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How To Lower Your Prescription Copay

Updated on May 3, 2010

THE TRUTH ABOUT YOUR COPAY

Imagine I gave you $50.00 to spend at your favorite restaurant...what would you order? A nice juicy steak? A succulent seafood dish? Some kind of decadent dessert? Imagine your mouth watering as you wait...eager and famished...for the arrival of your food. Your waiter arrives and uncovers your plate...to reveal a single bottle of your prescription medication. "Sorry" he says sardonically "you cannot afford this meal, you PAID TOO MUCH FOR YOUR PRESCRIPTION!"

The choice is yours. Would you rather spend your money on pills...or prime rib? Tablets...or Tiramisu? Maybe you simply do not believe that you can actually pay less and save money at the pharmacy. You can. I will show you how.

THE TRUTH is that you may be taking a drug which costs you $50.00 per month and there might very well be another prescription drug which is equally as effective for a $5.00 or $10.00 copay on your plan. Month after month you are pouring out $50.00 for pills that are no better than another prescription for less than half the cost. How would you know? Well, unless you happen to take the time to research it, you may never realise just how much money you could save. In the following paragraphs I am going to explain exactly how to find out if you are getting the best deal and taking advantage of the best prices your prescription insurance policy has.

Sample Drug List

STEP 1: MAKE YOUR LIST

The first step is to make a list of the prescription drugs you currently take and the amount you pay for each refill. Just write them down. If you can't remember, call your pharmacy, and simply ask them what your copay was the last time you picked up "x" medication. They will be happy to tell you. In order to find a lower copay alternative, we first have to know what you currently get and what you currently pay.

Do you have your list? Now, if you are only taking generic medications and your copay is already very low (by today's standards, that would be anywhere between $1.00 and $10.00 for each prescription), then it is likely you are already getting the lowest possible prices available through your plan. If so, you may still be able to save MORE money. Just read my separate article on HOW TO SAVE MONEY ON PRESCRIPTION DRUGS.

If, however, you have 1 or more prescriptions that are "brand name" (i.e. not a generic) and your copay is pretty high (let's say more than $10.00), then you may be able to reduce your costs on this medication. How? By finding out if there is another medication IN THE SAME FAMILY that is available at a lower copay.

 

A Sample of "Tiers" for a drug class

In this example Altoprev is tier 3 (more costly) and simvastatin is tier 1 (least expensive)
In this example Altoprev is tier 3 (more costly) and simvastatin is tier 1 (least expensive)

STEP 2: RESEARCH ALTERNATIVES

Here is the part that seems scary. What? Research alternatives to my precious prescription? Are you serious? Yes, I am. Sit down and take a deep breath. This is not going to hurt as much as you think. The problem is that your drug may be in the highest "tier."  See an example from a prescription formulary in the picture to the right. All those drugs (in the picture) are "similar" (i.e. they work the same general way) but some may cost you more than others on your plan. You see, let me explain something to you. In all likelihood the prescription medication you take is not the only drug on the market for your specific condition. Your doctor chose this medication because he/she is confident in the fact that it is safe and effective, generally well tolerated, and currently available. These are all good reasons. But guess what? So are (probably) quite a few other prescription drugs which he/she might have chosen also! The fact is that you might be treated equally well with another quality prescription drug which happens to be less expensive on your plan.

You have to understand something about prescription insurance plans and your copay. If you are taking a drug that has a very high copay and costs you a ton of money every month...guess what? This drug is also probably very expensive to the insurance company. In fact, your $50.00 copay may not be very much money compared to the $300.00 or more that the insurance company has to shell out for your medication every month to the pharmacy. By finding a less costly alternative for you...it will also be (probably) a less costly alternative for the insurance company. Note: Less costly DOES NOT mean less effective. The copay amount is mostly a reflection of several complicated elements including rebates from manufacturers and discounts that I won't go into at this time. The point is...you insurance company should be HAPPY to help you find something less expensive!

So...get out your insurance card. Yep, that little plastic or paper thing that you showed the pharmacy the first time you went there. It probably says "prescription" or "RX" somewhere on it. Look for the "800" number on the front or back for "customer service." Call it. Remember...you ARE the customer. Follow the prompts to speak to a customer service representative about your prescription plan. Eventually...a human being should answer. When they do, say something like this:

Hi, this is [your name]. I am currently taking a prescription from my doctor for [your drug]. Would you be able to tell me if there are any other similar medications that might be available at a lower tier on my plan? I know I would have to talk to my doctor about taking an alternative. Thank you.

Give them a few moments to check it out. Be prepared to write down the names of any medications they suggest. Find out exactly what it would cost on your plan. Ask the same question for ALL your medications that you currently pay a high copay for.

Once you have done this, thank the representative and hang up. There...that is your research! That wasn't too hard! Now you are ready to move on to the final step!!

STEP 3: CONTACT YOUR DOCTOR

The hard part is done. In all likelihood you now have a list of some alternatives that would be less costly on your particular prescription plan. Let me emphasize again at this point: your doctor did not prescribe your medication because he/she wanted you to spend as much as you possible could. He/she did not prescribe it because they somehow are getting certain rewards every time you fill your prescription. He/she probably has NO IDEA what your copay is for this prescription. Your neighbor may get the same drug for $10.00 that you have to pay $50.00 for because you have a different insurance plan. What I am trying to say is this: don't be upset with your doctor. It is nobody's fault that your medication happens to fall in the highest tier on your plan. Let's just focus on changing the medication to something less expensive if possible.

So...what to do now? If you have just 1 medication that is too expensive, and you have just been given 1 or more alternatives to consider, then you may be able to call your doctor's office and request that he/she considers switching you to one of these alternatives. How do you do that? Call your doctor's office, and when the secretary picks up, say something like this:

Hi, this is [your name], and I'm a patient of Dr. [your doctor's name]. I am currently taking a prescription for [your prescription]. This particular medication is becoming too expensive for me to continue. I called my insurance company and they gave me a couple alternatives that I would like Dr. [your doctor's name] to consider for me. I know these are not exactly the same, but if he/she thinks they might be appropriate, I am willing to give them a try. Thank you.

That is it! They will probably give the note to your doctor and he/she will consider if any of these alternatives are appropriate for you. If so, they will probably call in your new prescription to the pharmacy.

If you have several medications...my personal advice is to switch only 1 at a time. That way, if you have a reaction or side effect, you can determine what is causing the reaction more easily. Make sense? Good.

DISCLAIMER

Having given you the instructions to effectively lower your monthly copay and your expenses on prescription drugs, I do need to make several extremely important comments about this article:

1. Sometimes the medication you have been prescribed is, in fact, the only option for your particular condition. This may be due to an allergic reaction or failed attempts at using other available products.  Due to your past experiences with other medication or other conditions for which you are being treated, sometimes there are simply no other less expensive options. 

2.  You must also consider the fact that switching medications, although it might save some money, may not always be in your best long-term interest.  Not all medications are created equal.  There may be additional benefits from your medication, which may help reduce the costs related to treating your condition in the long-term.  Also, if a different medication results in a side-effect, or ends up being less effective, you may have to be prescribed an additional drug to help manage this circumstance. 

3.  Finally, nothing in this article should substitute for the good advice of your own doctor who has been treating you and is in the best position to evaluate your medical needs. 

In a day when making every penny count is more important than ever, finding ways to reduce the cost of your prescriptions, without sacrificing effectiveness, is extremely important for many patients.  I hope this article has provided some useful information for you.

Comments

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    • profile image

      rbell 

      7 years ago

      They don't call them death panels, they are simply raising the price of the co-pays for everyone that are on essential (life supporting)medications to an unaffordable level, so you just die and all insurance companies are happy.

    • pharmacist profile imageAUTHOR

      Jason Poquette 

      8 years ago from Whitinsville, MA

      Hi jstankevicz,

      Thanks for reading and for commenting! Great points!

    • jstankevicz profile image

      jstankevicz 

      8 years ago from Cave Creek

      Very good detail and great advise to actually talk to the doctor and the insurance provider about alternatives. Too many people automatically take the first pill the doctor prescribes. The pharmacist can be a great help in finding alternates to run past the doctor. I like the sample script you offered for talking to the doctor’s office!

    • pharmacist profile imageAUTHOR

      Jason Poquette 

      8 years ago from Whitinsville, MA

      Thanks for the comment Rochelle! Yes, staying local has some significant advantages. And I'm sure you are never a pest ;)

      Sincerely,

      Jason

    • Rochelle Frank profile image

      Rochelle Frank 

      8 years ago from California Gold Country

      Good, practical advice as usual. Our insurance company is trying to direct us to "their" mail order pharmacy, but we found that prescriptions can be changed to a generic or a lower priced alternative.

      I , personally prefer to deal with a local pharmacy where I can actually talk to a living pharmacist-- or hang around and make a pest of myself until I get attention.

      You can't do that through the mail, and I hate to wonder if medicines will appear on time.

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