Prescription bargain hunting...

I am blessed with a GP who is willing to help me work on the best prices. She will look up things on my formulary and try to find options on Tier 1 and Tier 2. She will also make changes based on free programs (such as changing me from Advair to Dulera) and based on pill pricing (the 10 mg of baclofen is much cheaper than the 20 mg pill, so we changed my dose to two 10 mg pills at a time instead of using the 20 mg pills so I have less of an impact on my Medicare prescription spending total).

I currently use four different local pharmacies and a mail order pharmacy. At the local pharmacies, I switch between using my Medicare Advantage Plan and GoodRX coupons depending on the price. I also get three prescriptions for free using the manufacturer's patience assistance program (Celebrex, Combivent, and Dulera). All of those free ones are Tier 3 drugs and would take me to the donut hole around April if I didn't get them free, making my medication costs soar out of reach for me, being on a fixed disability income. With the assistant programs and my bargain hunting, it is November and I am still not yet in the Donut Hole.

So, right now I am considering asking my doctor about Cymbalta (duloxetine) to see if it helps with my nerve pain. I spent much of today looking it up on my formulary, calling for the price it will be charged to my insurance, seeing what it will be using a GoodRX coupon, and seeing if the manufacturer (Lilly) has a patience assistance program (it does, but I do not qualify based on my medication spending). In this case, my insurance co-pay would be $45 and the cost to insurance (charged against my medication total before reaching the donut hole) would be around $100. However, if I use GoodRX, the price will be $19.50 AND, being cash, it will not be charged against my medication total (a total win in my book). I will be taking the GoodRX coupon for Meijer Pharmacy to my next GP appointment to ask if it is time that we add Cymbalta to my drug regimen.

For the newbies to the Prescription Bargain Hunting game, to sum, the things I do are:

1) Ask the doctor for other options in that drug class in case I find a cheaper one when I do my drug pricing research.

2) Look to see if there is a manufacturer patient assistance program or coupon for my drug and for the other option drugs. The programs usually based on some combination of insurance (or lack thereof), income, and total prescription spending.

3) Check my formulary for my drug's tier and then look up the similar options to to see if there is a cheaper tier. I asked my insurance company for a stand alone copy of the formulary and bring it to all my medical appointments.

4) Check GoodRX to first see if there is a price different between the pill sizes to see if there is savings to be had by taking more pills at a lower dose (like two 10 mg pills to get a 20 mg dose). Then I look to see if the coupon prices are lower than my co-pay. Finally, if I am going to be using the GoodRX coupon, I check to see which pharmacy is lowest at the dose I will be taking.

5) For my maintenance drugs, where possible I try to get 90-day supply from the mail order pharmacy. This is because Tier 1 and Tier 2 drugs are free in 90-day supplies on my Medicare insurance. Many insurance companies have a mail order pharmacy that is cheaper in 90-day supplies. However, my mail order pharmacy is always more expensive where I have co-insurance (a fluctuating amount usually based on a percentage) instead of a co-pay (a fixed amount). So, I only use it for Tier 1 and Tier 2 drugs where they are free. Thus, it is important to do some research on the cheapest way to use your specific mail order program.

5) Every time I get a refill and that refill will be using insurance, I double check GoodRX to see if the cash prices are better because drug prices can really fluctuate. If I am already using GoodRX, I do another search in case switching pharmacies will save money. For example, last month the hormones I take dropped from $15.27 to $9.80.

6) To every doctor appointment, I bring a chart of all my medications that shows where I buy them so that when I need refills sent, I know what location/method is the cheapest. I also bring a copy of my formulary in case we need to look up new medications.

7) For every new prescription where I will be using GoodRX, I get a paper prescription so that I can bring the coupon with me. If the doctor's office hems and haws about paper because their policy is to use electronic prescriptions, I very calmly and bluntly say that the only way I can afford that particular medication is using GoodRX and when starting up a new prescription with a pharmacy paper is best ... the smoothest process. I've never had a doctor refuse to give me paper once I start talking about trying to afford my medical expenses. Once GoodRX is in a pharmacy system, the coding will stay on the refills. But if you have a new prescription because you are out of refills, it is best to get a new paper prescription instead of having that new prescription called in so as to avoid the problem of having the new prescription run through on insurance instead of GoodRX, even though it was run through on GoodRX previously. Insurance seems to be the default entry of most pharmacy computer systems.

This is exhausting, but it is necessary if you are on a fixed budget.  And, to me, it is really necessary for anyone looking to save on their prescriptions.  Unless your co-pays are really low on the upper tiers of your plan, checking out GoodRX is prudent.  I have saved ever so much money using it even with prescription coverage.  And, with the two prescriptions I have that are not on my formulary, GoodRX saves me a substantial amount each and every time I pick them up, especially the benzonatate.

I am grateful that I found an more economical way of paying for cymbalta should my GP choose to go that route with nerve pain control.  GoodRX is $24.50 cheaper, per month, than my Medicare Advantage Plan insurance.  Of course, I would be even more grateful if the nerves shocking me would stop!  SIGH.

I've said it before and I'll say it again:  dealing with chronic illness is the work of a graduate degree.  Really, it is several graduate degrees, such as Prescription Management, Insurance Claims Management, and Illness Specialities.  When you battle chronic exhaustion, working up the energy to throw yourself into the prescription or claim or treatment fray is daunting.