1. Are there any lifestyle changes I can try before starting a drug regimen?
"For many chronic medical problems, treatment should start with lifestyle changes," says Edward Jardini, MD, the author of How to Save on Prescription Drugs: 20 Cost-Saving Methods and a family physician at a private practice in Templeton, Calif., where he was formerly the chair of the Pharmacy and Therapeutics Committee and chief of family practice. One of Dr. Jardini's patients, Ernesto (not his real name) was 49 when he developed diabetes in 1999. Instead of going on drugs, Ernesto decided to try losing weight first. He dropped 10 pounds in three months, and was down to 232 pounds. Even that small weight loss stabilized his blood-sugar levels, and his diabetes has been undetectableand he has been drug-freeever since.
Of course, though healthy eating and exercise can help many conditions, they cant always cure every medical problem or replace a drug regimen. Plus, they can be tough to stick to or integrate with your job or other responsibilities. If you decide you want to start with lifestyle changes, set a time frame (say, three months) with your doctor to see if its working; if its not, then you may want to reconsider medication. Some conditions may require medication from the outset, which can then be reduced if lifestyle changes have enough of an effect.
2. Can I try the least expensive option first?
“If you're starting a new treatment, why not start with the most economic medication rather than a brand-new drug?" says Dr. Jardini. Ask your doctor, "Are there any generics or similar medicines or ones in the same class that are less expensive that I can try first?"
Generics are copies of brand-name drugs that contain identical active ingredients and work the same way in the body. Theyre less expensive because the manufacturers of generic drugs, unlike brand-name makers, do not have to invest money in research, development, and marketing. And because generics are available only for drugs whose patent has run out, the competition in the marketplace among manufacturers drives the price down. For example, ninety 10-mg tablets of generic simvastatin, a drug used to lower cholesterol, sell for around $90, while the same amount of Zocor, the brand-name version, costs about $400. (These are approximate market prices, not insurance co-pays, and prices might vary on a prescription drug plan.)
Older drugs, which will usually be generic versions, are often as effective as newer ones for certain conditions but are usually a lot less expensive. For instance, one of the newer drugs to treat diabetes is Actos, which costs about $1,000 for a 90-day treatment of the lowest starting dose (15 mg). The generic version costs $561. And while Actos or its generic version both help to stabilize blood sugar, so do other diabetes drugs, according to Dr. Jardini. Metformin, an older treatment, is only about $35 for 90 days of the lowest starting dose (500 mg), and a study in the Journal of Clinical Endocrinology showed it had almost identical blood-sugar control as Actos. Plus, Actos has actually been associated with a higher risk of heart failure, Dr. Jardini adds.
A third option is to ask your doctor if theres a less expensive drug in the same class. Beta-blockers, for example, are used to treat hypertension. At some drug stores, the price for a three-month supply of the lowest starting dose (5 mg) of bisoprolol fumarate is about $140, while another beta-blocker, atenolol, costs only around $20 for the lowest starting dose (25 mg)..
3. Will I be able to afford this long-term?
Think long-term, especially if you will be taking multiple medications. "It's really important for patients to be proactive and ask their doctor if there are cheaper alternatives," says Derjung Mimi Tarn, MD, PhD, assistant professor of family medicine at the School of Medicine at the University of California, Los Angeles. It might not occur to your doctor to bring up your pocketbook. In a 2006 study, Dr. Tarn found that physicians prescribing new medications brought up cost and acquisition issues with patients in only 33% of cases.
4. Should I take the free samples?
One study at the University of Chicago Medical Center found that patients who had received samples had significantly higher prescription costs than patients who didn't. That's because samples will always be the newest and most expensive brand-name drugs, and after the free samples run out, you are more likely to continue buying that brand. You may be better off getting a prescription for a cheaper generic, if possible.
"Most studies show that it's not a good idea to take samples," says Dr. Tarn. "The drugs that are available as samples are the newer, more expensive medications and once you get started on it and it works you tend to stick with it. It's almost better to get started on generic medication then scramble later on to try to meet your copay for much more expensive medications."
5. Can I talk to my pharmacist to figure out the least expensive option?
If you already have a prescription, it's not too late to consult your pharmacist. "Talk to your pharmacist and we can go through the medication list," says Janet Engle, Pharm.D., head of the department of pharmacy practice at the University of Illinois at Chicago College of Pharmacy and past president of the American Pharmacists Association. "Are there other options you can recommend to your doctor?"