If you’ve been following the news, huge price increases on necessary drugs like Daraprim and cycloserine may seem unusual—they both dropped in price again once people noticed and complained, right?
The unfortunate reality as that price increases happen in the pharmaceutical industry day-in and day-out. While the majority aren’t quite as dramatic as the Daraprim price hike, they happen more often than you might think. In fact, you may be taking a medication that’s seen a price increase without even realizing it.
How can a price increase affect what you pay?
If you have insurance, you may continue to pay the same co-pay depending on how much more your drug costs at the pharmacy. If you pay a portion of the cost (coinsurance) instead of a flat co-pay, have a high deductible plan, or if you pay cash for your prescriptions, you’re more likely to be affected by changes in price.
Where might you see an increase without an explanation?
Many big retail pharmacy chains like Walmart, Target, and Winn-Dixie have a list of discounted generic medications—often costing only $4 for a 30-day supply or $10 for a 90-day supply. This selection of low-price generics can be incredibly helpful for keeping your costs down, and may be lower than many insurance co-pays. However, the lists of covered generics are subject to change with little to no notice, and most of the time it’s due to the increased cost of a medication.
Why do drug prices go up?
Higher cost to the manufacturer is one of the most common causes of a price increase, and you will see the difference passed on to you at the pharmacy. Shortages can affect price as well. If a medication that many people need isn’t widely available, the price may spike (sometimes temporarily, sometimes not). Shortages can be due to manufacturing issues, higher demand than expected, or a shortage of the active ingredient, among other causes.
Which other drugs have seen recent price hikes?
- Daraprim for toxoplasmosis
- Pain medications like Vimovo
- Heart medications like Isuprel or Nitropress
- Cycloserine for tuberculosis
- Antibiotics like doxycycline and tetracycline
What about pricey new treatments?
New drugs can also be very expensive, and there has been controversy around the high price of new treatments that can save lives like Hepatitis C medications Sovaldi, Harvoni, Olysio, Viekira Pak, and Daklinza. Sovaldi, for example, can still run up to $84,000 for a full course of treatment.
Another example: new injectable cholesterol medications Repatha and Praluent can help people for whom regular treatments like statins may not be enough. They both also carry a hefty cost at over $14,000 per year.
Manufacturers often justify the price of these drugs by stating that they are less expensive than current alternatives, they will lower the cost of hospital care by preventing other health issues, or that the cost is justified by the amount of research and development necessary for a new medication.
Studies show that Alzheimer Disease is feared more than any other medical condition in people over 55, even cancer. It’s normal to be concerned if you find your memory is not as good as it used to be as you get older.
You may wonder: is this normal memory loss or do you have Alzheimer Disease (AD)? Are there any tests that can help you find out? There are a few ways to narrow it down.
If you or a family member is worried about memory loss, a referral for neuropsychological testing is the place to start. A neuropsychologist will ask questions and have you perform simple tasks. The evaluation takes several hours. Given the lack of a reliable blood test or imaging that can distinguish AD from normal aging or other forms of dementia, this is the best we’ve got. Studies show that memory deficits associated with Alzheimer’s disease (AD) are distinct from age-related memory loss. Neuropsychological testing will help you figure this out.
Genetic testing and blood tests.
Despite easy access online to genetic testing for AD, a genetic basis is rare and really only associated with the early-onset form (symptoms before age 65), which accounts for less than one percent of cases. As of now, there are three genes that have been identified as causes of early-onset Alzheimer disease: amyloid precursor protein (APP), presenilin 1 (PSEN1), and presenilin 2 (PSEN2).
For late-onset AD, which accounts for the lion’s share of AD, the most firmly established genetic risk factor is apoprotein E ε4 (APOE ε4). In other words, late-onset AD is more complex with many factors likely playing a role,including genetics and environment. Because of this, APOE genotyping in people without any memory impairment is generally discouraged.
Imaging studies of the brain.
What about brain MRI or CT scan to see if I have AD? While it is true that a brain MRI in patients with AD shows decreased activity in certain areas of the brain (the temporal, parietal and prefrontal cortices), imaging studies alone are never enough to make a diagnosis. In someone with dementia, brain imaging can help detect treatable causes of dementia and differentiate among the subtypes. But as you know, AD is not a treatable cause of dementia—and honestly most aren’t.
What’s new in imaging for AD patients?
PET and SPECT imaging of the brain are common imaging techniques used in AD patients. PET and SPECT work when a tracer is injected (something that will latch onto amyloid) allowing us to image areas of amyloid in the brain. Why amyloid? Misfolded proteins result in plaques of amyloid and tau proteins in the brain, leading to AD.
The use of amyloid PET imaging is a huge area of interest in Alzheimer Disease patients. The downside of amyloid PET is that amyloid can be demonstrated in the brains of adults with normal cognition as well as those with AD. Ten percent of 50 year olds with normal cognition and up to 44% of 90 year olds will have a positive amyloid PET scan. Also, a negative amyloid PET scan in a normal person does not mean that individual cannot develop AD in the future, while a negative scan in a person with dementia reflects a high likelihood that AD is not the cause. Because of this, amyloid PET is certainly not recommended as a screening test for AD.
Flu season is officially underway, and it’s time to get vaccinated if you haven’t already. You need to know where to go to get your flu shot, and—more importantly—how to make sure you don’t overpay. Did you know that flu shots can cost anywhere from $0 (yes, free) to $50 or more?
The importance of getting a flu shot can’t be overstated, especially for those who are at a higher risk like young children, pregnant women, older adults, and the immunocompromised or disabled. (If you’re living or traveling outside the US, you’re also at higher risk.)
Whether your insurance will cover your flu shot, or you need some help with the cost, here’s what you need to know.
Why is it so important to get vaccinated?
Having the flu makes you more susceptible to getting pneumonia—particularly in those high-risk groups. The flu virus is actually the most common cause of viral pneumonia and can cause bacterial pneumonia as well. Pneumonia is much more serious, and can be life-threatening to someone with a weaker immune system.
How much do flu shots normally cost?
Medicare Part B covers flu shots at 100% (meaning you pay nothing). Many other insurance plans will now also cover flu shots at no cost to you, because they are considered preventive care. Be aware though—if you get a shot from your doctor, there’s a chance you may still have to pay for the office visit.
Check with your plan and with the location where you’d like to get your vaccination for exact prices.
Do I need to get the flu shot from my doctor?
Over the past several years, flu vaccine accessibility has gotten much easier, in the hope that the vaccine will be available to a wide range of patients. The flu shot, and several other vaccines, are now available at places other than your doctor’s office—including your local pharmacy, clinics, your employer, and health departments.
If you want to get your flu shot from your doctor, check with the office first to see if they have the current flu vaccinations available for the 2015-2016 flu season. You may or may not need to make an appointment.
Where else can I get a flu shot?
There are several places you can get vaccinated for the 2015 – 2016 flu season.
- Your employer
- Drive-thru flu clinics
- Community center flu clinics
- School flu clinics
- Health departments
How can I find out where flu shots are available near me?
First, check GoodRx for discounts at flu shot prices at pharmacies in your area!
The flu vaccine finder from Flu.gov is also great tool for finding where to get vaccinated. You can find it here. The Flu.gov finder allows you to search by location, and to see a list of places near you that have the shot available. Keep in mind though, while the tool can be helpful, it isn’t all-inclusive. Try calling your location of choice if it’s not on this list—they may still offer flu shots.
Is there anywhere I can find low-cost or free flu shots?
There are many, many free clinics and events offering low-cost or free flu shots across the US. Watch for announcements on your local news station, or in the local newspaper—or search online for free flu shots in your area.
Many pharmacies also have programs offering discounts or other deals when you get a flu shot. For example:
- CVS offers a 20% off savings pass when you get a flu shot.
- Target has shots starting at $25, and offers 5% off your other purchases on the same day.
- Costco has shots starting at $15 (and a great list of tips on how to prepare for your shot.)
- Safeway offers 10% off your groceries when you get a flu shot.
- Walgreens doesn’t offer a discount, but they do have a “give a shot, get a shot” program. When you get vaccinated at Walgreens, they will provide a vaccine to a child in need.
- Walmart also offers flu shots starting at $25.
I need more help with the cost, what are my options?
Click on your state to see some examples of where to find free and reduced-cost flu shots near you, at clinics, health departments, and one-time events.
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Carolina
- South Dakota
- West Virginia
- District of Columbia
Price increases on previously affordable medications is a familiar, though unwelcome, practice from the pharmaceutical industry. Recently though, aggressive price hikes have sparked outrage, even attracting the attention of presidential candidates Hillary Clinton and Bernie Sanders.
- Martin Shkreli, CEO of Turing Pharmaceuticals, has made headlines this week with a huge price hike on Daraprim.
- Daraprim went from $13.50 to $750 per pill. After Turing acquired Daraprim from another pharmaceutical company last month, the price jumped 5,000%.
- This isn’t the first time. Shkreli is the previous CEO of Retrophin, another biopharmaceutical company where the price of Thiola (tiopronin) was raised. Thiola is a medication used to treat cystinuria (cystine kidney stones), a rare genetic disorder commonly diagnosed in young children. The price for Thiola went from $1.50 per tablet to $30 per tablet—not quite as devastating as the Daraprim price change, but still a 2,000% increase.
- Daraprim is one-of-a-kind in the US. Shkreli’s reasoning for this increase was the rare use of Daraprim—but it is currently the only US-approved medication for toxoplasmosis, leaving patients who need treatment with no other options. Toxoplasmosis is a parasitic disease that may not need treatment if you’re healthy, but can be harmful to anyone who has lowered immunity. Daraprim is commonly given to AIDS patients to prevent infection, though it is also used to treat toxoplasmosis infections in otherwise healthy people who show symptoms.
- The price is going back down—but by how much? Now, Shkreli has said that Turing will lower the price of Daraprim “in response to the anger that was felt by people.” However, he has not stated what the new cost will be, only that it will still allow Turing to make a “very small profit.”
- Other drug prices are also going back down. You may have also heard about Seromycin (cycloserine), a tuberculosis medication. Similar to Daraprim, cycloserine was acquired by a new pharmaceutical company, Rodelis. Rodelis then raised the price from about $17 to about $360 per pill—another increase of more than 2000%. Rodelis has now agreed to return cycloserine to its former non-profit owner, but cycloserine still won’t return to the old price. The new cost of cycloserine will be double the original—$1050 for 30 pills, rather than $500—but still far, far less than Rodelis’s $10,800 price tag.
Have you seen significant price increases for your prescriptions recently? Let us know, and watch for more information on high drug prices in the US.
“I don’t need to worry about drug prices; I have insurance!”
At GoodRx, we hear people say this all the time. After all, isn’t that what health insurance is for? You pay your premium and then insurance pays for your medical bills. Right?
If you use GoodRx, you probably already know that prescription drug insurance isn’t what it used to be. Not long ago, most Americans had generous prescription benefits as part of their insurance. You probably remember $10 co-pays and never being shocked at the pharmacy counter.
So what’s changed? In general, health insurance is simply paying for less than it used to. The cost of healthcare has gone up, and the payors (whether the insurance company, your employer, or even the government) need to control their costs.
As a consumer, you need to watch out for these “features” of your insurance policy, all of which could cost you at the pharmacy counter:
- Deductibles. Most plans these days have deductibles, where you’re responsible for your own costs up to a certain limit. In fact, deductibles are increasing faster than wages in the US. Some common plans now have up to a $5,000 deductible! Many Americans now have High Deductible Health Plans (HDHP’s), which means they’re on the hook for most of their healthcare costs throughout the year.
- Formularies. Formularies are the list of drugs that your insurance will cover, and they’re shrinking. Fewer drugs are being covered and more drugs are being excluded. If your drug is not on the list, you’ll pay significantly more.
- Tiers. Formularies often price drugs by tier—each tier indicates how much you’ll pay. Recently, more and more tiers have been added to increase your co-pay. A Tier 1 drug might be a $10 co-pay, a Tier 2 might be $30, etc. There are now some plans that have up to 6 tiers.
- Co-insurance vs. Co-pay. Sound confusing? It’s not. A co-pay is a set amount, regardless of the cost of the drug. Co-insurance means you’re responsible for a percentage of the total cost. More and more plans are moving to co-insurance which could mean significant increases for you.
- Prior Authorization. Just because a drug is on formulary doesn’t mean it’s covered. Many drugs these days require the insurance company’s approval before you fill—and there’s no guarantee they will approve it.
- Step Therapy: Some drugs (typically expensive ones) require you to try another (typically cheaper) drug first and provide evidence that the first drug hasn’t worked before they’ll approve the second.
- Quantity Limits: Most insurance formularies will limit the amount of a drug you can purchase at one time.
Wait—here’s the good news! Cash and coupon prices are often lower than insurance co-pays, and GoodRx offers an easy way to make sure you’re getting the lowest price out there, whether you have insurance or you’re paying out of pocket.
These 6 tips will help you get the most out of GoodRx if you have insurance.
- Know what you should be paying for your prescription.
GoodRx lists free discount coupon prices, and provides the coupons so you can receive a discounted price when you pick up your prescription. The coupons are free and there are no obligations or hidden fees. You can also compare with cash prices, pharmacy membership program rates, and online pharmacies.
- You can still use a discount if you have health insurance.
You can always use a GoodRx discount instead of your prescription insurance if the cost is lower. Our coupons can’t be used to lower your co-pay, but you can ask your pharmacist to use a coupon, pharmacy membership program, or check the cash price instead.
If you don’t already know your co-pay or co-insurance for your prescription, you can often use your insurance’s web portal to look up what you will pay—or you can give them a call to get an estimate.
- Using a discount at your pharmacy is easy.
If you choose to use a GoodRx coupon or other discount program, just ask the pharmacist not to run your prescription through your insurance (they do this all the time). Ask that they use the coupon or discount card to process the transaction instead. If your pharmacist has any trouble using the discount, ask them to call the phone number on the coupon for help processing or to answer any questions they might have.
- How does GoodRx help?
Health insurance will offer either a discounted co-insurance price on your prescriptions, or a set co-pay (often starting at $10).
When you’re deciding whether to fill with your insurance, keep these questions in mind:
- Is this drug covered by your plan? If so, how much will it cost? Remember, your formulary lists the drugs your plan will cover. Your co-pay may be determined by tiers—or for many brand name drugs, your plan may cover just a percentage of a negotiated price. Check your insurance company’s website to see if they provide pricing. Some drugs may cost you more with insurance than if you use a GoodRx coupon and pay cash.
- Have you satisfied your deductibles? If you haven’t, you’ll usually still get a discounted rate negotiated by your insurance plan—but it may not be as low as the prices GoodRx can find. Check your insurance company’s website to find your deductible status.
- Can GoodRx beat your co-pay? Don’t be surprised if there are local and mail order prices lower than your co-pay. The typical insurance plan in America offers a $10 co-pay for preferred drugs (and it goes up from there). Many, many generic drugs can be bought for less than $10. Why pay $10 when you could pay $4?
For example, if you take metformin for diabetes, your co-pay may be $10 for a 30-day supply. What you may not know: many pharmacies have metformin available for $5 or under with a discount, and some, like Publix or Meijer, will even fill your prescription for free. Compare prices at pharmacies in your area here.
- You can also use a discount if you have Medicare.
Just like with other types of insurance, you can still use GoodRx if you have Medicare Part D or Advantage. Your Medicare co-pay may not be the pharmacy’s lowest price, especially if you haven’t reached your deductible, are in the donut hole, or are purchasing a drug that’s not on your formulary. GoodRx can still help you control your prescription drug costs and find prices that are lower than your typical co-pay.
Even better, GoodRx can tell you your Medicare co-pay, as well as the prices you’ll pay until you meet your deductible, while you’re in the donut hole, and after you leave the donut hole, and let you compare your co-pay with our prices on the same page.
Just add your Medicare plan after searching for any prescription on GoodRx to compare our prices with your co-pay.
- Need more than a coupon? GoodRx offers other ways to save.
GoodRx also provides savings tips, suggestions for alternative less-expensive drugs, information on manufacturer coupons, assistance programs, drug shortage and recall info, pill identification tools, and much more. Our goal is to make you an informed consumer by providing as much information as possible in an organized, easy-to-read way.