5 ways to save on prescriptions.
At some point in life, the odds are pretty high that you’ll see a doctor and receive a prescription to soothe, clear up, prevent or help control whatever is ailing you. The right medication can improve your quality of life in profound ways.
That same medication can also drain your bank account.
Approximately a quarter of adults taking a prescription drug said it was challenging to afford their prescription drug medications, as reported in the 2023 Kaiser Family Foundation (KFF) Health Tracking Poll.1 The high cost of medication was cited as the reason approximately one in five people chose not to fill their prescription at all, and the reason one in 10 people cut pills in half or skipped doses, according to KFF.
Here are cost-saving tips and ways to maximize your pharmacy benefit—without skipping refills or cutting doses.
1. Understand how your insurance works.
If you’re hoping to pay the lowest prescription drug price, it helps to have a basic understanding of how your health insurance works. Under the Affordable Care Act, all health insurance plans are legally required to include coverage for prescription drugs, but that doesn’t mean all plans work the same way. The prescription drugs included in your benefits plan, and how much of the cost is covered, depends on the plan’s formulary. A formulary is a list of generic and brand-name prescription drugs covered by your health plan. What you’ll pay for a prescription depends on how drugs are classified within tiers.
Different prescription drug tiers
According to the Patient Advocate Foundation, the tiers are “determined by cost of the drug, the cost of the drug and how it compares to other drugs for the same treatment, drug availability, clinical effectiveness, and other cost factors, including delivery and storage.”
- Tier 1: Generics and some lower-cost brand products (typically the least costly at the pharmacy)
- Tier 2: Brand-name drugs that are typically more affordable and some high-cost non-preferred generics
- Tier 3: May include some high-cost generics
With many plans, you pay a price—commonly referred to as a copay—when you pick up the prescription from the pharmacist. The amount you pay depends on your plan, the formulary, the deductible—if your plan has one—and other variables. High costs, with some plans, can be avoided when an equally effective generic alternative exists. This lowest-net-cost philosophy can help drive down costs for employers and employees.
With some plans, you have to meet an out-of-pocket deductible before your health insurance starts paying for covered prescriptions. And some health plans have a separate deductible for prescriptions than for other health care services. Your plan’s Summary of Benefits and Coverage will often detail what’s covered, requiring a fair amount of research on your part.
If you don’t have the time or energy to print out a formulary, there are plans that do the research for you. “With Surest, you can type in a medication and find out within seconds if a prescription drug is covered, find out if there’s a generic prescription drug equivalent, and find out the cost,” explains Giovanni Gioia, Surest pharmacy lead. “It’s that easy. You can validate coverage before you even have a prescription service rendered.”
This can help you avoid surprise costs.
2. Don’t pay more than you have to pay.
Is a prescription less costly at an independent pharmacy? A grocery store? A big-box retailer? A mail-order pharmacy? There can be a pretty big variation in prescription drug prices from one vendor to another. Why? The short answer is that different pharmacies charge different prices for the same medications.
“This is known as generic spread,” Gioia explains. By shopping around and comparing prescription drug prices, you may have the potential to save money—sometimes a lot of it.
Shopping and comparing is part of the Surest plan design. When members check prices in advance and compare options, they’re empowered to choose pharmacies “that historically charge less for the same medications,” he says.
Be your own advocate. Do some shopping beforehand. Use competition to your advantage.
3. Ask about alternatives.
There’s no hard and fast rule that generics cost less. Some brand-name medications are actually cheaper than generic medications, Gioia says.
How would someone know that?
“With the Surest plan, our philosophy is to promote the most cost-effective drug on our formulary,” he explains.
And if a drug isn’t covered, seek out alternatives with your physician. Bring your cell phone to your appointment and use the Surest app to check drug prices in real-time. Being able to use technology to your advantage—in the moment, during a conversation with your provider—“is the definition of personalized health,” Gioia says.
Another way to get cost-saving tips? Ask a pharmacist. He comments, “I don’t think most people realize that pharmacists can answer questions about less expensive alternatives.”
4. Find a health plan that values transparency.
When it comes to how prescription drug prices are set, and how savings are factored in, price visibility is crucial. Without it, hidden expenses can easily drive up costs.
Within the supply chain, pharmacy benefits managers negotiate rates on behalf of health insurance plans, then work closely with pharmacies and manufacturers to secure prescription drug prices, rebates and discounts. The idea is that these companies then pass the savings along.
But that isn’t always the case.
It’s not uncommon for some pharmacy benefits managers to charge companies more for their prescriptions (generic spread), sometimes exceeding the value of the drug. For example, a medication could cost $10. The copay could be $50. The extra money is sometimes referred to as a “clawback,” because that money is “clawed back” to the pharmacy benefits manager—defeating the purpose of insurance.
Other signs of a transparent health plan:
- Knowing the thought process behind what drugs are covered and why (hint: data science and analytics should play a large role in determining pharmacy prices.)
- Charging less for proven treatment methods
- Requiring new, high-priced FDA-approved drugs to undergo clinical formulary review before added to the formulary
- Giving people the option of safely self-administering injectable and infusible drugs from the convenience of home vs. a medical outpatient setting
5. Recognize the power of positive lifestyle changes.
There’s no arguing that medication can be invaluable in giving some people the best chance of improving their health. In many cases, it can also be invaluable to address the root cause of certain preventable chronic conditions and the roles that nutrition, physical activity and emotional and psychological factors can play in positively affecting quality of life.
According to the World Health Organization, between 30-50% of cancers are preventable by healthy lifestyle choices.2 Positive lifestyle changes can even reverse certain diseases, including type 2 diabetes, according to results found during the Diabetes Remission Clinical Trial.3
Small lifestyle changes can make a big impact:
- If you have a sedentary job, get up frequently. Set a timer for every hour to remind yourself to stand and stretch. Take a short walk around the block. Drink more water. (You’ll be forced to get up.) A study published in the British Journal of Sports Medicine found that participants who sat 12 or more hours a day had a 38% higher risk of death than people who sat eight hours a day.4 The good news, though, is small amounts of physical activity—just 22 minutes of activity a day—eliminated that risk altogether.
- Quit smoking. According to the American Lung Association, smokers have a better chance of quitting if they address the three-link chain of physical, mental and social components of smoking addiction. Wanting to quit—and remembering why—is half the battle.5
- Get enough sleep. The National Sleep Foundation recommends adults get between 7 to 9 hours per night.6
- Help control your blood pressure through physical activity. According to the American Heart Association, regular physical activity can lower blood pressure, control weight, and reduce stress. “Get at least 150 minutes per week of moderate-intensity aerobic activity, 75 minutes per week of vigorous aerobic activity, or a combination of both, spread throughout the week.”7
- Limit processed foods high in fat, starches and sugars, as recommended by the World Cancer Research Fund International.8
- Take care of your mental health, including learning how to manage stress in healthy ways. According to the National Alliance on Mental Health, “When experiencing long-term stress, your brain is exposed to increased levels of a hormone called cortisol. This exposure weakens your immune system, making it easier for you to get sick.”[8] Practice relaxation. Set aside time for you. Talk to someone. Prioritize activities.
With a shift in thinking, “prescribing” lifestyle changes can be a highly effective form of medication, without any side effects.
(1) “Public opinion on prescription drugs and their prices,” KFF Health Tracking Poll, July 2023.
[1] Cancer: Facts in pictures, World Health Organization, Feb. 2022.
[2] “Weight loss can put type 2 diabetes in remission,” Diabetes Remission Clinical Trial (DiRECT), 2023.
[3] “Device measured physical activity, sedentary time, and risk of all-cause mortality: an individual participant data analysis,” British Journal of Sports Medicine, 2023.
(4) “Freedom from smoking,” American Lung Association, 2022.
[5] “Is seven hours of sleep enough?”, National Library of Medicine, updated 2023.
[6] “Getting active to control high blood pressure,” American Heart Association, May 2024.
[7] “Limit ‘fast’ foods,” World Cancer Research Fund International, accessed 2024.
[8] “Managing stress,” National Alliance on Mental Illness, accessed 2024.