Prescription Cost Savings

If you feel like you pay too much for prescription drugs, you’re not alone. Bloomberg reports that people in the U.S. spend $100 per month on average, and cancer patients face medication costs up to 100 times higher. Prices continue to rise each year, making it increasingly important to look for prescription cost savings. Here at Sustain Meds, we can help!

Pharmacy Prescription Cost Savings

Drug expenses vary significantly depending on the brand, insurer, insurance plan and pharmacy. The same five medicines sell at prices ranging from $66 to nearly $900 at different drug stores, according to Consumer Reports. Don’t expect every pharmacy in a chain to charge the same amount; you might pay a much higher or lower price based on the specific location. Costs even differ at stores in the same county or city.

Some types of pharmacies tend to offer more affordable pricing. They include supermarkets, warehouse clubs, online sellers and independent drug stores. Retailers often charge less if they have low overhead expenses or sell a wide range of products (and don’t rely on a pharmacy as their main income source). You’ll probably pay somewhat less at a warehouse club if you’re a member. Still, certain medications remain quite expensive regardless of what store you choose. Discount pharmacies have to charge substantial amounts when drug manufacturers demand exorbitant prices.


Another complicating factor is that drug stores don’t necessarily offer everyone the same rates. Many insurers negotiate agreements with “preferred” pharmacies. The insurance companies receive discounts in exchange for urging their customers to use these stores. Consequently, you’ll probably have a smaller co-pay if you select one of your insurer’s preferred pharmacies when you need medications. Other ways to reduce the price include coupons, retail discount programs and larger purchases. It frequently costs less to buy 90 days’ worth of pills rather than a one-month supply.


Prescription Costs and Co-Payments

Occasionally, it makes sense to pay in cash regardless of your health coverage. Why? Around one out of four customers spend more money on co-pays than it would cost to buy a medication without insurance, according to PBS. Another option is to apply for a drug manufacturer’s patient assistance program. You’ll probably be eligible if you have relatively low earnings and don’t possess insurance that covers your medication. Some patients also qualify for prescription-focused government assistance. For example, New York’s EPIC program helps seniors with low to moderate incomes.

Many individuals can benefit from negotiating with their insurers. If an insurance company refuses to cover a prescription drug, you could appeal the decision. While this isn’t a simple task, it’s often rewarding. Insurers approve over half of the appeals they receive. You might reduce a burdensome co-payment by requesting a tier exception. Each insurer categorizes specific drugs into different tiers, and customers face larger co-pays when their medications have higher tier numbers. Your health plan’s formulary may consist of up to seven tiers.

Some insurance companies also expect members to pay prescription drug deductibles if they take high-tier medications. This makes it even more beneficial to use low-tier drugs when possible. If you don’t have this option, a tier exception could result in considerable prescription cost savings. Insurers sometimes approve requests to reassign medicines to lower tiers. For instance, a tier-four drug will usually cost at least $65 less if it moves to the third level. A medication that shifts to the first tier may have no out-of-pocket expense.

Expert Assistance for Prescription Cost Savings

You might need help navigating these complexities. Insurance companies reject about nine out of 10 tier-exception requests. It also takes extensive research to determine what pharmacy, discount membership, coupon or assistance program would yield the lowest cost. Most people don’t have the time and expertise needed to attain optimal results. A prescription savings expert can quickly find the best solution, potentially eliminating your out-of-pocket expenses or reducing them by hundreds of dollars per month.

Sustain Meds provides a range of personalized services that could help you afford vital medications. We serve insured and uninsured clients as well as Medicare recipients. Our professionals assist customers with tier exceptions, appeals, prior authorizations and more. If you’d like to benefit from these services, please fill out our case form to get started. You only need to enter your contact information and answer five simple questions. We offer free consultations, so you’ll quickly find out how we can help you achieve prescription cost savings.

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Sustain Meds is a leading Authorized Representative that acts on the patients behalf to ensure their prescription treatment plan issued by the doctor has the best chance of getting through the administrative process.