A Patient’s Guide for Affordable Psychiatric Medication

Robert Bransfield, MD; Linda Gochfeld, MD; Jeff Mattes, MD

Background

Medications for psychiatric problems are an important part of mental health treatment; however, cost can be an obstacle to your obtaining the medication your doctor prescribes.  If so, you should let your doctor know that cost is an issue.  A discussion of benefits, side effects, and cost, between the patient and his physician, is the best way to choose a medication.  Lower cost alternatives, as described below, are sometimes available.  The New Jersey Psychiatric Association is providing the following information which you may find helpful.

Selection of Medication

People have individual responses to psychiatric medications.  Often treatment requires trying several medications to find the best for that person.  Sometimes there is a choice of many, and the less expensive is fine; sometimes only one medication that is effective for a person.  On occasion new, more expensive medications are better; sometimes not.  There are times when serious side effects are not discovered until after a medication is on the market for several years.

 

Generics

Newly developed mediations remain patented for a limited number of years, sold only under the brand name by one manufacturer. Thereafter, the drug can be manufactured as a “generic” by other companies, and the price usually decreases. The prices of generics may change over time.

99% of antidepressant prescriptions are now generic. Generics may vary slightly and the inactive ingredients are often different.  Some patients have different responses to generics. Keep a record of the name of the company that makes the generic and record how it works. If a generic made by a certain manufacturer doesn’t work well, you may have a better response by either adjusting the dose or avoiding the generic made by that company and instead using one made by a different company.

After generics have been on the market cost usually decreases due to greater competition between manufacturers. It is important to do comparison pricing to find the best price for a generic; not all pharmacies stock all generics.  Price comparisons can be made by looking up the cost of the medication on the Internet.

Sometimes it is more affordable to pay cash and use the discount cards than to use your insurance and pay the co-pay. Sometimes it is best to use both the discount cards and your insurance.

Pharmacists may not be able to volunteer better pricing information to you. If you initiate the conversation with them about pricing options, they are then ethically required to provide accurate information.

Different but Similar Medications

For medications which are not available as generics, you might ask your doctor if there is a similar medicine which is available as a generic.  There are few truly unique medications on the market; most medicines are similar to other medicines, and one may be considerably less expensive.  However, even when medications are very similar, there are always patients who do better on one than another, for unknown reasons.

Different Forms of the Same Medication

Sometimes medications are available in different forms.  For example, a sustained release form of a medication (given just once a day) may still have patent protection, but the original form of the medication, which might require doses two or three times a day, may be available as a less expensive generic.  You should talk with your physician about the pros and cons of different forms of a drug.

Pill Splitting

Many pharmaceutical companies price higher dose pills about the same as lower dose pills.  Therefore, it is sometimes more cost effective to purchase tablets in the larger strength and break them in half.  Be aware, though, that cutting tablets in half may result in slight variations in dose, particularly if the tablets are not scored; also, most sustained release pills should not be split or crushed.  You should discuss possible advantages and consequences of pill splitting with your doctor.

When Your Pharmacy Plan Does Not Cover a Medication

If you have a prescription plan that does not cover a medication that you need, you and your doctor may be able to get approval by following the appeal process of your plan.  As an alternative to using insurance to purchase medications, there are prescription savings programs that can be found by web search and may save you a significant amount. 

Discount Pricing for Brand Medications:

Many medications have discount cards you can get from your physician or from the website for the medication. Also, many companies offer patient assistance programs and provide brand medications for free if certain income requirements are met.

Non-profit Pharmacies:

Non-profit pharmacies can be found on the web and they provide discount prices to those meeting certain income requirements.

Low Income Government and Pharmaceutical Sponsored Plans

Many pharmaceutical companies have programs which provide low cost or free medication to low income patients.  Your doctor or pharmacy may know about these programs, or you can obtain information from the drug company that makes the medication (over the Internet, or you can call).  Usually these programs will only cover patients who do not have medication insurance and who have a limited income.  Similarly, there are government programs which may help; for example, in New Jersey there is the PAAD Program for patients whose income is below a certain level (information can usually be obtained from pharmacies).  It’s worth checking if you are eligible for any of these programs. 

Medicare D Pharmacy Plans

If you are on Medicare and have no other drug insurance plan, you can choose a drug plan under Medicare Part D.  There are many different options, with significant differences between the plans in terms of cost and which medicines are covered.  Many medications may not be covered by many plans.  Be sure you choose a plan that adequately covers the medications you are receiving. People with low income and resources will pay very little for this drug benefit.

Choosing the best plan is most easily done on the Internet.  Information by telephone is available at 1-800-Medicare. Your pharmacist can tell you which plans will be participating with his/her pharmacy. 

International Mail Order Pharmacies

Some international pharmacies provide brand name medications at significant savings.  However, medications obtained from the international market may be counterfeit or of poor quality.  Some Internet drug sites are misleading and unsafe; Canadian pharmacies may not be in Canada and may ship from other countries.

Local Pharmacies

Although prices may be higher, there are advantages to dealing with your local pharmacy because they know you, have availability for personal counseling, and are geographically convenient.  Many small independent pharmacies continue to offer free delivery and have plans for 24-hour emergency prescriptions.

Prior Authorization Requests

There have been increasing obstacles in which insurance companies request “prior authorization” before prescriptions are covered. Although this may be understandable with some high-priced medications, pharmacy benefit management companies and insurance companies are now sometimes using this as an obstacle to deter prescriptions or to change the prescriptions to so called “formulary” medications which are sometimes lower cost or more expensive but they provide a greater rebate to the pharmacy benefit management company. The basic assumption they make is medications in the same “class” are interchangeable,” which is only sometimes correct. When this process is a barrier, using the discount cards and paying cash is often a better alternative to the delays and professional costs from negotiating the prior authorization process.

Additional Comments

The New Jersey Psychiatric Association hopes that the above information has been of some value to you.  Regarding all of these issues, it’s important that you discuss differences between medications with your physician, since each patient is different.  You are encouraged to research other sources of information and to ask additional questions of your treating physician.

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