PRESCRIPTION COSTS: A look at the burden and how to save

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PITT COUNTY, N.C. (WITN) - When it comes to how much Americans are paying for prescriptions, it's enough to make you sick.

Winterville resident, Sarah Hooker, 75, says she pays $280 or more per month for her prescriptions. That's at least $3,360 per year and she's not alone.

"I can't afford anymore," she tells WITN.

The U.S. is paying far more for prescriptions than any other country, with the average American dosing out more than $1,000 annually, according to the Organization for Economic Cooperation and Development.

"It's getting worse," says Richard Zech, the executive director of the Pitt County Council on Aging. "The problem is, as seniors are living longer, the quality of life in order to sustain it comes with the cost of prescription drugs. And as there are more and more prescription costs, they're really becoming a burden on people, so there is a downside to living longer and it is the prescription drugs."

"I have a heart condition, asthmatic, they told me I have a hernia, plus I have cancer, plus I'm an amputee, and arthritis, and diabetic," Hooker explains. She tells WITN her cancer diagnosis just came a few months ago.

She was a medical research tech at the Brody School of Medicine, now living off her retirement and Social Security, but says it's still not enough.

Sarah says she's been left on her own with her husband in a nursing home in Windsor suffering from severe dementia.

She says she's just fighting to stay alive. "I got to pay my electric bill to keep lights on and the heat, so I have to forfeit my medication because I can't afford both."

"I see the cutting back on medications all the time," says local physician, Dr. Thomas Ellis, the clinical director for ECU Physicians Firetower medical office.

He warns that cutting back can cause extremely serious health implications. "If I have more people out there not taking medications like they should, that means there's going to be more hospitalizations, there's going to be more strokes, there's going to be more heart attacks. All the expensive complications."

"So that's an adverse effect to everybody who has insurance," he explains.

But there are safe ways to save, starting with analyzing your health insurance plan.

"The average person doesn't know plans," Zech says. "They think, 'If I have insurance coverage, I'm covered.' The problem is, different plans cover different pills, different types of pills. There are actually plans that one will cover the tablet and one will only cover the capsule. Some do generic, some do not. Some only go up to a certain milligram, so it really depends on the individual plan."

Zech says the Medicare counselors with the Council on Aging were able to save over $1.5 million for seniors during the past open enrollment by finding them plans better suited for their prescription needs.

Another issue is your doctor typically doesn't know how much your prescription is going to cost you until you get to the pharmacy, so Dr. Ellis says the next step is getting your plan's formulary or the list of preferred drugs.

"They can be very similar drugs, but on this formulary, the preferred medicine will be a $20 co-pay and with the non-preferred, you have to pay the whole cost," Ellis explains.

He says finding a medication that treats the problem and is the most affordable option can be difficult without that formulary list. "I've even told patients to bring that formulary book every time you come to an appointment." Helping you and the doctor.

The Trump administration says the FDA approved a record number of generic drugs in 2017. "One of my greatest priorities is to reduce the price of prescription drugs," President Trump said during last week's State of the Union Address.

Ellis says one of the easiest ways to reduce your pharmacy bill is by always asking your doctor if there is a generic option.

Zech says pharmacists are also stepping up to help. "Pharmacies are being open to helping and assisting in giving ideas because these are qualified individuals who really know the different types of drugs and the different types of plans," he tells WITN.

Pharmacies like Publix that offer 14 medications for free, and they've just unveiled a new Next Best Thing to Free program where you can get a 30-day supply of 29 generic medications for $2.50, or $7.50 for a 90-day supply. Both programs are available whether you have insurance or not.

Zech is a big advocate for price shopping. "Call the local pharmacy and ask, 'How much will this cost me?'"

Unlike major chains, independent pharmacies have more flexibility to work with you on the price of your prescription. Often they'll help look for manufacturer coupons or other ways to cut costs, and because they have leeway on prices, always ask if they can beat a cheaper competitor.

Sometimes your prescriptions will cost less without your insurance. An easy way to check the cash price of your prescription is with GoodRX. It's a website and is also available as an app.

"GoodRX is a national organization that basically does a comparison shopping of kind of your local pharmacies," Ellis says. "A medicine can be $4, it could be $100 depending on the pharmacy they go to."

Independent pharmacies may not show up in your search, but GoodRX says their coupons are typically still honored at those locations. A local independent pharmacist says they may even be able to beat those prices, so again, call around and ask.

GoodRX will also help you find other coupons available and compare the price of generics.

As for other options, Ellis says, "A patient who needs a brand named drug and who's a commercial patient, it is definitely to their benefit to ask for co-pay cards, sometimes there are free trial cards."

With some medications costing hundreds of dollars each month, it pays to do your research.

"Pharmaceuticals rule the world and so, what people can really do is be good consumers, price shop," Zech says.

Currently, there are restrictions, especially when it comes to patients like Sarah Hooker.

Medicare recipients cannot use discount cards, but a senior White House official says in President Trump's new budget plan, seniors would be allowed to share in rebates that drug companies pay to insurers and middlemen, and it would expand Medicare's "catastrophic" drug benefits.