — This website 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 website 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.

Website: www.benefitscheckup.org

Phone: 1-800-677-1116

Needymeds — This is an independent nonprofit organization that provides information about patient assistance from drug companies and the government. The website 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 website: www.needymeds.org

Website with SHIP information: www.needymeds.org/ship

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 website helps people find programs that will get them medicines for free or for a reduced cost.

Website: www.pparx.org

Phone: 1-888-4PPA-NOW (1-888-477-2669)

Rx Assist — This website 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.

Website: www.rxassist.org/patients

Phone: 1-401-729-3284

Rx Outreach — This website offers medicines and diabetic-treatment supplies at a reduced cost to people who make less than a certain amount of money each year.

Website: www.rxoutreach.org

Phone: 1-800-769-3880

Learn more — These websites provide extra information and tips to help you make smart choices and protect your rights when looking for healthcare.

FDA information for consumers

Government websites 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 websites with information about buying drugs online safely:

"Know your Online Pharmacy": http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/BuyingMedicinesOvertheInternet/BeSafeRxKnowYourOnlinePharmacy/default.htm

(See 'National Association of Boards of Pharmacy' below.)

Government websites 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

National Association of Boards of Pharmacy

Online (internet) pharmacies certified by the National Association of Boards of Pharmacy are licensed and operated according to appropriate quality standards https://nabp.pharmacy/programs/vipps/vipps-accredited-pharmacies-list/


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 website (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 education: Reducing the costs of medicines (The Basics)
Patient education: When you have multiple health problems (The Basics)
Patient education: 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.

Literature review current through: Nov 2017. | This topic last updated: Wed Jul 19 00:00:00 GMT+00:00 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Susan Jaffe. USA grapples with high drug costs. Lancet 2015; 386:2127.
  2. Kesselheim AS, Avorn J, Sarpatwari A. The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform. JAMA 2016; 316:858.
  3. Choudhry NK, Avorn J, Glynn RJ, et al. Full coverage for preventive medications after myocardial infarction. N Engl J Med 2011; 365:2088.
  4. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353:487.
  5. Baroletti S, Dell'Orfano H. Medication adherence in cardiovascular disease. Circulation 2010; 121:1455.
  6. Roumie CL. The doughnut hole: it's about medication adherence. Ann Intern Med 2012; 156:834.
  7. Mazer M, Bisgaier J, Dailey E, et al. Risk for cost-related medication nonadherence among emergency department patients. Acad Emerg Med 2011; 18:267.
  8. Tamblyn R, Eguale T, Huang A, et al. The incidence and determinants of primary nonadherence with prescribed medication in primary care: a cohort study. Ann Intern Med 2014; 160:441.
  9. Rosenthal E. The Soaring Cost of a Simple Breath. The New York Times Website. http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html?nl=todaysheadlines&emc=edit_th_20131013&_r=1& (Accessed on April 18, 2014).
  10. Luiza VL, Chaves LA, Silva RM, et al. Pharmaceutical policies: effects of cap and co-payment on rational use of medicines. Cochrane Database Syst Rev 2015; :CD007017.
  11. Gagne JJ, Choudhry NK, Kesselheim AS, et al. Comparative effectiveness of generic and brand-name statins on patient outcomes: a cohort study. Ann Intern Med 2014; 161:400.
  12. Choudhry NK, Denberg TD, Qaseem A, Clinical Guidelines Committee of American College of Physicians. Improving Adherence to Therapy and Clinical Outcomes While Containing Costs: Opportunities From the Greater Use of Generic Medications: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2016; 164:41.
  13. Purvis, L and Schondelmeyer S. Rx Price Watch Report; Trends in retail prices of brand name prescription drugs widely used by older American 2006 to 2013; AARP Publicy Policy Institute; November, 2014. http://www.aarp.org/content/dam/aarp/ppi/2014-11/rx-price-watch-report-AARP-ppi-health.pdf.
  14. Purvis L and Schondelmeyer; Trends in Retail Prices of Generic Prescription Drugs Widely Used by Older Americans, 2006 to 2013; AARP Public Policy Institute (May, 2015) http://www.aarp.org/content/dam/aarp/ppi/2015/trends-in-retail-prices-of-generic-prescription-drugs.pdf.
  15. Hakim A, Ross JS. High Prices for Drugs With Generic Alternatives: The Curious Case of Duexis. JAMA Intern Med 2017; 177:305.
  16. Davit BM, Nwakama PE, Buehler GJ, et al. Comparing generic and innovator drugs: a review of 12 years of bioequivalence data from the United States Food and Drug Administration. Ann Pharmacother 2009; 43:1583.
  17. Kesselheim AS, Misono AS, Lee JL, et al. Clinical equivalence of generic and brand-name drugs used in cardiovascular disease: a systematic review and meta-analysis. JAMA 2008; 300:2514.
  18. Dentali F, Donadini MP, Clark N, et al. Brand name versus generic warfarin: a systematic review of the literature. Pharmacotherapy 2011; 31:386.
  19. Hauptman PJ, Goff ZD, Vidic A, et al. Variability in Retail Pricing of Generic Drugs for Heart Failure. JAMA Intern Med 2017; 177:126.
  20. Greenberg J. Ten Tips to Help Outpatients Save Money. Am J Med 2017; 130:283.
  21. Tylee T, Hirsch IB. Costs Associated With Using Different Insulin Preparations. JAMA 2015; 314:665.
  22. Lipska KJ, Hirsch IB, Riddle MC. Human Insulin for Type 2 Diabetes: An Effective, Less-Expensive Option. JAMA 2017; 318:23.
  23. Ross JS, Kesselheim AS. Prescription-drug coupons--no such thing as a free lunch. N Engl J Med 2013; 369:1188.
  24. Ubel PA, Bach PB. Copay Assistance for Expensive Drugs: A Helping Hand That Raises Costs. Ann Intern Med 2016; 165:878.
  25. Tablet splitting. Med Lett Drugs Ther 2012; 54:63.
  26. Pill splitting. Consumer Reports Website. Available at: http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/money-saving-guides/english/PillSplitting-FINAL.pdf (Accessed on September 17, 2013).
  27. Tablet splitting. JAMA 2014; 311:521.
  28. The Possible Dangers of Buying Medicines over the Internet http://www.fda.gov/forconsumers/consumerupdates/ucm048396.htm (Accessed on October 01, 2012).
  29. BeSafeRx: Know Your Online Pharmacy http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/BuyingMedicinesOvertheInternet/BeSafeRxKnowYourOnlinePharmacy/default.htm (Accessed on October 01, 2012).
  30. FDA takes action against thousands of illegal Internet pharmacies http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm322492.htm (Accessed on October 16, 2012).
  31. How to Save Money on Medicines: Dos and Don’ts (May 8, 2016) https://crediblemeds.org/blog/save-money-medicines-dos-and-donts/.

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