When you purchase a new item of clothing, television set, or a car, as a general rule you can assume that the higher-quality items are the newest and/or those with the highest price tags, even if you know little about the products themselves. But this approach is often a poor guide to purchasing medications, where the newest and most costly drugs are often no better than, and occasionally inferior to, older and less expensive ones.
Most family practices have a "sample closet" stocked with free samples of brand-name prescription drugs for common conditions. When I was in training, I often gave financially needy patients who were starting a new medication a one month supply of samples instead of a prescription. Although it seemed like a money-saving idea at the time, it wasn't long before the samples ran out, and my patients were left with the choice of paying for an unnecessarily expensive medication or switching to a less expensive drug that they hadn’t tried before. In fact, a 2006 study in the Journal of the American Board of Family Medicine found that practices that distributed free drug samples actually cost their patients an average of $7 more per prescription per month than practices that did not give out samples.
This added cost might have been worth it if patients were paying for higher-quality medications, but most new drugs offer no clinical advantages. The Food and Drug Adminstration requires only that new drugs be superior when compared to a placebo, not to the best drug already on the market. Also, in order to maintain patent protection and prevent competitors from offering cheaper versions, pharmaceutical companies often develop “new” drugs with trivial differences from the originals. For example, prescription Clarinex for seasonal allergies is more expensive, but no more effective than, over-the-counter Claritin, and prescription Nexium for acid reflux is more expensive, but no more effective than, generic omeprazole.
Even worse, a few drugs that are commonly stocked in sample closets turn out to be downright dangerous to your health, since rare and potentially fatal side effects often don't become evident until a drug has been on the market for several years. I remember (and regret) giving out countless samples of Vioxx instead of over-the-counter ibuprofen to patients with arthritis pain; this drug was withdrawn from the market in 2004 after studies showed that it increased the risk of heart attacks and strokes. Avandia, an expensive diabetes drug that has been a fixture in sample closets for years, is the subject of an ongoing FDA safety review about its potential to increase the risk of heart attacks and heart failure.
There are a few easy things that you can do to avoid paying too much for your medications. When your doctor suggests that you need a new medication, ask if it’s possible to prescribe a less costly or generic alternative. Many pharmacies and discount chains offer one month supplies of generic medications for $4 or 90-day supplies for $10. If you are taking more than one medication for a condition (high blood pressure, for example), generic pills may be available that combine two drugs in one. If you don’t have insurance coverage for prescription drugs, some pharmaceutical companies and local and state government agencies often offer sizeable discounts on frequently prescribed drugs for people who meet certain financial requirements. (Here are more details on the Together Rx Access program offered by drug companies.)
Finally, after you have been on a stable dose of a medication for three months or more, consider buying several months’ supply in bulk via mail order. The Pharmacy Checker website provides a useful tool for comparing drug prices among reputable online pharmacies. I have usually advised patients to check with me before doing this, in case I anticipate making a change in their dose or frequency.
The above post is adapted from "Drug Discount: 5 Ways to Save at the Pharmacy," first published on my Healthcare Headaches blog on USNews.com.