How to cut your prescription costs by getting better coverage

By Diane Lee

(SPARTANBURG, SC)

Does it feel like every time you go pick up your prescription it costs a little more?

You’re not alone.

In fact, the latest AARP study finds the average cost of most brand name drugs doubled in just seven years.

Most insurance companies have had to make changes in what they cover to keep up. But there are steps you can take to fight those changes, and lower your drug bill.

Dawn Wilson in Anderson has been taking an anti-depressant and a sleeping pill each day since her soldier son, Matthew died.

“After they knocked on my door it was like, oh my God my son is dead. And I have trouble sleeping because I don’t want to go to sleep because I know when I wake up he’s not going to be here.”

This month she discovered the cost of two of her drugs jumped by a combined $70 a month. That’s $840 a year.

“I was so upset and I was like, OK, why is it going up?”

“The answer is the insurance companies are struggling to control the costs,” said Hank Steinberg, a healthcare consultant in Spartanburg.

He says providers are reacting to rising prices set by brand name drug makers. They are having to change coverage to lead you to less costly drugs.

But there are ways you can work around that.

1) First step, see if you can switch to a comparable drug that is favored by your provider.

2) If there aren’t other drugs that work, ask your doctor to request what’s called a “prior authorization” from your insurer.

We asked Steinberg, “They will consider it if there aren’t?”

“Absolutely. They’re not trying to be mean. They don’t get paid a profit because they’re cutting people down,” he said.

3) Now some plans may require that you go through something called “step therapy” first which is where you take lower cost medications for that condition, and then your doctor makes the case on whether they work or they don’t before getting prior authorization.”

4) If that doesn’t work, you can even file an appeal, again with the help of your doctor.

“This will definitely help me get the cost down one way or another,” said Wilson.

Even if an appeal is denied, you have one more step you can take to get the drug you need covered.

You can file for an independent review with either the state insurance regulator or the Department of Health and Human Services, which will make the final decision.