A checklist and a new (to us) tip
Getting Meds for Less, part two: Order of Operations
Hey there,
Welcome to part two of our series summing up what we’ve learned about getting prescription meds for a price you might be able to afford — all based on your stories and tips.
Last time, in part one, we went straight to the deep end: If you’re stuck without help from insurance, can you find a decent price online? And we built a tool you could use to compare your options.
Here, we’ll back up a little and run through a checklist, distilled from your tips. It’s a pretty-good, efficient order of operations — because there are so many avenues to look down, it can be hard to know where to start.
And this checklist ends with a tip that was new to us.
To preview, it looks like this:
Check online for a quick fix (really).
If that doesn’t work…Ask your pharmacist — and your doctor — for alternatives.
And if that doesn’t work…Ask your doctor for help fighting insurance.
And — this is the new tip — for samples that can buy you time while you fight.
As always: NONE of this may work well for you. Our whole system is designed to suck money out of you, and to make it hard to get what you need.
But thanks to your contributions, we’ve got this roadmap to make the process less random and frustrating.
Check the internet for a quick fix
For generic drugs, the resources we talked about last time — GoodRx and its competitors — are worth a quick look, even if you don’t fill out a whole spreadsheet.
For brand-name drugs, manufacturers often offer coupons that can actually knock your out-of-pocket price down to something affordable.1
They’re generally not hard to find — just googling your drug’s name plus “coupon” or “discount card” will pull it up — and you can often download them with no fuss.
This won’t always work, for lots of reasons:
You’ve gotta have insurance, and it can’t be from Medicare, Medicaid, Tricare, or the VA.
Your insurance company may have put up roadblocks that more or less cancel these coupons out.
Your particular drug just may not have a decent coupon.
But it’s all worth checking. Your pharmacist can also help you figure out if a given coupon will work with your insurance.
Ask your pharmacist — and your doctor — about alternatives
For most conditions, your insurance should offer some medicine — another brand, or a generic — something. And your pharmacist should be able to tell you what that would be.
Then you want to know: Will this alternative work for me?
You may already know the answer is “no” — for instance, if you’ve got a chronic condition and have already tried the alternative.
But otherwise, you’re gonna want to ask your provider.
I know: Actually getting a response from your provider? That can be easier said than done.
But here’s an example of how helpful it can be — from the listener whose story (and process) inspired this order-of-operations checklist.
Jeanne’s husband got prescribed two antibiotics for a gut infection. With his insurance, one of them would be relatively cheap — $30.
The other one would be $1,200. His insurance didn’t cover it at all.
Jeanne went through Step 1 and did a quick web search, which turned up a “bargain”…for $800. Ugh.
On to step 2: Call the doc. Who said: Actually, you can probably skip the $1,200 med.
(Jeanne says her husband did just that, and did just fine.)
So, yep! Worth the call.
But if this step doesn’t fix the issue — if your provider doesn’t think the expensive drug is skippable, and that your insurance company’s preferred alternative won’t work for you — you’ve now got a head start on step 3:
Ask your doc for help — two kinds
You’re already talking with your provider, and now you’ve got two questions for them.
The first will probably sound familiar: Will you help me fight the insurance company here?
Your insurance company may require a “prior authorization,” or maybe they just say they don’t cover this drug at all.
Hence, the fight: You’ll need your doctor to write letters of medical necessity, fill out appeal forms, whatever it takes.
For some providers, this whole thing can be routine, but if your case looks like a big fight, check out our tips on getting ready for war.
But all of this fighting will take time, and meanwhile, you need medicine.
Enter our next tipster: A drug-company sales rep! We’ll call him John.
The new (to us) tip: Ask for samples
He says: Ask your provider if they can get free samples from the drug company — from a rep like him — to tide you over while you fight.
Some hospitals and medical practices don’t allow providers to meet with pharma reps, to prevent any possibility of bribery or other sneaky stuff.
John says: No problem. A provider can use the pharma company’s website to request samples, no human contact required.
Like everything else, this may not work. Some companies don’t give out samples, for instance.
And like everything else, it’s worth knowing about. We never would have known if we hadn’t asked for your input.
You sent us so much, it’s gonna take two more installments of First Aid Kit to share the rest. More next week.
Till then, take care of yourself.
— Dan
Of course, they don’t do this to be nice. They do it to make money. We’ve looked before at how pharma companies and insurance companies are both sharks. And at how these coupons make drug companies money, at everyone’s expense. For more enraging (and entertaining) detail, we made this podcast episode all about it.