What to Do if Your Prescription Costs Too Much 

Sticker shock is a label people normally equate with a new SUV or a fancy home. But increasingly, it’s a term synonymous with the rising costs of some prescription medications. Even with capped copays and health insurance coverage, some people are finding it difficult to budget for the higher prices being charged for their needed monthly medications. But there is relief available. Here’s what to do if your prescription costs too much. 

The problem is widespread. People should understand that they are not alone when it comes to getting hit with price hikes during trips to the pharmacy. Recent studies have shown: 

  • More than 800 drugs rose in cost by nearly 5% in January 2021 — the largest number of increases in years, an analysis by Good Rx showed. Drug manufacturers can increase the price of medication at any time without notice or oversight, but typically do so either at the beginning or the middle of the year. 
  • Three in 10 adults reported high cost was the reason they did not take their medications as prescribed in the past year, according to the Kaiser Family Foundation.  
  • One in 10 adults say they skipped doses of their medication or cut pills in half to stretch their prescriptions. This is dangerous because skipping medication or taking less than the dose prescribed can lead to serious problems, including hospitalization.  

Insurance companies are helping members. While these rising list prices on drugs are putting pressure on people’s pocketbooks, the insurance companies are the ones primarily covering the extraordinary cost of these medications. Blue Cross Blue Shield of Michigan has put programs and guidelines in place to help members get the prescriptions they need. As drug prices fluctuate, insurers are working to alleviate the price impact on their members. Insurance companies are remaining flexible, with the goal to keep premiums and costs affordable for members even as drug prices continue to climb. 

Reducing costs. There are several ways you can try to reduce out-of-pocket medication costs. Here are some strategies to try: 

  • Talk to your doctor or pharmacist to see if there are generic drug options available. 
  • If there is no generic drug available, ask about lower-cost brand-name drug options. 
  • If affording medications is a barrier to taking them as prescribed, talk to your doctor or pharmacist to see if there is assistance available from the drug manufacturer. 

Money-saving programs. Make sure to talk to your insurance company to see if there are programs available that will help you save money on your prescriptions. For example, Blue Cross Blue Shield of Michigan offers a discount program to help make members’ existing medications more affordable:  

  • Drug Adherence Discount Program, powered by Sempre Health: Enrollment in this free program enables Blue Cross and Blue Care Network members to receive discounts when they refill their medications regularly as prescribed. The program focuses on certain drugs treating common chronic conditions, and currently involves medicines used to treat diabetes, cardiovascular conditions and respiratory conditions. 

For people who have been prescribed a high-cost drug with no generic alternative available, Blue Cross works to find cost-saving options for its members so that they can adhere to the medication regimen their doctor has prescribed: 

  • High-Cost Drug Discount Optimization Program, powered by PillarRx: For some high-cost drugs, there are no generic alternatives. For members on these types of medications, Blue Cross and BCN offer a high-cost drug discount program managed by PillarRx. The free program connects members to existing manufacturer copayment assistance programs, helping them take advantage of the best discounts for the high-cost, brand-name drugs they’re already taking.  

To learn more about prescription drug coverage, Blue Cross and BCN members can log into their online member accounts at bcbsm.com or the Blue Cross mobile app. Go to “My Coverage” and look for the section on prescriptions. 

  • On our website, select Price a Drug. 
  • On the app, go to Express Scripts, and select Price a Medication from the main screen; you may have to scroll down a little. 

Blue Cross and BCN members can also review lists of covered drugs online here: Drug Lists | Help Center | bcbsm.com. 

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Photo credit: Getty Images

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