Lowering Prescription Costs: A Practical Checklist
Lowering Prescription Costs: what is worth doing, what is worth avoiding, and when to stop and see a doctor.
Practical ways to pay less for medicines, including generics, plan formularies, 90-day supplies and assistance programs. People who cannot afford their medicines often skip doses or stop them, which can make a condition worse.
Key takeaways
- Generic medicines: FDA requires them to have the same active ingredient, strength, dosage form and route as the brand
- Formulary: your plan's list of covered drugs, usually grouped into cost tiers
- Most useful single change: Ask your doctor or pharmacist whether a generic or lower-tier alternative would work for you.
- Commonest mistake: Skipping doses or splitting pills to make a prescription last without asking your doctor.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
Do
- Ask your doctor or pharmacist whether a generic or lower-tier alternative would work for you
- Check whether a 90-day supply or mail-order pharmacy lowers your cost
- Ask the pharmacist to compare your insurance price with the cash price
- Ask about manufacturer patient assistance programs if you cannot afford a brand-name drug
Do not
- Skipping doses or splitting pills to make a prescription last without asking your doctor
- Buying medicines from websites that do not require a prescription
- Switching to a different drug on your own because it is cheaper
The numbers behind the list
The list is built from the numbers below, which come from the bodies cited at the end.
| Measure | Figure |
|---|---|
| Generic medicines | FDA requires them to have the same active ingredient, strength, dosage form and route as the brand |
| Formulary | your plan's list of covered drugs, usually grouped into cost tiers |
| Prior authorization | some drugs need approval from the plan before it will pay |
| Exceptions | you or your doctor can ask the plan to cover a drug that is not on the formulary |
| Medicare insulin | covered insulin costs no more than $35 for a month's supply under Medicare |
If you change one thing
Ask your doctor or pharmacist whether a generic or lower-tier alternative would work for you. If you only change one thing, make it that.
Related topics
- What the Guidance Really Says About Part D and Extra Help (Medicare and Medicaid)
- What the Guidance Really Says About Benefits and Financial Support (Long-Term Conditions)
- Low-Cost Healthy Eating: What the Evidence Actually Says (Healthy Recipes)
- The Evidence on Travel Insurance and Healthcare Abroad, Without the Hype (Travel Health)
Where to go next
- Lowering Prescription Costs: Just the Figures
- Lowering Prescription Costs: What Published Guidance Supports
- Lowering Prescription Costs — the reference entry
- Health Insurance: The Complete Guide
- Hospital Financial Assistance: Sorting the Evidence From the Noise
- Premiums, Deductibles and Copays: What the Evidence Actually Says
When to speak to a doctor
Tell your doctor if you cannot afford a medicine rather than stopping it, since stopping some medicines suddenly is dangerous. Call 911 for chest pain, trouble breathing or a severe allergic reaction, and call Poison Control at 1-800-222-1222 if someone takes too much of a medicine.
Where this comes from
- FDA — Generic Drugs: Questions & Answers
- Medicare.gov — How Medicare drug coverage works
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.
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