Prescription medications are an essential component of healthcare; they aid in the management of symptoms, the treatment of illnesses, and the saving of lives. However, the exorbitant expense of prescription pharmaceuticals can devastate most people’s monthly budgets in the United States.
It can even harm those who can afford good health insurance coverage, not to mention those who choose Medicare. Those $30 copays can add up. When you consider that some therapies are only available as brand-name prescriptions, it’s no surprise that customers are going into debt to purchase their medications.
The bad news is that it does not appear like healthcare spending will be reduced anytime soon.
More than 450 prescription medications’ prices increased by 5% in 2022, with a 5% median rise. This includes significant price increases on major prescriptions such as the HIV meds Biktarvy and Descovy, as well as a 6.9% increase on the Prevnar pneumonia vaccination and the breast cancer therapy Ibrance.
Unfortunately, this implies that some patients are struggling to pay for much-needed prescriptions or, in the worst-case scenario, foregoing them entirely. Even without the regular price increases, certain prescription medications are exorbitantly priced.
Consider Humira, which is used to treat various autoimmune diseases such as arthritis, Crohn’s disease, and ulcerative colitis. A 28-day supply costs about $7,000, making it one of the most costly pharmaceuticals accessible in the United States in 2019.
The most surprising is Afinitor, a cancer medicine that costs roughly $19,000 for a 28-day prescription if your insurance doesn’t cover it. And these are just a few of the brand-name medications for which no generic alternatives exist.
Copaxone (glatiramer), used to treat multiple sclerosis, is roughly $6,300 for a 30-day supply of the generic form. Regardless of how drug costs affect our health daily, few of us understand how the pharmaceutical market works, what drives up already high drug prices, and how to save money on prescription expenditures. Let’s examine why pharmaceuticals are so expensive, why your options matter, and how SingleCare can assist with prescription prices. Why are prescription medications so costly?
1. No price regulation
Most importantly, drugmakers control the decisions about how many American patients pay for their medications. The Food and Drug Administration (FDA) in the United States supervises how new drugs are tested, marketed, and distributed to the public, but it has no price control over prescriptions.
Customers are thus vulnerable to the whims of what many refer to as “Big Pharma.” According to one 2013 study, out-of-pocket costs with insurance outweighed the cash price of the medicine without insurance 23% of the time.
2. Drug exclusivity safeguards
When a new drug enters the market, it is instantly protected by a patent and drug exclusivity, with patents lasting 20 years from the date of application. Because of drug exclusivity, other pharmaceutical companies cannot compete by manufacturing generic pharmaceuticals with identical effects.
Patenting and drug exclusivity, in principle, encourage additional research and development of better and more effective therapies for debilitating diseases such as cancer and have even benefited the race toward a COVID-19 vaccine and coronavirus treatment.
They ostensibly prevent competitors from stealing hard-earned research. However, this frequently results in payers being saddled with exorbitant medicine prices.
According to Peter B. Bach, MD, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center, one of the most serious issues is that the law practically mandates insurers to include every expensive prescription in their coverage, regardless of efficacy or cost.
3. Supply chain price increases
Meanwhile, insurers are exerting pressure on consumers by raising monthly costs and offering health plans that don’t necessarily cover brand-name prescriptions. Then there are pharmacy benefit managers (PBMs), who negotiate prices with pharmacies, insurance companies, drug producers, and even your employers to create a list of authorized pharmaceuticals covered under your plan. It’s a tangled supply chain that ultimately hurts your bottom line.
4. Excessive administrative costs
The United States has the unfortunate distinction of charging its residents several times more for healthcare than citizens of high-income countries such as Sweden, France, the United Kingdom, and Canada, among others. So, why are medicine prices so high in the United States? “Contrary to some reasons for high spending, social spending and health care consumption in the United States did not differ significantly from other high-income nations,” according to the Journal of the American Medical Association. Labor and product prices, including medications, gadgets, and administrative costs, were the primary drivers of spending disparities.”
5. Low market competition
In Europe and Canada, on the other hand, there are fewer insurance firms, giving them leverage over the pharmaceutical business. They have the right to refuse high-priced pharmaceuticals, so pharmaceutical corporations must compete in a free market.
As a result, prescription medicine prices are more reasonable overall, and contrary to what the pharmaceutical industry maintains, decreasing pricing does not appear to have an impact on research and drug development.
Alternatives to generic prescription drugs
Despite all this bad news, don’t give up hope—you have more options than you think to receive the medicines you need at a price that won’t make you (even) sicker. When generic medications are available, you can choose them; they can cost up to 85% less on average and provide the same benefits as brand-name drugs. You may be suspicious of such a significant price decrease, but there is a simple explanation, and it has to do with FDA restrictions (or the lack thereof).
When a drug’s patent and drug exclusivity expires, other pharmaceutical companies are free to produce their identical version of the treatment, requiring drug pricing to become more competitive. Furthermore, the FDA regulates how generic pharmaceuticals are manufactured, packaged, and tested, so even if your medication looks somewhat different, it will function the same way.
For example, the ADHD medication Ritalin is also available under the generic name methylphenidate at a lower cost. Metformin used to treat Type 2 diabetes, is marketed under the brand names Glucophage, Glumetza, and Riomet; with a SingleCare coupon, you can obtain generic Glucophage for $30 to $40, whereas Glumetza costs $1,000, depending on where you reside.
And, of course, the price of insulin is exorbitant. In 2019, Eli Lilly and Company released insulin lispro, a less expensive generic version of Humalog. According to the Congressional Budget Office, generic medications save customers $8 to $10 billion in drug spending each year. So, the next time your doctor writes you a prescription, ask if it’s a new medication and if a generic version is available.
Tools for reducing prescription costs: Drug cards, rebates, and pharmacists
Going generic can help you save money on your prescriptions. There are also different ways to find the most excellent medicine pricing. With some knowledge and persistence, you can at least reduce the amount of money you spend on medications.
The biggest surprise is that utilizing your insurance to pay for medicines may not save you any money. A conventional $10 copay on generic pharmaceuticals may appear acceptable at first glance, but the same drugs may only cost you roughly $3 if you pay out of pocket without insurance.
And, whether you have insurance or not, you should always compare the cost of your prescription to a drugstore savings card, such as SingleCare. You might save up to 80% on your prescription medications—and there are no hidden fees or catch-up charges.
You can also inquire with your pharmacist about patient assistance programs, which many pharmaceutical firms provide for prescriptions and even immunizations based on various criteria. Another excellent strategy to save money is to compare Rx prescription rates at various pharmacies—some will charge less for specific medications than others. Go to singlecare.com, enter your medication, and then join your zip code to compare drug prices at local chains and big-box stores. People in the United States believe they have little choice when filling their prescriptions, yet SingleCare offers a more transparent and cheap alternative to obtain the pharmaceuticals they require.