How to Pay Less for Prescription Drugs

The doctor's office is often your first stop on the road to treating a medical problem. It's also the place to begin when you're looking to trim drug costs. By communicating openly with your doctor, you can help increase the likelihood your problem will be diagnosed and treated correctly the first time, saving added rounds of doctor visits, medical tests, and drugs. Your doctor(s) is a partner with you in your health care. And each visit is an opportunity to fine-tune your medical care to ensure that you're getting not only the best but the most cost-effective treatment. It's an opportunity you can't afford to miss.

If you want to save money and get good medical care, you need to understand and get involved in each step of the prescribing process. Your input, questions, and feedback along the way can help your doctor determine which treatment is best suited to you, your medical condition, and your pocketbook.

Get Involved in the Process

Diagnosing the problem: To properly diagnose your medical condition, your doctor needs as much information as you can give about your current health status and symptoms and about your medical history. Do your best to be prepared for this initial visit.

Write down, in as much detail as you can, what your symptoms are, what they feel like to you, when they occur, what seems to make them better or worse, and how long you've been experiencing them. By thinking about and writing down this information before you enter the doctor's office, you help the doctor pinpoint the problem and decide on a treatment.

Another important element in proper diagnosis and treatment is making sure your doctor has your up-to-date medical history. The term "history" can be a bit confusing here, since it includes not only your past medical treatments and any history of diseases in your family but also any other conditions you are currently being treated for. Your medical history should also include a medication history.

You should inform your physician of all the medicines you currently take as well as those taken in the past, noting any adverse drug reactions and drug allergies you've experienced. Also mention any use of nonprescription drugs, herbal and alternative medicines, vitamins and supplements, tobacco, caffeine, alcohol, and recreational drugs.

Setting treatment goals: You and your doctor will need to discuss the goal of treatment. Is it to simply diminish symptoms or to provide a cure? You may have no symptoms but may still require treatment, for high blood pressure or high cholesterol levels, for example. There are many possible goals of treatment, and you should have input in setting those goals. By knowing the goals, you'll also be better able to follow treatment instructions and recognize whether or not a given treatment seems to be benefiting you.

Sizing up treatment options: Generally speaking, your doctor can choose one or more of the following four treatment paths: simply providing information or advice; recommending nondrug treatment, such as lifestyle changes; prescribing one or more medications; or referring you to a specialist or other health care provider. The doctor must decide not only which treatment is the most effective, safe, suitable, and cost effective for a particular condition but for you in particular.

This decision must take into account many factors, including your age; gender; pregnancy or nursing status; kidney, liver, lung, and heart function; other health problems; currently used medicines; success or failure with past treatments; allergy history; ability to self-administer the treatment; and ability to pay for the medicine. Once again, an up-to-date medical history is truly helpful here. In addition, your doctor should discuss with you what the possible treatment options involve, so that your preferences, abilities, and needs are taken into account. After all, a treatment regimen that you cannot stick to is not going to do you any good.

Understanding the treatment: Once the specific treatment plan is chosen, the physician should discuss it with you and provide an explanation of why it is important. Usually the explanation is brief, so don't be afraid to ask questions. If the physician uses words you don't understand, ask for an explanation in simpler language.

Make sure you don't leave the office until you have a full understanding of what the medicine is for, how to take it, and possible side effects. For example, if you have a cough and your doctor prescribes a cough medicine with codeine, you should be informed that codeine will suppress the cough, that it may take two to three hours to start working, that it may cause constipation, that it may affect your ability to drive or operate machinery, and that you should not consume alcohol while you are taking it. You should be advised to come back if the cough does not go away within one week, if you develop a fever, or if unacceptable side effects occur. Finally, you should be advised to follow the dosage schedule and to not take more than prescribed. Take notes, or ask your physician for a written copy of the instructions. You should be able to summarize, in your own words, the key information, to be sure you understood it clearly. You may, therefore, want to repeat it to your doctor to confirm it before you leave the office.

Monitoring the treatment: Once you get the medicine home and begin treatment, you will need to do your part by following the instructions for use as closely as possible and being alert to side effects and changes in your condition. If you are having trouble following the directions for use -- maybe the dosing schedule is too complicated or the taste of the pills is intolerable -- or you have questions about the medication you didn't think of before, contact your doctor or pharmacist (as you'll learn in the next chapter, your pharmacist can prove invaluable in the treatment process).

If you have any unexpected problems while using your medicine, write down a description of the problem and alert your doctor immediately. If your symptoms don't improve, your doctor will need to consider whether the diagnosis, treatment, and adherence to treatment were all proper. In fact, the whole process of diagnosing and prescribing may start again. In some cases, of course, drug therapy may be ongoing, such as in controlling diabetes. Even so, your doctor will monitor your condition and will likely re-evaluate your treatment regimen from time to time to be sure it continues to be the best and most cost effective for you.

Ask About Generics

Whenever your doctor prescribes a medication for you, ask if a less-expensive generic version is available and appropriate for you. If not, ask if there are any similar medications with generic equivalents that might be an option for you. Be honest and up front with your doctor about your financial concerns.

But remember that in addition to a medication's cost, your doctor must consider the safety and effectiveness of that drug for you, based on your specific medical history, your current health condition or disease, and other medications you may be taking. A generic medication may have a cheaper price tag, but it could end up costing you more money, sick time, or worse in the long run if it is not the best medication for you.

In some cases, the least-expensive medication will do the trick. In the case of high blood pressure, for example, recent medical studies have shown the benefit of inexpensive thiazide diuretics (water pills) as a first-line treatment for some patients, with the newer, more-expensive blood-pressure medications reserved for when diuretics prove ineffective in controlling the disease.

Many people who have high blood pressure will eventually require more than one medication to control their condition, but if lifestyle changes and a simple water pill can keep their blood pressure under control for a while at least, the amount of money they end up saving can be tremendous.

In other cases, however, it may be more economical overall to use a pricier medicine that is more targeted in its actions, more effective for your condition, and/or more likely to get the job done better or faster, with fewer unpleasant side effects.

There are also certain medical conditions, such as epilepsy, in which very precise dosing is required, and brand-to-brand switching or generic substitution may not be recommended. (In such cases, your doctor will indicate on the prescription blank that substitution is not allowed.)

Practice Prevention

Yet another immensely important step you can take to keep your medication and health care costs down is to seek out and use information from your doctor (and other reputable sources) about preventing disease and injury. Healthy lifestyle changes such as quitting smoking, starting a regular exercise program, and improving your diet and eating habits can go a long way toward reducing your need for medications in the first place. Indeed, for some medical conditions, altering unhealthy habits and getting weight under control can often reduce, delay, or even eliminate the need for medication.

Getting regular medical checkups and following the advice of your health care partners are also essential. And, of course, habits such as always using seatbelts, never driving under the influence of alcohol, and avoiding illicit drugs can help prevent injuries that require a lot more than medications to repair.

Certainly, it can take some serious effort on your part to make the lifestyle changes that can improve and protect your health. But putting in that kind of effort can pay off in the long run by saving you money on medications and other health care costs.

Once you and your doctor are on the same page about saving money on prescription drugs, it's time to work on your pharmacist. In the next section, we'll show you how to save money when you get your prescription filled.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

The brand name products mentioned in this publication are trademarks or service marks of their respective companies. The mention of any product in this publication does not constitute an endorsement by the respective proprietors of Publications International, Ltd. or HowStuffWorks.com, nor does it constitute an endorsement by any of these companies that their products should be used in the manner described in this publication.

When you think of getting your prescriptions filled, you may picture a person in a white lab coat counting tablets and sliding them into tiny bottles. But a pharmacist does much more than fill pill bottles. Taking full advantage of this valuable resource can help ensure safe and effective use of your medications. By providing information about your medical history and asking questions about proper medication use, you can work with your pharmacist to not only prevent medication mishaps but to improve the quality of your health care and avoid paying unnecessary drug and other health care costs.

Understanding the Pharmacist's Role

Before discussing the pros and cons of various drug channels, it helps to know what role the pharmacist plays in the health care process. A registered pharmacist is a licensed health care professional who has spent years learning about medications and their effects. Pharmacists can provide you with important information about prescription and nonprescription drugs, including their intended effects and side effects; other medications, foods, conditions, and activities that affect their actions; and how to use and store them properly to ensure safe, effective, economical treatment.

Your pharmacist can screen for duplication of medicines and dangerous drug interactions, which is especially important if you see more than one physician. Your pharmacist can work with all of your physicians and any third-party payers you may have, to make sure you get all the medications you need. And your pharmacist can also work one-on-one with you, explaining your drug therapy and even demonstrating how to use various drug products.

Understanding the steps the pharmacist goes through in filling your prescription, and knowing what responsibilities and opportunities you have for input along the way, can help you make the most of this resource.

Maintaining your medication record: The very first time you submit a prescription to a particular pharmacy (or, in the case of chain drugstores with linked computerized patient records, the first time you ever use one of their pharmacies), you will be asked for information about yourself. The pharmacist (or pharmacy technician) will ask for the correct spelling of your name, your date of birth, and contact information. You'll also be asked for information on any prescription insurance you may have, since the pharmacy may bill the insurance company directly and/or charge you only a copayment.

This information is used to create your medication record. Some pharmacies may ask additional questions about your medication history or give you a patient profile form to fill out. The medication record is one of the most valuable tools the pharmacist has to ensure your safety. It should be kept as accurate and up-to-date as possible, because the pharmacist will refer to it each time you request a prescription or refill.

At the initial visit, you should also inform the pharmacist of all the medications -- both prescription and nonprescription -- you currently take as well as all of the supplements, herbal remedies, and/or other alternative medicines you use. At each subsequent visit, tell the pharmacist if you have added or discontinued any medications or supplements so your record continues to be current. Also, inform the pharmacist of any allergies you have and any significant adverse drug reactions you have experienced.

The pharmacist will check the record each time you bring in a new prescription to make sure you are not being given a drug that contains any ingredients to which you may be allergic or that may conflict with any other medications or supplements you are taking. This can be a lifesaving service and may help you avoid costly visits to the emergency room.

Choosing generic medications: Your pharmacist is responsible for choosing a generic product to substitute for a brand-name drug if your doctor has indicated that substitution is allowed. Your physician generally indicates this on the prescription blank by checking the box marked either "Do Not Substitute" or "Substitution Allowed." If your doctor has okayed substitution, the pharmacist is free to substitute an equivalent, lower-cost generic and will use government guidelines to choose a generic that is considered equivalent to the branded drug.

When you submit your prescription to the pharmacy, be sure they know you want generic products where allowed. Some pharmacies have a policy of automatically filling all "Substitution Allowed" prescriptions with generics unless the patient requests the brand-name drug. Ask about your pharmacy's policy.

Verifying the prescription order: If you've ever tried to read doctors' writing, you can imagine what a challenge it must be for pharmacists, who read and fill countless prescriptions every day. But deciphering and confirming the drug name, dosage, and directions for use on your prescription blank is one of the pharmacist's most important tasks -- and one that has a vital impact on your therapy, safety, and pocketbook.

There are thousands of medicines on the market, many of them spelled similarly, which means your pharmacist has to be extremely diligent in deciphering your doctor's handwriting. After all, a misread or improperly filled prescription can have deadly consequences. If unsure, the pharmacist will contact your doctor directly to clarify. The same is true on occasions when other important information, such as dose, route, or quantity of medication, has been inadvertently left off the prescription blank. You, too, can help in this verification process by taking notes at the doctor's office and relaying your understanding of your therapy to the pharmacist.

Screening for potential problems: The pharmacist uses your medication record to screen for potential drug interactions and duplications each time you present a new prescription to be filled. This is an extremely valuable step in the process, especially if you have more than one doctor.

Drug interactions can occur between two or more prescription medicines, a prescription and a nonprescription medicine, a medicine and a food, or even a medicine and a disease. Some drug interactions may simply need monitoring or are minor and not considered serious as long as you can tolerate them. Others are serious and indicate that you should not take the drug.

Drug duplication can occur if you are prescribed two medicines that have the same ingredient or two medicines that have the same purpose. There are times when two drugs from the same class of medicines are purposely used together for the combined benefit they provide. But other times, drug duplication is a mistake. Such unplanned drug duplication not only exposes you unnecessarily to an increased risk of side effects and toxicity, it also wastes money. And the more doctors you see, the higher the risk of duplicate prescribing.

So make sure your medication record includes all of the prescription medications you take. And be sure your pharmacist knows about any and all over-the-counter medications, supplements, and remedies that you use.

Checking your regimen: Your "drug regimen" refers to the dosage, route of administration, frequency of use, special instructions, and duration of treatment of the drug, or drugs, you take. Your pharmacist checks that all of these components, as prescribed by your doctor, are appropriate for your condition. In addition to the information on the prescription blank, the pharmacist relies on the information you supply, based on your understanding of the treatment.

But this is also where the pharmacist's knowledge, skill, and experience can play an important role. If a component of the written drug regimen is not consistent with standard practice or just seems incorrect, the pharmacist will call your prescriber to clarify any unclear components and confirm the regimen.

 

Once the prescription is filled (which may be done by a pharmacy technician), it is the pharmacist's responsibility to double-check the prescription label for accuracy, confirm that the dispensed medication is the correct one, and see that your medication bottle carries appropriate warning labels. These are all critical last steps to ensure that you get the right medication with the proper directions for use.

When you receive the prescribed medication, you should do your own check. Confirm that what is written on the label matches what the doctor told you. If it is a drug you take on an ongoing basis, check if the pills in this refill look like those you've been taking. Ask your pharmacist about any discrepancies.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Patient counseling: There's one step more that you and your pharmacist should take together to increase the likelihood your medication will work for you and decrease the risk you'll waste money or jeopardize your health. That step is the patient consultation.

Before you leave the pharmacy with your medication, you should understand how to use your medicine properly for the greatest effect and without waste and know what signs to watch for that might indicate a problem. Here is the list of questions you should ask the pharmacist:

Making sure you get this information can be one of the greatest money-savers available to you. If you don't take your medicine correctly, you risk not only wasting money but undertreating your condition (which may prolong your illness) or overdosing on your medication (which may have tragic consequences).

Fortunately, a major part of the pharmacist's job is patient consultation and education. Your pharmacist is there to answer your questions and provide advice on using medications safely and wisely. The pharmacist can explain and demonstrate proper use of medications and medication-delivery systems, such as eye ointments, eardrops, skin patches, sprays, nebulizers, and inhalers. (And before you leave the pharmacy, you should demonstrate back to the pharmacist the steps you should take in administering your medication and repeat your understanding of how and when to take the medication, to make sure you can do it properly once you're home.) The pharmacist can also help you work out a medication schedule and demonstrate the use of a medication organizer to help you better manage your drug therapy. Your pharmacist is also an excellent source of information and advice on nonprescription drug products. You can even ask your pharmacist for a more in-depth counseling appointment -- a special time set aside for a "brown-bag session." For this meeting, bring a bag filled with all of the medicines you are taking, including prescription and nonprescription drugs, herbs and/or other alternative remedies, vitamins, minerals, and any other supplements. Make sure you bring with you all of your medication containers and all of the dosage forms (pills, creams, ointments, eyedrops, sprays, skin patches, etc.) of the drugs and supplements that you use. During the session, you should review each one with the pharmacist to make sure you are only taking what you need and are doing so properly.

Getting the most out of your pharmacist is not your only consideration when lowering prescription drug costs. You must also learn how to choose the appropriate pharmacy. We'll help you make this decision in the next section.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

When it comes to having your prescription filled, you have several sources, or channels, to choose from. Not all channels provide the same level of service or reliability, however, and their prices for your particular medicines may or may not vary. It's important, therefore, to understand the pros and cons of the various outlets and know how to evaluate them before you decide.

If you have any type of prescription insurance, you should inquire ahead of time whether your plan requires you to use a specific network of pharmacies in order to get reimbursed. What it all boils down to is that you have to take the time to evaluate your particular situation, needs, and preferences as well as the drug channels themselves. The following discussion can help you make a more-informed choice.

Walk-Up Pharmacies

Of the various drug channels, walk-up, or "brick-and-mortar," pharmacies are the ones that allow you to meet face-to-face with a pharmacist, giving you the chance to take advantage of the full range of benefits that this valued health care partner can provide. When it comes to choosing one of these pharmacies, you should consider several factors.

Convenience is one such factor. If you'll be driving to the pharmacy, for example, you may want to choose one that is conveniently located to your home and has plenty of parking. Some even offer drive-up windows and/or allow you to request a refill in advance, via telephone or Internet, to cut down on wait time. You might also check into one of the pharmacies located in supermarkets, so you can have your prescription filled while you shop.

If you have trouble getting around, you might seek a pharmacy that offers delivery of prescriptions to your home. And if you use one or more nondrug items -- such as ostomy or diabetes supplies -- you should ask if the pharmacy can bill these directly to Medicare or your insurance. Many larger pharmacy chains also offer Web sites that you can access 24 hours a day.

Service is the next factor to consider. Consumer Reports rated pharmacies in 1999 and found that independent pharmacies ranked highest in terms of service, information, and speed compared with drugstore chains, supermarket pharmacies, and mass merchandisers. Survey respondents said independent pharmacists provided more personalized service, were more accessible, kept customers waiting less time, and provided better information about prescription drugs than the competitors in other drug channels. Still, individual drugstores do vary, and you'll need to decide what level of services you require and whether a specific pharmacy can deliver it.

Price is the final factor to consider. In a pricing comparison based on 26 sources of five popular prescription drugs, independent pharmacies were the most expensive. Mail-order and Internet pharmacies charged the lowest prices. Chains, supermarkets, and mass merchants were in between the two ends of the cost spectrum. In some cases, there was as much as a 25 percent price difference for the same medication.

Clearly, then, prices on prescriptions do vary, so if you have the need and desire, you could shop around for the best price on each of your medications. But the disadvantage of pharmacy hopping is that you forfeit the huge advantage of having one pharmacist/pharmacy get to know you and maintain a complete medication record to screen for potential problems.

If you've found a pharmacy that provides the convenience and services you seek but have seen lower prices advertised elsewhere, you could ask if your pharmacy will match the lower prices offered by a competitor. If not, it's still important to place price in perspective, because the cheapest isn't always the best when it comes to taking care of your health. Your aim should be to choose a pharmacy that, overall, provides the convenience, service, and generally low everyday prices you need.

Domestic Mail-Order Pharmacies

If you are on long-term drug therapy, filling your prescriptions through a U.S.-based mail-order pharmacy may be convenient and may save you money. Indeed, some managed care companies require it.

Mail-order pharmacies often offer discounts on medications bought in bulk. So if you take a medication for a chronic condition, such as high blood pressure, you can order a 90-day supply at a lower cost per pill. However, because it can take a few days or even weeks for your medication to arrive, this is not a practical choice when you need a prescription filled quickly for an acute condition (such as an infection or injury).

As with other important choices, you should do your research before choosing a mail-order pharmacy. If possible, get a recommendation from your health care provider, insurance company, or other trusted source.

Make sure the mail-order company offers basic services such as pharmacist consultations, computerized medication records, drug interaction and duplication screening, and refrigeration of transported medicines if required (proper handling can sometimes be hard to verify). Check to make sure the mail-order company will work with your insurance company. Then do a trial run using one of your less-expensive prescriptions; that way, if anything goes wrong, you will not be out too much money.

Test the system: Call and ask to speak with a registered pharmacist to ask a medication question, keep track of how long it takes for the medication to arrive, and do a cost comparison with your local pharmacies. Get a legitimate U.S. street address for the company, not just a Web address, in case there are problems. Make sure your medication can be sent to you overnight in an emergency, even if it costs you extra. Also, ask if you will have to pay an extra shipping charge if one of your drugs is out of stock and must be sent separately.

Internet Pharmacies

There are hundreds of drug-dispensing Web sites ready to sell you medical products, often at deep discounts. Some of these are legitimate, but many more operate illegally. The Food and Drug Administration (FDA) cautions that purchasing a medication from an illegal Web site puts you at risk of receiving a contaminated or counterfeit product, the wrong product, an incorrect dose, or no product at all. The result could be dangerous drug interactions or other serious medical problems. In addition, these Web sites may not protect your personal information.

Some sites offer to send you a medication based only on your answers to a questionnaire, without requiring you to visit a doctor for an exam and prescription. The American Medical Association considers this substandard care; just filling out a questionnaire provides insufficient information for a prescriber to determine if a drug is safe and appropriate for you, if another drug would be better, or if an underlying medical condition might make the drug unsafe for you.

Due to an increase in the number of fraudulent Internet pharmacies, FDA concerns, and consumer outrage, steps were taken in 1999 to help consumers locate and safely obtain prescriptions online. The National Association of Boards of Pharmacy (NABP) developed a voluntary program of certification for Internet pharmacies -- called the Verified Internet Pharmacy Practice Sites (VIPPS) program -- to help consumers identify high-quality, legitimate Internet pharmacies.

Pharmacies participating in the program have a VIPPS seal on their Web sites, which links directly to the VIPPS Web site. There, you can verify a pharmacy's certification and obtain additional information about the pharmacy. Currently, 12 Internet pharmacies have been VIPPS-certified. More information regarding the VIPPS program is available at www.nabp.net/vipps/consumer/faq.asp.

Foreign Pharmacies and Drug Sources

There is a growing movement among cash-strapped consumers, particularly the elderly on fixed incomes, to seek out Canadian and other foreign sources of less-expensive prescription medications. The FDA is very concerned about this growing trend as well as the proliferation of online and storefront operations offering to help U.S. consumers obtain medications from these foreign sources. Some of the FDA's major concerns in this regard are summarized below.

Lack of quality assurance. Medications not approved for sale in the United States may suffer from substandard manufacturing practices.

Counterfeit potential. Some drugs imported from foreign countries are actually counterfeits, containing useless or even toxic ingredients.

Presence of untested ingredients. Foreign medicines may contain substances that are not FDA-approved as being safe or effective.

Lack of medical supervision. Drugs are considered "prescription" because they are not safe for you to take on your own. To use the drug safely, you may require regular monitoring of your disease, the level of the drug in your blood, or side effects.

Labeling, information, and language issues. The medication's label may be incomplete, in error, or in a foreign language. That will make it almost impossible for you to take the drug "as directed," because you won't know what the correct, complete directions are.

Little or no recourse. If something goes wrong as a result of your use of a medication from one of these foreign sources, you're probably out of luck. You may not know who or where the actual seller is, and you may have unknowingly signed away your right to sue by accepting their terms of use. The FDA has little or no ability to take corrective action on your behalf under such circumstances.

It's illegal. Under the Federal Food, Drug, and Cosmetic (FD&C) Act, it's illegal to import into the United States any drug that is adulterated, misbranded, or unapproved, which would include the foreign versions of medications that have been approved by the FDA. It is also illegal for anyone other than the drug's manufacturer to re-import a prescription drug that was originally manufactured in the United States.

Recently, the FDA has identified a growing number of online companies that claim to be legally selling Canadian drugs directly to U.S. consumers, but it's not legal. However, a loophole in the law allows consumers to import up to a 90-day supply of medications for personal use only, and Canadian Internet pharmacies have been taking advantage of this loophole for years to sell and export medications to Americans through mail-order and Internet pharmacies.

Likewise, a number of Canadian drug Web sites and ordering services advertise, perhaps in an effort to allay U.S. consumers' fears, that they are dispensing drugs only for existing prescriptions written in the United States that are then rewritten by a Canadian doctor in order to comply with Canadian law. However, prescribing and dispensing medications to a patient sight unseen is against the Canadian Medical Association's Code of Ethics, which states that physicians have a responsibility to do a patient history, conduct a physical exam, and discuss the risks and benefits of the medication with the patient. In many cases, these essential activities simply do not occur.

A hybrid form of foreign-drug distribution has also cropped up in the United States. It consists of storefront operations that offer to facilitate the importation of Canadian drugs by providing the consumer the forms and the guidance to order medications from Canadian pharmacies. The employees of these operations are generally not licensed by a state board of pharmacy and often have no medical background whatsoever. They are simply in business to broker the arrangement between a U.S. consumer and a Canadian pharmacy, which pays a finder's fee to the storefront operation.

The FDA and state boards of pharmacy across the country are of the opinion that when these storefront businesses engage in such activities, they are unlawfully acting as pharmacies. Consumers may get a false sense of safety and legitimacy when ordering foreign drugs through these businesses, since there is an actual business to walk into with staff onsite for assistance. But these storefront operations generally do not guarantee that consumers will get the correct, unadulterated medicines they ordered. What's more, these businesses usually require consumers to sign a waiver releasing the businesses from all liability, so the consumer has little or no recourse should something go wrong.

Still, the problem of seemingly out-of-control drug prices, and the reality that many patients in the United States must choose between using these illegal means to buy their drugs or simply not being able to afford them, has forced the entire issue of drug affordability to the fore. In 2004, the U.S. Department of Health and Human Services Task Force on Drug Importation estimated that the dollar value of imported prescription drugs was $1.4 billion -- about 0.6 percent of total U.S. drug sales. However, if drug importation were to become legal in the United States, it has been suggested that imported prescription drugs could account for 10 to 15 percent of the entire U.S. prescription drug market.

As of this writing, the U.S. Congress is debating the issue of drug importation, pitting the hope of lower prices against the fear of counterfeit drugs. A recent study published in the Annals of Internal Medicine compared the cost of 44 common brand-name drugs sold by 12 Canadian Internet pharmacies and 3 large, U.S.-based "brick-and-mortar" pharmacy chains that also offered Internet pharmacy services. It was found that Americans could save approximately 24 percent if they purchased their prescription drugs from Canadian Internet pharmacies.

The pharmaceutical industry has long argued that not only can it not guarantee the safety of imported medicines, but the higher prices charged in the United States are necessary to fund research and development. They also argue that allowing these drug importations would amount to blocking free trade -- we would, in essence, be importing foreign price controls along with the drugs. And the FDA fears that the measure would threaten patient safety.

Yet busloads of Americans are already buying their medications from foreign countries, either in person, through the mail, or over the Internet, because they can't afford the drug prices in the United States. And consumers -- as well as some lawmakers -- are outraged by cheaper prices in nations such as Canada, whose governments limit drug prices.

Indeed, some government officials at the state and even local levels have suggested programs to save their constituents tax money by reimporting drugs from Canada for select populations, such as government workers who receive drug benefits or inmates in state prisons, despite the federal regulations prohibiting it. So it is hoped that the arguments from both sides can be heard and that eventually some sort of compromise will help to guarantee not only safe but also affordable medicines for all Americans who need them.

For now, however, the bottom line is that you should be wary of foreign sources of prescription medications. You are always safer going the traditional route to get your prescriptions filled -- that is, purchasing your prescriptions through a licensed U.S. pharmacy. In doing so, you will be taking full advantage of the United States' well-developed approval and distribution system for prescription medications, a system that employs the necessary controls to keep your medications safe and effective for you and your family.

We know that this is a lot of information to digest, but there are agencies out there to assist you. On our final page, we will show you some resources you can use to lighten the load of the prescription drug problem.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

You may be eligible for outside help in paying for your prescriptions; the key is knowing where to look for aid.You now know the various ways you can work with your doctor and pharmacist to lower your prescription costs safely. If you are still struggling to cope with your rising drug bill, be aware that there are some programs available that might afford you some financial relief.

Government Sources

Effective since January 2006, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 -- and specifically a provision under the Act known as Medicare Part D -- provides for outpatient prescription drug insurance coverage to those entitled to Medicare Part A or enrolled in Medicare Part B. Previously, those Medicare participants were limited to drug coverage that related to a physician's services, such as the administration of chemotherapy drugs, or that were delivered in an institutional setting, such as a hospital or skilled nursing facility. Participants enrolled in Medicare Advantage (formerly known as Medicare Part C) had access, and continue to have access, to outpatient prescription drug coverage through their selected private health plans.

Medicare participants who enroll in Part D must select from stand-alone drug plans administered by private companies. Each plan has a different premium, deductible, copayment, and Medicare-approved formulary. The total out-of-pocket costs for participants will vary depending on the plan chosen and the number of drugs purchased, as well as how expensive the specific drugs are.

In 2006, participants will on average pay a $25 monthly premium and a yearly deductible not exceeding $250. After reaching the deductible, Medicare will pay 75 percent of total drug costs between the deductible and $2,250. Under most plans, participants will be responsible for all medication costs above $2,250, up to a maximum of $5,850.

Once costs reach $5,850 -- referred to as the catastrophic limit -- Medicare will kick back in and pay 95 percent of medication costs. The gap in prescription drug coverage between $2,250 and the catastrophic limit of $5,850 is known as the "doughnut hole." When drug costs fall within the "doughnut hole," participants will pay 100 percent of those costs. This amounts to $3,600 in out-of-pocket expenses.

Some prescription drug plans may offer coverage during the "doughnut hole" gap. Even if yours does not, you should still bring your prescription drug plan card with you to the pharmacy when you are in the gap, because you may be eligible for other drug discounts on your medications. Additional assistance will also be available for people who have low incomes and limited assets.

Although Medicare Part D provides much-needed access to prescription drugs for many consumers, it comes at a hefty price. The Congressional Budget Office estimates that Medicare Part D will cost nearly $33 billion in 2006, increasing to $140 billion by 2015. Costs for Medicare Part D participants will increase as well. In 2007, the maximum yearly deductible will be increased to $265, and the catastrophic limit will increase (the exact amount has not yet been determined), which means that the "doughnut hole" coverage gap will increase and out-of-pocket expenses will be higher.

Some consumer advocacy groups fear there may be an additional, less obvious cost related to the "doughnut hole" gap in Medicare Part D. They are concerned that some patients may simply stop taking their medications while they are in the gap, potentially leading to an increase in emergency room and physician office visits (not to mention a rise in complications that could conceivably cost lives as well as money).For more details about the new Medicare prescription drug benefit, go to the Medicare Web site at www.medicare.gov.

Medicaid may also be a source of assistance for you. You can determine if you are eligible for Medicaid by contacting your state's Medicaid office. Many state plans provide prescription drug benefits. In addition, if you served in the military, you may be eligible for Veteran's Administration benefits, including prescription drug coverage.

Manufacturer Programs

Some drugmakers have set up drug assistance and/or discount card programs for low- and moderate-income consumers, especially seniors.

The Pharmaceutical Research and Manufacturers of America (PhRMA) and 46 of its member companies created the Partnership for Prescription Assistance (PPA), which provides access to more than 475 private and public patient assistance programs. To search for prescription drug assistance programs in both English and Spanish, visit PPA at www.pparx.org.

You, your health care provider, or your caretaker will have to fill out a basic online questionnaire that guides you to programs that may provide you with discounts or financial assistance in obtaining your particular medicines. According to PhRMA, in 2004, millions of patients received an estimated 22 million donated prescriptions with a value of more than $4 billion. This represents an increase over the 18 million prescriptions and $3.4 billion worth of prescription drugs donated in 2003.

AARP

Another source of useful information for seniors is the Web site of senior advocacy group AARP, at www.aarp.org. Click on the link for the AARP Bulletin and then the link to pharmacy assistance programs. This section of the site provides a useful listing of state-sponsored and manufacturer discount programs, discount cards, discount pharmacies, and other sources of prescription drug assistance.

Investigational Drug Opportunities

Participating in an investigational drug study may be a way of getting your medicines for free, at least for a while, but the situation has to be the right one. If you are interested in exploring this option, you must discuss it with your doctor. Your doctor may be able to identify for you any clinical trials of the drug you need.

Conversely, you may be able to find information on available trials by contacting or checking the Web site of the National Institutes of Health (www.clinicaltrials.gov) or a patient-support program devoted to your medical condition (for example, the Alzheimer's Association). If you are the one hunting down open clinical trials, however, you still need to discuss this option thoroughly with your physician, who knows the specifics of your condition and your medical history.

As an example, a cancer patient's doctor might suggest participation in a clinical trial as one treatment option, or the patient or a family member might ask the doctor about clinical trials of new drugs available for treatment of the patient's specific type of cancer. To learn about new cancer drugs being tested in clinical trials, the doctor and/or patient can check the National Cancer Institute (NCI) PDQ database. This database contains information on a large number of ongoing studies, as well as information on cancer treatment and prevention. Individuals can receive guidance on using this database via NCI's cancer.gov Web site (see Finding Clinical Trials), or they can call the NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). Information specialists there can search the database and provide a list of trials.

There are some potential downsides to receiving an investigational drug. The purpose of the investigation is usually to determine if the drug is better than standard therapy for treating a disease, and there is always the chance that a patient who receives an investigational drug will not benefit from it. Side effects (both long and short term) from the drug may be unknown and may be more likely to occur before a drug is approved, especially if the drug is in the early phases of testing. Finally, although the drug is usually provided free of charge, there may be other costs associated with the treatment that may or may not be covered. Patients should check with their insurer about coverage of these costs prior to beginning treatment.

Reducing your prescription drug costs is no small task. There are many factors to consider, but there is help available. By consulting with your doctor, your pharmacist, and other agencies, you can lower your prescription drug bill.

^©Publications International, Ltd.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.