Articles Cost & Spending Healthcare

Shopping For Medications

Medications aren’t expensive but they are marked up quite a bit and their actual price is often kept hidden from the patient and even physicians. When shopping for medications there are 2 important points to keep in mind, 1) is the prescription necessary, 2) what’s the best price you can get.

Wasteful Overuse of Prescription Medication

We overprescribe, overmedicate, overtest, and overtreat quite a lot in Western Medicine. You might read that and say “What?! I’ve been trying to get an MRI forever!” And while individual cases vary, at least 50% of what we do in medicine is considered unnecessary.

This particularly includes prescription medications, surgeries, and chemotherapy. Many of these interventions aren’t based on solid evidence and may cause more harm than good. This is why patients who are shopping for medication find themselves in unaffordable situations.

Determine Necessity

On my LinkedIn channel I talk a lot about determining the actual need for a patient and making sure we do less, not more. Why? Because medical interventions are designed to be highly effective and, therefore, must cause a lot of harm if overused.

Who needs what test? When? What medication do they need, for how long?

These aren’t easy problems to solve because our medical research is biased toward interventions, defensive medicine, and billing for interventions.

Do my patients need a statin drug for their cholesterol? If so, which one, at what dose, for how long? What are non-prescriptive alternatives, and how likely are they to succeed?

Medication Price Shopping

Prescription drugs come in brand name and generic. Unfortunately, there is very little transparency in the quality of these medications. Except for brand name drugs, the generics are often manufactured overseas and the goal is to minimize overhead so cutting corners and lack of FDA oversight is common.

Assuming that most generics are fairly equal in quality, the patient should shop for price. Some drug manufacturers follow much better manufacturing guidelines, and if you can figure out who they are, it’s definitely worth paying a little more for those drugs.

When shopping for price, it’s important to have as many resources available and understand what you’re getting. In the patient resource section here at Digital Nopmd Health, I’ve compiled a few of my favorite pharmacies where patients can shop for affordable prescriptions.

Price Markup By Insurances & Pharmacies

A recent example was a steroid cream called clobetasol propionate (generic) or Clobex (brand name). Clobex is manufactured in Switzerland and has high manufacturing standards. At least 10 different pharmacies manufacture generic clobetasol propionate.

My patient went to the pharmacy to pick up generic clobetasol and was told that this cream would cost $298. Instead, the pharmacy said the patient could have a different steroid cream for $45.

The problem here is a middleman phenomenon called PBMs. The insurance company hired the PBM to negotiate a specific medication for a certain price into their list of accepted prescriptions, and anything outside of it is quoted as absurdly high even though the pharmacist knows the drug’s cash price might be much lower.

At Cost Plus, for example, clobetasol costs less than $20. Even cheaper versions are available, such as the cream, for half the price.

Medication Access Specialist

I didn’t know such a term existed, but medication access specialists help their patients navigate the complex, expensive landmine of drug prices.

I do the medication price shopping for my patients when we decide that they need a specific medication forever. In most cases, the patient chooses to get these medications from online pharmacies in the US or Canada.

Communication With Your Doctor

Here at DNH, we don’t deal with insurance, but we tell our patients that the big-name pharmacies usually don’t have the most affordable drug prices.

Should you get a prescription for a particular medication, it’s good to ask your doctor for a few alternatives. For example, blood pressure can be lowered with quite a few drugs and though I have some personal preferences, I’m quite comfortable recommending alternatives, when appropriate.

The Medicine You Don’t Take

It’s so easy to go down the medication path in Western Medicine. Don’t get me wrong; your doctor is likely well-intentioned, and it’s what they know how to do best. But when an auto-immune drug can cost tens of thousands of dollars a year, if not hundreds, we must consider what our patients deal with on the payment front.

Is this prescription absolutely necessary? What are all the alternatives my patient can consider? Will their overall health improve because of this medication?

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