Choose Prescription Drugs

Prescription drugs are now the fastest-growing health care expense in the U.S.

A number of factors are fueling these increases, including the high cost of research and testing—now averaging $800 million to bring each new medication to market.* But there’s also the simple fact that, as a society, we’re being prescribed and taking more medications than in the past.

What This Means to You

As prescription drug costs rise, so do your overall costs—in the form of higher premiums. Even though many of the factors that drive prescription drug cost increases are out of your control, you can take steps to save money, get more out of your coverage, and create a healthier you. You can start by asking the right questions at the right time.

  • Ask your doctor or pharmacist about an over-the-counter (OTC) treatment. For an occasional minor ailment such as joint pain, heartburn or allergies, call your doctor’s office or visit your pharmacist and ask if you can try an over-the-counter treatment first. You’ll save money two ways—the cost of the medicine is less, and you won’t have to pay for a doctor’s visit to get the prescription. Also keep in mind that if you participate in a Health Care Reimbursement Account, you can be reimbursed for certain OTC drugs.
  • If a prescription drug is needed, ask your doctor to prescribe a generic or write “may substitute” on your prescription. Always ask your doctor if an effective generic medication is available or to write “may substitute” to allow for substitution of a generic-equivalent prescription at the pharmacy. Keep in mind that out-of-pocket costs are lowest when you use generic drugs—and you also may be able to reduce your costs even further if you ask your doctor to prescribe a 90-day supply for maintenance drugs (see below).
  • Request a preferred brand-name drug when a generic is not available. If a generic is not available, ask your doctor to prescribe a brand-name drug that’s listed in your health plan’s preferred drug formulary. A formulary is a list of prescription drugs for which your plan will pay the maximum brand-name drug benefit, so you pay less. Your out-of-pocket costs will be higher if you use a non-preferred brand-name drug.

    It’s important to take a copy of the formulary with you each time you see your doctor. If your doctor prescribes a drug, ask him or her if a less costly, equivalent drug is available for your needs. To request a copy of the formulary, contact Medco Health at 1-800-711-3460 or visit the Medco Health Web site.

  • Ask your doctor to prescribe a 90-day supply for maintenance medications. If you’re taking longer-term prescriptions (for example, medications for arthritis, allergies, birth control or high blood pressure), you can ask your doctor to prescribe a 90-day supply. You can purchase up to a 90-day supply through the home delivery pharmacy service provided by Medco Health. Also, go to the Medco Health Web site for details on how to use the home delivery pharmacy service.
  • Use your prescriptions correctly. Taking a prescription improperly can lead to reduced effectiveness, discomfort and a possible relapse of the original condition (plus wasted health care dollars). That’s why it’s always a good idea to follow the instructions that come with your prescription, and to contact your doctor or pharmacist if you have any questions.

A Refresher on Generic Drugs

So what’s the difference between a brand-name drug and a generic? The primary difference isn’t in the drug itself, but in who makes it and how long it’s been on the market. In return for its investment in developing a new drug, a company receives a patent and is the only one that can make it for a certain period of time, often 20 years. The drug carries this company’s “brand name,” and it’s priced to earn back (at least) the development cost over the life of the patent.

When the drug’s patent runs out, any company can make its “generic” equivalent, meeting the same Food and Drug Administration (FDA) requirements for effectiveness and safety. Without the development cost—and with more competition, these companies charge a much lower price for the same drug. Currently, almost half of all prescriptions are filled with generic drugs.

The good news is that generic prescription drugs have the same chemical makeup as brand-name drugs, but cost much less. And, in some cases, over-the-counter drugs that you can buy without a doctor’s prescription may work just as well as a generic or brand-name prescription drug.

*J.S. DiMasi et al., “The Price of Innovation: New Estimates of Drug Development Costs,” Journal of Health Economics (March 2003): 151-185.