Lower Cost Prescription Drug Options

Mail-Order & Online Options

Given their favorable prices, you might want to consider mail-order/online stores—especially for prescription drugs, where their price advantage is greatest.

There are also advantages to mail-order/online buying other than price. Delivery may be an important convenience which is of particular value for persons who are disabled, are too sick to travel to a local store, or lack the time to make regular trips to a store for maintenance drugs. In addition, if you use one of the more user-friendly pharmacies, you will be able to access the firm’s Web site 24 hours a day, find information about specific drugs and drug interactions on the Web site, and ask the pharmacist questions by e-mail. With e-mail, you can avoid asking embarrassing medical questions in public and you’ll have a written record of the pharmacist’s answers.

But mail-order and online pharmacies are useless if you need a drug immediately and can’t wait for it to be shipped. Also, controlled substances might not be available through the mail-order or online pharmacies. In addition, consumers who have a personal relationship with a local pharmacist or who want to support a nearby independent drug store might prefer not to buy prescription drugs through the mail.

If you do decide to try mail-order or online buying you’ll find variation in how the firms work. Some expect you to make all inquiries and orders by phone or mail; some have Web sites that provide information on prices and products but don’t take orders; some expect you to get all the information you need from their Web site and place your order on the Web—though most of these have phone numbers you can call with questions or to place an order. Most mail-order and online stores expect you to have your purchased items shipped to you, but with CVS.com, you can pick up your order at a local CVS store, and Drugstore.com has a similar arrangement for pickup at local Rite Aid stores.

If you decide to use an online pharmacy, here is the typical process after you connect with the firm’s Web site. First you fill out a patient profile, giving the firm information needed to fill and mail a prescription, such as medical conditions and allergies, current medications, credit card information, and address. Next, if the medication will be covered by insurance, you provide information on your coverage. The pharmacy will then check whether it accepts your insurance plan; this might take as much as several days. If it does accept your insurance plan, it will bill you for copayments and charge the remainder to your insurance provider; if not, it will inform you that your plan is not accepted and ask whether you still wish to order and be charged for the full amount of your medications.

Keep in mind that even if a mail-order or online pharmacy has no special relationship with your insurance company, you may be able to order from the pharmacy and then get partial reimbursement from your insurance company; you will simply be responsible for the same types of deductibles and coinsurance that apply if you use a non participating local pharmacy.

Once insurance coverage questions are answered, you will need to get the actual prescription to the pharmacy. Online pharmacies usually offer several options: you can mail or fax the prescription to the pharmacy; the pharmacy can call the doctor for verification; or the doctor can phone or fax the prescription to the pharmacy. If you would like to have an existing prescription transferred from another pharmacy, the online pharmacy will usually call your current pharmacy or will accept the prescription by phone or fax from the other pharmacy.

Getting a refill of a prescription you have previously filled with a mail-order or online pharmacy is simpler than getting the prescription filled initially. At CVS.com, for instance, you just enter a prescription number at the site’s refill area. When you need a refill at DrugEmporium.com, you go to your profile on the Web site, see a list of your prescriptions, and click on any you want to refill.

For standard shipping, which is typically three to five business days, many online pharmacies charge $5 or less. Several online pharmacies (including CVS.com, Drugstore.com, and PlanetRx.com) have free standard shipping for orders that include prescription medicine. Two-day shipping will cost you about $6 to $7, and overnight delivery starts at about $10.  Look for special promotions for reduced or free shipping.

If you need medicine right away, be sure you know what the firm means by "two day" or "overnight" shipping. Often overnight means the next business day. Also, some online pharmacies warn that verifying a prescription may take several days if the doctor or other pharmacy is hard to reach.

With hundreds of online pharmacies, how should you decide which to use? Not all online pharmacies deserve your business. Some have sold unapproved drugs, mislabeled drugs, or phony versions of medications.

The Food and Drug Administration (FDA) offers the following guidelines (see www.fda.gov). Don’t deal with a pharmacy that will sell prescription medicine without verifying a doctor’s prescription. Make sure that the online pharmacy has a registered pharmacist available to answer questions. Be certain that the online pharmacy is located in the United States since foreign-based online pharmacies may sell drugs that are not up to the FDA’s quality standards and these pharmacies might not be so easily disciplined if they cheat consumers. Avoid online pharmacies that sell unapproved drugs or claim to have "miracle cures." You are encouraged to report suspect online pharmacies to the FDA at www.fda.gov.

To be certain you are dealing with a legitimate online pharmacy, the FDA suggests checking whether the firm has gone through the certification process sponsored by the National Association of Boards of Pharmacy (NABP) to become a Verified Internet Pharmacy Practice Site (VIPPS). This voluntary certification program was started in the spring of 1999. To become VIPPS-certified, an online pharmacy must be licensed in good standing in all states in which it does business, undergo an inspection by NABP, and meet standards for such things as filling prescriptions, shipment of drugs, and patient confidentiality. Certified online pharmacies display the VIPPS seal on their Web sites. You can confirm that an online pharmacy has VIPPS certification by contacting the NABP at 847-698-6227 or by checking the NABP Web site (www.nabp.net). As we go to press, four online pharmacies have been certified.

Since VIPPS certification is voluntary, there have been proposals for legislation mandating consumer protections. One budget proposal calls for requirements that all online pharmacies get FDA approval in order to operate. The proposal also calls for fines of up to $500,000 each time a prescription medicine is sold without a valid prescription.

To ensure your privacy and safety when shopping for drugs or any other product online, keep your passwords secret, change them often, and use different passwords for different online sites. Be sure that a site has a privacy policy; read the policy to find out what information the firm collects, how the information is used, and whether you may restrict how your information is used. Order only from Web sites with secure servers; you’ll see an unbroken key or padlock pictured at the bottom of your browser’s screen that will indicate when the site’s server is secure. Pay by credit card. After making a purchase, print out the order information that appears on the screen, just in case your order arrives late or not at all.

Even among legitimate online pharmacies, it’s worthwhile to compare site quality as well as prices before choosing a firm to use. Some sites have extensive information resources, including detailed information on each drug, available in an easily used format. Some have simple, streamlined ordering procedures. Some provide prompt, helpful answers to your questions either by e-mail or by phone. Others fall short on all these features. You will form judgments of the sites with a quick visit to each. Keep in mind, of course, that you can use one site for information and a different one for your purchases.

Saving with Generics and Substitute Brands

As important as picking a low-priced pharmacy is picking a low-priced product at that pharmacy. You can save by purchasing "generic" prescription drugs and by selecting the cheapest comparable brand for health and beauty care products.

Nonbrand, or "generic," alternatives are available for many popular brand name prescription drugs. Prices for these generics typically beat brand name prices by 30 percent or more, and sometimes by well over 60 percent.

For some drugs, there is no generic alternative. These usually are drugs that are still protected by a patent. A drug patent, which can last a maximum of 17 years in most cases, gives the developer of a drug a monopoly and thus an opportunity for substantial profits. The intent is to give manufacturers an incentive to develop, test, and bring to market new drugs. Only after the patent expires can other qualified drug manufacturers begin producing the drug.

Very likely your doctor will write your prescription using a brand name. This name is usually shorter and easier to remember than the generic name, which is simply the chemical name of the compound. Also, the brand name is likely to be more familiar because that was the name used for many years before generic substitutes became available.

Your pharmacist is legally permitted to substitute a generic drug even if your prescription names a brand name drug unless your doctor specifies that only the named brand is to be used. But not all druggists make such substitutions. To be sure of getting the best-priced alternative, tell your doctor to write your prescription so that it allows generic substitution; then tell your pharmacist that you want a generic if it will save you money.

You might hear industry propaganda about the risks of generic substitutes. Ignore this propaganda. The large drug companies that develop patented drugs just want to hang onto their big profit margins long after the patents have expired.

To be approved by the U.S. Food and Drug Administration (FDA) as therapeutically equivalent to an already-approved brand name drug, a generic substitute must differ only in such superficial characteristics as color, taste, tablet shape, and packaging. The FDA says a generic must:

• Contain the same active ingredients (inert ingredients may vary).

• Be identical in strength, dosage form (tablet, solution, and so on), and route of administration (for example, taken by mouth or injected).

• Be used generally for the same illnesses with the same precautions, warnings, and other instructions on the label.

• Be bioequivalent. That is, based on test results provided to the FDA, it must release the same amount of drug into the body at the same rate and affect the body in the same way as the brand name drug.

Along with the results of bioequivalence studies, a generic drug manufacturer must submit details about its manufacturing plant and personnel, and how it will make the drug. FDA inspectors visit the plant to determine whether it has the capability to produce the drug properly, and samples of the drug, from the plant and from the marketplace, are tested periodically in an FDA laboratory to ensure they meet appropriate standards.

Not only must each generic drug meet FDA requirements; so must each drug company. All drug manufacturers, including those that manufacture only generics, must register with the FDA, must inform the FDA of any reported adverse reactions to their products, must be open to periodic FDA inspection, and must follow the FDA’s "Good Manufacturing Practice" regulations. In fact, most generic drugs are manufactured by the very same big manufacturers that make brand name drugs. In some cases, a single manufacturer makes both the brand name drug and a generic substitute; it simply makes a bigger profit on the former.

According to experts at Consumers Union, the only note of caution regarding generics is that there are a few "critical" drugs for which there is a narrow range of blood levels at which the drug goes from being ineffective to effective to toxic. These drugs, Consumers Union has said, include digoxin (Lanoxin), and levothyroxine (Synthroid, Levothroid). The slight change (up or down) in strength that might result from shifting from a brand name to a generic substitute for one of these drugs warrants the monitoring of blood levels at the time of the switch. Discuss this point with your doctor. But for the vast majority of drugs, there is no reason not to switch to a generic and save.

Other Ways to Cut Costs

Although your major savings will come from choosing the right pharmacy and buying generics and store brands wherever possible, a few other steps may help you reduce your costs still further—

• If your needs are small, ask your doctor for free samples. Your doctor frequently gets samples from manufacturers’ sales representatives and may be willing to pass some along to you.

• If your doctor approves, buy in quantity. The per pill cost for 90 pills is often less than that for 30 pills. For instance, when we checked prices on Premarin (.625 mg), Prescriptions By Mail was selling 30 tablets for $17.74 ($.59 per tablet) and 90 tablets for $43.22 ($.48 per tablet). If you know you’ll be taking a mainteance drug for months or years, ordering in quantity makes sense. But remember that medications deteriorate over time.

• Don’t feel you have to buy drugs from your doctor. Some doctors dispense drugs (at a fee) directly to patients, cutting out the drugstore. This is a source of additional income for the doctor and may save you time, but be sure to compare the doctor’s charges to what you’d pay at the drugstore. Also, be aware that this practice injects a new conflict of interest into your relationship with your doctor, since prescribing more medicine makes the doctor more money.

• Be sure to ask for a senior discount if you qualify. Most of the local stores we surveyed offer senior discounts, usually 10 percent off the prices.

• Be sure to use all of the insurance coverage you are entitled to. In many cases, stores participate in plans that allow you to pay nothing or only a small copayment while the store collects from your insurer. If you have one of these plans but don’t purchase at a participating store, be sure to submit a claim to your insurance company for at least partial reimbursement.

• Ask your doctor whether a lower priced drug will work just as well. When a new drug is released, it is often heavily marketed to doctors and widely discussed. A doctor may prescribe it just because it is on his or her mind although a cheaper, older drug— possibly even one that has a generic substitute— might be equally effective. An established alternative might also be less risky since its effects might be better known.

• Ask about nondrug alternatives. It might be that weight loss, reduction of salt intake, drinking more fluids, or some other change in your habits can be tried as an alternative to drug treatment.

• If you’ve been taking a drug for a long time, ask your doctor if continued use still makes sense. Sometimes doctors simply forget to stop the use of drugs after a long-term problem has been relieved.

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