This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.
This information is not intended for diagnosis or treatment. Before making health decisions, discuss with your physician or other qualified healthcare provider to decide what is right for you.
This content is for your “information and inspiration”, and does not imply my endorsement or recommendation.
Does my insurance cover this?
When I was in practice, patients often asked this question. Patients wanted to know if insurance would pay if I ordered a test, imaging study, or a referral.
But patients most often asked if their insurance would pay when I prescribed a new medication.
Most of the time, I could not answer their question. Sometimes I would prescribe a generic drug or an older brand-name drug that I thought any insurance would cover, but it didn’t.
Sometimes it depended on the deals the insurance plan made with the pharmaceutical company, or the employer, Medicare, or Medicaid had negotiated with the manufacturer.
Whatever the issue, even patients with adequate insurance coverage might not afford the medications they need, or find them a significant strain on their budget.
In a past post, I discussed sources for health insurance, most of which also cover medications. This post explains how to get extra help paying for prescription drugs.
Talk to your doctor
The first and most important step is to talk to your primary care doctor. Take ALL your meds, both prescription and OTC (over-the-counter, non-prescription), including vitamins, supplements, and anything else.
Ask your doctor to review the reason for each medication and confirm that you need it. If you do, is there an alternative that might be less expensive?
Are you receiving the generic version from your pharmacy?
Is there an OTC alternative (although since they are usually not covered by insurance, may not be less expensive.)?
If you receive care from more than one doctor, you may need to do this with each one.
Learn about generic drugs and how they can lower your costs.
Get help paying for prescription drugs
Co-payment cards are provided by brand-name drug manufacturers to decrease patient out-of-pocket costs for a specific drug. These are found on drug company websites.
These are available to patients with private health insurance taking a brand-name prescription drug without an appropriate alternative medication.
The discounts often have monthly or annual limits and can be withdrawn at any time. If this happens the patient reverts to paying full price, or will need to seek other alternatives.
Check availability at Needy Meds or GoodRX
Non-profit organizations
There are non-profit organizations that provide assistance for medications and other health services.
HealthWell Foundation
Our vision: To ensure that no patient goes without health care because they cannot afford it.
PAN Foundation
We envision a future where equitable, accessible healthcare is a reality for all.
Direct-to-consumer pharmacies
You probably already use these retailers for other purchases. They also sell medications and may provide savings over typical pharmacies. These include Walmart, Costco, and Amazon. (affiliate link)
How to Buy Medicines Safely From an Online Pharmacy
Importing Prescription Medications
In general, the Food and Drug Administration discourages and prohibits the importation of medication from foreign pharmacies. The reason is
The FDA cannot ensure the safety and effectiveness of medicine purchased over the Internet from foreign sources, storefront businesses that offer to buy foreign medicine for you, or during trips outside the U.S.
For these reasons, the FDA recommends only obtaining medicines from legal sources in the U.S.
However, in certain situations it may be permitted. These include
“Product is for the treatment of a serious condition (Prescription Drug Products):
- The product is for a serious condition for which effective treatment may not be available domestically either through commercial or clinical means.
- There is no known commercialization or promotion of the product to persons residing in the U.S.
- The product does not represent an unreasonable risk.
- The consumer affirms in writing that the product is for personal use.
- The quantity is generally not more than a three month supply “
Additionally, the prescribing physician must be identified.
Check the FDA website for information about this option.
What about Compounded Medications?
A drug may be compounded for a patient who cannot be treated with an FDA-approved medication. They usually are not covered by insurance. If you are considering using a compounded medication due to cost considerations, here are some points to consider from the FDA.
Compounded drugs are not FDA-approved. The FDA does not review these drugs to evaluate their safety, effectiveness, or quality before they reach patients.
If a compounded drug does not meet appropriate quality standards, is contaminated, or contains too much active ingredient, it could cause serious injury or death. Labels on compounded drugs may not include adequate directions to help ensure the drugs are used safely.
Only use compounded meds under supervision of qualified health professionals.
Veterinary Meds-not for Human Consumption
During the COVID-19 pandemic, a drug used to treat worm infections in dogs and cats was touted as an effective treatment for COVID in humans. It isn’t, but it can be used in humans for parasite infections, just like in animals.
But that doesn’t mean any medication approved for use in animals can be used safely in humans. Products for animal use are likely to be formulated differently to products for human use.
Animal medicines may be made with different strengths of active ingredients, different dosage forms or different non-active ingredients that could cause allergic reactions in some people.
There can be severe unintended consequences if you use animal medicines to treat your condition. And you may not pay any less.
Find Free or Low-cost Vaccines
- Use Vaccines.gov to find free COVID-19 vaccinations near you.
- Learn about the Vaccines for Children program (VFC) for free childhood immunizations.
- Search for a local health center that can give your family immunizations at a cost based on your income.
Exploring the HEART of Health
I hope you find these suggestions helpful. Whatever you do, going without a medication is not a safe option and should be an absolute last resort, and only with your doctor’s supervision. Overprescribing does happen, so it is worth a doctor visit to see if you can safely stop any meds you routinely take.
Many people take nonprescription supplements and vitamins with little benefit. Stopping those can free up funds to pay for beneficial medication or other health-related expenses.
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Before you leave, read this related post.
How to Pay for Medical Care: A Guide for Americans
In this post I review how people pay for their healthcare. In the U.S., medical care financing includes employer-provided insurance, Medicaid, Medicare, the Affordable Care Act, and COBRA. Eligibility for these programs varies based on income, age, and employment status. Additional financial assistance exists through Medicare Savings Programs and nonprofit organizations, helping manage medical bills…
Keep reading
watercress words by Dr Aletha 