10 Things You Should Know About Advertised Drugs
Big Pharma spends billions to get you to ask for brand-name drugs. Here’s how to protect your wallet.
Prescription drug companies spent more than $7 billion on television campaigns alone last year. Two of the most advertised drugs — Tremfya and Skyrizi — treat moderate to severe plaque psoriasis and other inflammatory diseases, and can cost anywhere from $19,000 to $30,000 per dose without insurance.
Ads for weight-loss medications like Zepbound and Wegovy, which can cost up to $600 for a month’s allotment of four pre-filled pens, also pervaded the airwaves, particularly on streaming services.
The most heavily advertised drugs aren't necessarily the most expensive drugs, says Geoffrey Joyce, chair of the department of pharmaceutical and health economics at the University of Southern California. To make television advertising worthwhile, a drug generally needs to be branded, still under patent and used to treat a condition that impacts a large number of people.
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That explains why drugs for conditions such as plaque psoriasis and diabetes get so much airplay. Claritin, an over-the-counter allergy medication, was a top-advertised drug on YouTube last April and May. Why? Allergy season.
The ads can make medications look like magic bullets, and research shows that the colorful reels with catchy jingles get patients to ask for them at the doctor's office — and physicians are more likely to prescribe the brand-name drug if requested. But buyer beware, as Medicare Part D plans may not cover brand medications, so make sure to check your plan's list of approved medications — known as a formulary — as well as the plan comparison at Medicare's comparison website.
Some plans require patients to try cheaper alternatives first, which could be beneficial as research found that most of the new drugs advertised may not benefit patients more than older drugs.
What the commercials don't mention is the cost. The price can vary widely depending on insurance coverage, deductibles, formularies, rebates — and even the location where the prescription is filled.
Merith Basey, executive director of Patients for Affordable Drugs, a bipartisan patient organization, says Americans pay the highest prescription drug prices in the world. That's in part because — unlike other countries — pharmaceutical companies set the prices of drugs when they come to market in the U.S.
Other countries with national healthcare have stronger negotiating positions with pharmaceutical companies because those governments control what's allowed on the national formulary — the list of recommended and covered drugs.
Experts say that while pharma ads may raise awareness and get patients in the door for a conversation with their doctor, consumers should be wary, as brand-name drugs and brand-new options aren't always the best choices for your health or your wallet.
So here are 10 suggestions to consider before asking your doctor for a prescription "as seen on TV."
1. Compare costs locally and don't forget Costco
Joyce says that consumers often assume a prescription has a fixed price no matter where it’s filled. But that’s not true. In a 2017 study, shoppers visited more than 500 pharmacies with identical prescriptions and found wide price differences for the exact same medications. They were also less expensive in low-income areas. One antibiotic was as much as $52 less within one zip code, he said.
Don't forget to check in at Costco's pharmacy as well, as one study found that Costco beat Medicare’s prices for generic medicines nearly 50% of the time.
2. Ask for generic or biosimilar options
Most prescriptions in the United States are filled with generic drugs and Joyce says that, generally speaking, a generic equivalent is expected to provide similar quality and effectiveness. Ditto with "biosimilar" drugs, which treat a range of chronic diseases. For example, Humira is a brand-name injection used to treat autoimmune diseases like rheumatoid arthritis, costing up to $10,000 for a month's treatment without insurance. But there are many "biosimilar" options that cost under $500.
You may also be able to opt for older versions of drugs. Basey says that drug companies can introduce modified versions of existing medications as patents approach expiration. Ask whether an older, less expensive version remains available.
3. Over-the-counter (OTC) drugs may be more expensive
Surprisingly, OTC drugs such as ibuprofen are sometimes covered by insurance. So talk to your doctor to see if there’s a prescription option. In one personal example, a consumer was able to get a three-month prescription from her doctor for 5% lidocaine patches, used for a back injury. The OTC cost for six 4% lidocaine Salonpas back patches is just over $10, but through insurance, she received 180 patches for $15.
4. Use online comparison tools
If insurance is not delivering the lowest price, experts suggest looking at other options, whether it’s GoodRx, SingleCare or Costco’s pharmacy. Some states are even getting in on the act — Pennsylvania has a prescription price comparison site. Joyce pointed to price-comparison services and newer pharmacy models that allow consumers to compare costs across pharmacies and purchasing options.
5. Check CostPlus
Mark Cuban's direct-to-consumer pharmacy model, CostPlus, cuts out the pharmacy altogether and offers many common prescriptions used to treat everything from acid reflux to women's health. For example, lansoprazole delayed-release (generic for Prevacid) is sold retail for $122.40, but is sold through CostPlus for home delivery for $10.75. Joyce says models like this have highlighted how inexpensive many generic drugs can be outside traditional insurance arrangements.
6. Ask your doctor and pharmacist for advice
Medical practitioners may not know what patients will pay at the pharmacy, because every patient has different insurance with different co-pays and coverage. But they may be aware of generic options, older versions with equal benefits or even if cash payment lowers the bottom line. So it's important to ask if there's a less expensive option. Doctor's offices might be able to check if a medication falls under a particular insurance before you walk out the door.
7. Contact the manufacturer
Basey says some pharmaceutical companies and nonprofit organizations provide grants or assistance programs, although eligibility may vary. Manufacturers often offer patient-assistance programs or foundations that provide reduced-cost or no-cost medications, particularly for expensive treatments. For example, Tremfya has a rebate offer online. Search for "patient assistance" programs on their site or call the customer service number.
8. Consider compounding pharmacies carefully
Compounding pharmacies prepare medications on-site and may offer lower-cost options, especially during shortages or when insurance does not cover a medication, says Joyce. They have become particularly popular for GLP-1 medications, which are often unavailable. But there are safety concerns, including some fatalities due to patient error. The Alliance for Pharmacy Compounding suggests that consumers make sure that the pharmacy is licensed and that it requires a prescription.
9. Combination vs single ingredients
Fixed-dose combination drugs are a pharmaceutical development in which multiple drugs typically taken together are packaged into a single product. For example, Symbicort is an asthma medication that combines budesonide (a corticosteroid) with formoterol (a long-acting bronchodilator). Tylenol PM (acetaminophen-diphenhydramine) would be another. Joyce said consumers often pay more for those combinations than they would if the ingredients were prescribed separately. As long as taken together, as recommended, they work the same way.
10. Be cautious of overseas options
There's no question that Americans pay more for prescriptions, even routine medications. One comparison found that the price of Humira (a heavily advertised anti-inflammatory drug) is 423% higher in the U.S. than in the United Kingdom and 186% higher than in Germany. Another example is Eliquis, which costs $550 out of pocket for 60 5-mg tablets in the U.S., vs $150 in Canada, which offers a generic version. Both Florida and Colorado have been approved by the FDA to import drugs from Canada to lower prices, but concerns about supply have blocked progress. And officials warn about online pharmacy scams. So unless you have a doctor willing to send a script and you’re willing to make the drive, ordering from another country may not be the best option.
Note: This item first appeared in Kiplinger Retirement Report, our popular monthly periodical that covers key concerns of affluent older Americans who are retired or preparing for retirement. Subscribe for retirement advice that's right on the money.
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