We’ve heard the stories of drug manufacturers charging hundreds of dollars for a single course of treatment. Two years ago, Mylan CEO Heather Bresch found herself the center of a congressional hearing about her company’s decision to increase the cost of the EpiPen. Just one example of many high priced drugs, Americans report that they struggle to afford the cost of brand name drugs at a rate of one in four. What can we do?
Despite our wishes, bringing a new drug to market in the United States is very expensive. Between research, innovation, testing and FDA approval, the process can take years and cost millions, so it’s to be expected that drugs will be protected for several years by a patent. During this time, the drug manufacturer is aiming to recoup its investment and make a profit.
But patents end, and that’s why the one question patients need to ask their doctors is if there is an acceptable generic alternative. You might be surprised to know that 80 percent of brand name drugs on the market today have generic versions. Generic drugs work in the same way and provide the same clinical benefit as the brand name. They’re also approved by the FDA just as the brand name drug was years earlier, but at a significant lower cost because the research, innovation and testing need not be repeated.
What’s the difference in cost between brand name and generic?
According to the IMS Health Institute, generic drugs saved the American health care system $1.67 trillion from 2007 to 2016. How? A generic alternative is typically 85 percent less expensive than its brand name. And that cost savings is passed down to health insurance companies and, ultimately, patients.
Most health insurance plans have prescription drug tiers listed on their member ID cards. Often, you’ll see tier one is in the $5-30 range for a 30-day supply, while tiers two and three rise rapidly. (It’s important to note that some carriers have as many as five tiers, but that’s not the norm.)
How do you know which tier your drugs fall into?
The health insurance company provides a drug formulary that members can review. Not exactly practical to do while in your 20-minute physician appointment, but you can also ask your doctor. They often have a great deal of knowledge about the drugs they prescribe and can alert you if the drug is likely to be in a higher tier before you head to the pharmacy.
In some cases, there is no generic version of the drug being prescribed. But it doesn’t always mean you have no other option other than to pay a high tier copay. Most drugs fall into a class where there are several drugs designed to treat the same condition. While the newest drug might be all the rage, there is often an older drug that has years of proven efficacy that you can try first.
Bottom line…take control of your health care costs and ask your doctor if there is a generic drug that may provide the clinical benefit you need.
If you happen to face a situation where the only viable option is an expensive brand name drug, resist the urge to avoid treatment due to high cost. Most drug manufacturers offer rebates, discounts and financial assistance to Americans who can’t afford their prescription medication. Ask your doctor or the pharmacist for more information about how to apply.
We’re fortunate to live during a time of great medical innovation. We’re living longer lives as a result. So while there is much debate about the high costs of prescription drugs, we can find solace in knowing many conditions that were fatal or diminished a great quality of life in the past are now very manageable.
Have additional questions about your prescription drug benefits? Please talk with your human resources department or your PBG representative.