Michigan Association of Health Plans

Are you getting the best price for your prescriptions? Some strategies to pay less

Originally published by USA Today

Filling a prescription is pretty simple. In some states, including Maine, Minnesota and New York, your doctor electronically files the order. Elsewhere you bring the doctor’s scribbled instructions to a pharmacist.

Except that maybe it’s not so simple. Maybe there is a cheaper medication available that would do the same job. In that case, why doesn’t your pharmacist tell you?

Because in many states, your pharmacist operates under a contract that forbids telling you about less expensive alternatives.

“Every time a pharmacist dispenses a medication, they know a lot about other medications for sale that aren’t necessarily related to that person’s health plan,” said Shawn Bishop, vice president of programs that control health care costs and advance Medicare at the Commonwealth Fund. (The Commonwealth Fund is a health care policy research organization.)

Bishop compares buying a prescription drug to shopping for a sweetener.

“You can use a brand name like Domino sugar, or the supermarket’s house brand, which is a bit cheaper,” she said. “You could use stevia or another sugar substitute.”

Just imagine, though, that your supermarket steers you only to the name brand without mentioning any of the options.

“Pharmacists are the experts on these medications,” Bishop said. “They’re trained in the chemical properties of drugs and their interactions.”

The explosion in generic drugs — now at about a 90 percent dispensing rate — came in the wake of the 1984 Hatch-Waxman Act, Bishop explains, which was intended to encourage the manufacture of generic drugs.

“It literally went from 20 percent or so in the 1980s,” Bishop said.

But the language in some contracts prevents pharmacists from mentioning these alternatives. “Except for generics, pharmacists are not allowed to consult on other available products,” Bishop said.

Sometimes called “gag rules,” contracts between pharmacists and pharmacy benefit managers — who work on behalf of your company’s health plan — use boilerplate language to prevent a pharmacist discussing lower-cost alternatives.

The benefit manager creates the formulary of drugs on the health plan, usually in three cost tiers. The conflict arises when the benefit manager gets a rebate on brand-name drugs, said Bishop.

Read the full story at: https://usat.ly/2uXWCv7