Cost saving tips for prescriptions

Prescription drug costs have quadrupled over the last ten years, and continue to increase about 25 percent each year. Some of the rise is due to the advertising and promoting done by the pharmaceutical manufacturers and also from the costs involved in developing the drug, getting it tested and approved, a process which takes many years. There are a few ways to cut the costs to the consumer.

Generic drugs are considerably cheaper than brand name drugs. Generic drugs are made from the same chemical compounds as the brand. They are manufactured the same way as brand, and are FDA approved. Most insurance companies penalize the consumer for purchasing a brand if a generic is available. Generally, the consumer must pay the difference in price between the generic and brand, as well as the co-pay. It is a New York state law that a prescription must be filled with a generic drug if there is one available, unless the doctor writes a "DAW" (dispense as written) on the prescription form. A pharmacist is not allowed to dispense a brand name drug unless the DAW is on the prescription. You can check for a generic or less expensive brand name drug on the tier lists that most insurance companies provide on-line or through your employee benefits.

Another way to save money is to invest in a pill splitter, generally around $5 at the pharmacy. Some insurance companies offer lower co-pays if the patient gets a higher dose of the drug and splits the pill in half. For instance, if you normally take 50 milligrams of a prescription drug each day, having your doctor prescribe a 100 milligram tablet and then splitting it yourself may save you as much as 50 percent. This way you pay a one-month co-pay instead of a two-month co-pay. Many pills are already scored, allowing you to easily split the pill in half.

Blue Cross /Blue Shield offers a half tablet incentive program. By switching to the higher strength, it also saves the patient up to 50 percent. The drugs listed on their program include celexa, lipitor, monopril, paxil, pravachol, toprol xl, vioxx, zocor and zoloft. A new prescription for the higher strength must be written by the doctor to get the incentive.

Most insurance plans have gone to a three-tier program over the last few years. The first tier is for generic drugs, the second for preferred brands, and the third for non-preferred brand drugs. Depending on the prescription rider that your employer has, the co-pays generally range from $5 for tier 1, $15 to $20 for tier 2, and $30 to $45 for tier 3. If a generic is not available for the prescription that you are taking, ask your doctor to prescribe a preferred brand.

Many insurance companies, such as Blue Cross/Blue Shield, Preferred Care and EHS (Eckerd Health Service), require prior authorization for certain prescriptions from the doctor before they will let a pharmacy fill your prescription. The doctor's office must fax a prior authorization form to your insurance company stating why the drug is medically necessary.

The insurance company's pharmacy management team reviews the request and determines whether they will cover the prescription. Having the prior authorization before taking your prescription to the pharmacy saves time for the patient as well as the pharmacy. Most prescriptions for growth hormones and fertility drugs require prior authorization, as well as some arthritic drugs. Some common drugs that also need this authorization include vioxx, celebrex and viagra.

If you are vacationing or live in another part of the state or country for part of the year and will run out of medication, it is best to call your insurance company to ask how to get your prescription refilled. With the risk of losing your medication during your travels, Blue Cross/Blue Shield and Preferred Care ask that you have your medication filled at a pharmacy where you are staying, as their insurance card is accepted at pharmacies all over the United States. Your benefits go with you across the country. Getting a new prescription from your doctor to take with you on vacation can relieve some of your concerns. Some insurance companies will give you a "vacation override," which allows you to fill your prescriptions early at your local pharmacy to take with you on vacation. It's best to call the member services number on your insurance card in advance of your vacation to learn how to deal with the situation. Again, this saves you time and headache at the pharmacy, and also helps your local pharmacy out.

To view the tier plan for your insurance carrier, or to see the policies on vacation overrides as well as what drugs need prior approval, the following websites can be accessed for that information: