As healthcare costs have continued to escalate over the last 20 years, one bugaboo that has continued to work against Texans is the cost of prescriptions. It seems like the cost of prescriptions have skyrocketed at rates well above those of other aspects of the healthcare that we consume on a regular basis. The pharmacy companies seem to think that we are made of nothing but money. Because of this, one of the most common questions that we get from people shopping for Texas Health Insurance revolves around prescription coverage. Texans want to know can I get prescriptions without insurance.
How To Get Low Cost Prescriptions
As you begin to consider the options available to you when it comes time to fill that prescription, the first thing that we will recommend is using a generic medication whenever it is possible at all. When drugs are first released to the public, they fall under a patent which means that only one company is going to make the drug and sell it. This time period for a drug has a significantly higher price as the company that created the drug originally is attempting to recover their research and development. Once the drug has moved beyond that patent time period, many companies will offer the drug to the public and the price will come down.
Beyond that, your mechanisms to get prescriptions without an insurance pharmacy benefit are broken down in to three options.
- You can always pay full price at the likes or CVS or Walgreens as long as your doctor will write that prescription for you!
- You can leverage lower cost programs at discount retailers like Wal-Mart or even the local grocery store.
- You can participate in on-line cost saving programs GoodRx to compare prices at all pharmacies local to you.
There are pros and cons to all of these options, though we definitely recommend one in particular. Option number one of paying full price is typically the fastest way to obtain your prescription, but is almost guaranteed to cost more. Options two and three are typically your best bet to find the drug you are needing in the most cost effective fashion.
The lower cost programs at discount retailers like Wal-Mart do a wonderful job of providing prescriptions to Texans less expensively than full price pharmacies. However, they rely heavily on generics to provide these cost savings and may or may not be the least expensive. The programs, while effective, lock you into having your prescription filled in only one place. This is great for convenience, but may end up costing more in the long run.
We love showing our clients how to use a program like GoodRx. GoodRx contracts with both drug makers and pharmacies to act as a middle man in this exchange. They use their vast network of local pharmacies to order the prescription drugs in bulk from the maker at a lower price point due to volume. They then turn around and provide those lower costs to local pharmacy based on the volume that they can commit to selling to local Texans. The catch to you is that you need to use their website to determine which local pharmacy has the best price for the drug that you are seeking. This means that you may have your various prescriptions filled at multiple places over time as you use their website to determine that price winning pharmacy.
Is There A Catch?
While this system isn't perfect, it's worked really well for many Texans. The programs like GoodRx work for both generics and name brand drugs, though the savings on name brand drugs are not near as good. These programs do not rely on you buying a membership either as they make their money off of that middle that they capture.
Maintenance medications can become problematic at times. Some of the drug companies will take a generic, reformulate it in some way and then move it out of generic status claiming some added benefit to you the consumer. We have seen this with insulin as of late. This maneuver is frustrating to say the least, and we do not have a great answer for this. So be aware that this could rear it's ugly head for you.
Know Before You Buy!
Always make sure that you understand what your formulary coverage does and does not include when looking at purchasing prescription drug coverage. We have seen policies that have cost $50 a month that simply didn't provide much coverage to you when it came time to fill a prescription. Ask yourself the following five questions.
- What does the tiered list of medications include?
- How much is my co-pay per tier?
- On average, how many prescriptions do I fill each month?
- Is there a discount for 90 day fills on maintenance medications?
- How much is the cost of the prescription coverage?
Based on these questions, it should become evident quickly if the prescription coverage is right for you. Financially, the costs should not outweigh the benefits provided. Make sure that you understand where your regular medications fall on those tiers and what the subsequent costs are. For many Texans, the alternative programs are better fits.
If you aren't sure how you should proceed, the agents at Insurance For Texans would be glad to help you sort that out. Speak with one of our folks to make sure that your health insurance is in a great spot and working for you!