Advertisement
insurance

How to Pay for Pricey Prescriptions

Paying for expensive medications is especially painful if you’re in a high-deductible plan.

Over the past several months, my eyes have been dry. And I’m not talking about a little scratchy here and there. It’s more like no amount of sleep or Visine or time forgoing contact lenses can keep me from waking up looking like I spent the night with Cheech and Chong. So you can imagine the tears of joy I cried (or not) when the ophthalmo­logist wrote me a prescription for eyedrops that treat chronic dry eye. He told me the drug wasn’t available as a generic, so it might be pricey, but handed me a coupon. “Pay as little as $5* a month,” it said on the front. Sold!

I should have paid more attention to the asterisk. Because when I handed my prescription, along with my coupon, to the pharmacist, she told me I owed her $270 for my first month’s worth of eyedrops. My coupon only entitled me to a $250 discount on a drug that cost an eye-watering (sorry) $520 per month.

Advertisement - Article continues below

Managing sticker shock. I should take a moment to note that I’m enrolled in my com­pany’s high-deductible health plan, and my deductible is $1,500 (such plans must have a deductible of at least $1,350 for an individual and $2,700 for a family). But premiums are lower than they are for a preferred provider plan with a lower deductible. For me, a young, healthy person, the choice was simple. I have had infrequent and (usually) inexpensive medical costs. When I added the cost of my premiums to my out-of-pocket expenses, I came out way ahead.

Advertisement
Advertisement - Article continues below

High-deductible plans are growing in popularity. Nearly half of private-sector employees in the U.S. were enrolled in a high-deductible plan in 2018, up from 30% in 2013, according to data compiled by the State Health Access Data Assistance Center.

At the same time, “the cost of health care—especially for specialty drugs—has escalated dramatically,” says Marcus Sredzinski, executive vice president of pharmacy at prescription savings program ScriptSave. To lower the cost of a pricey drug, Sredzinski says to first make sure all of your doctors have your medical history and a full list of the medications you’re taking. “It could be your dry eyes are a side effect from a medication another doctor prescribed,” he says.

Let your doctor know you’re in a high-deductible plan and ask if there are cheaper alternatives to the prescribed drug. It may be that an expensive new drug is a combination of older, cheaper treatments, says NeedyMeds president Rich Sagall.

Advertisement - Article continues below

If there aren’t cheaper alternatives, compare prices across pharmacies and find out whether coupons for certain prescriptions are available on sites such as WellRx.com and GoodRx.com. Talk to your pharmacist or prescribing physician to find out if the drug manufacturer offers a co-payment assistance program, like the $250 discount I got. Make sure you read the fine print, however. The discount may only apply to a certain number of refills, and you may only be able to apply the discounted rate toward your deductible, says Sredzinski.

Depending on the medication and your income, you may qualify for a patient assistance program offered by either the manufacturer or a private foundation. Search for your treatment at NeedyMeds.org to find out if a program supports the drug you were prescribed and where to apply. I was eligible to apply for the program from the manufacturer of my eyedrops.

I had to fax in an application, which included my insurance information and a copy of my W-2, and browbeat my doctor’s office into completing an application form as well. Because my total cost for the drug exceeded a certain portion of my income, I qualified to receive the drug free. Now maybe I’ll cry actual tears of joy.

Advertisement
Advertisement

Most Popular

What Trump's Payroll Tax Cut Will Mean for You
Tax Breaks

What Trump's Payroll Tax Cut Will Mean for You

President Trump issued an executive order to suspend the collection of Social Security payroll taxes. How much will it save you?
August 10, 2020
5 Tips to Minimize Your Taxes in Retirement
tax planning

5 Tips to Minimize Your Taxes in Retirement

Don’t pay more than you have to. It all starts with a thorough understanding of the basics of how retirement income is taxed.
August 2, 2020
10 Things to Know Before Going to the Hospital (from a Legal Perspective)
personal finance

10 Things to Know Before Going to the Hospital (from a Legal Perspective)

A trip to the ER can be chaotic and scary, but getting your ducks in a row now can definitely help.
August 11, 2020

Recommended

The Insurance Company Denied My Claim. What Should I Do?
insurance

The Insurance Company Denied My Claim. What Should I Do?

A lawyer specializing in insurance bad faith law explains why this happens, and outlines how to fight back.
August 6, 2020
Time for an Insurance Review
Coronavirus and Your Money

Time for an Insurance Review

You may need to update your policies in light of COVID-19.
July 30, 2020
Insurance Question: Say Rioters Destroy My Business, Am I Covered?
insurance

Insurance Question: Say Rioters Destroy My Business, Am I Covered?

If you ask your broker, the answer may be no. But don’t just accept that response. Know what your policy covers, and how to protect yourself.
July 29, 2020
HSAs Get Even Better
Financial Planning

HSAs Get Even Better

A health savings account is a powerful, tax-advantaged tool to cover out-of-pocket medical expenses and a smart way to save for medical expenses in re…
July 3, 2020