Epipens. Sovaldi. Tysabri. Acthar. Harvoni. Every month, it seems, there’s fresh outrage–from president Trump, the Congress, in the media, and among the public–over the soaring cost of prescription drugs.
With good reason: The cash price for the average brand-name prescription drug has increased 48% since 2013. These increases put desperately needed treatments out of reach for many, and cost taxpayers (via Medicare and Medicaid) billions of dollars more every year.
But as expensive as they are, the brand name drugs in the headlines actually treat relatively few people.
Much less attention has been paid to the price of prescription drugs that tens of millions of Americans take every day–that is, the 85% of prescriptions that treat common chronic conditions such as high blood pressure, high cholesterol, chronic pain, diabetes, and depression–and are usually generic medications, not brand-name drugs. Generics are the versions of drugs that get released after a manufacturer’s patent expires, allowing other makers to sell the same compound for less money–well, that’s how it’s supposed to work, at least. More than 3 billion prescriptions are written for generics every year. And the story of generic drug pricing is even weirder than brands.
We should start with the good news: generic drugs are, on average, getting cheaper. Patents on many blockbuster drugs–Crestor, Abilify, Nexium–have expired in recent years, and in some drug categories–statins or anti-depressants, for example–most treatments are now available as generics.
In theory, that should mean cheaper prices. In practice, not so much. Here’s why.
Until the last few years, insurance covered the cost of most generics; patients would chip in an average co-pay of about $10 and never think twice about the cost of their medications. Over the last decade, however, the $10 copay has slowly begun to disappear, and patients are exposed to prices that can vary wildly.
Part of this is driven by Obamacare. The ACA included prescriptions as an Essential Health Benefit, but it also allowed for very limited formularies, (the lists of drugs covered by insurers), extensive use of prior authorizations, (requiring extra approvals from doctor and insurer), and startlingly high deductibles–as high as $6,500 a year for entry-level Bronze plans–before those old-fashioned $10 co-pays kicked in.
At the same time, employee-provided insurance also changed dramatically. Plans that used to provide just one or two tiers of drug coverage now have as many as six, with patient costs ratcheting up with every tier. Meanwhile, copays are being replaced with “coinsurance”, where the consumer’s financial exposure is far greater–a percentage of the total cost, rather than a flat fee.
All this means that the average American has been quickly exposed to what’s called “usual and customary” (U&C) prices, which are the staggeringly high list prices for prescriptions that were never really intended for consumers to actually pay. Think of these prices like the sticker price on a car–most buyers know that the MSRP is a fool’s price, and the real, lower price is hashed out directly with the dealer. Same with the U&C price on drugs, except there’s no back office for consumers to negotiate with.
Take atorvastatin, which came on the market as Lipitor but has been available as a generic since 2011; the cash price for the most common dosage is $120 or more per prescription. Gabapentin, an oft-prescribed pain reliever, has a cash price of $75. Nexium, which went generic in 2015, has a cash price at $250 per fill. The story is even worse with diabetes drugs, including insulin, which are often not covered on insurance formularies altogether, (same with medications for erectile dysfunction and many dermatological conditions).
These prices aren’t just what people without insurance–which still numbers 30 million Americans and could rise substantially if current laws change–will pay. Add up the people in high deductible plans, on Obamacare, and more than 50% of Americans are at risk of paying the full cash price for generic medications.
Fortunately, there are now ways for consumers to comparison shop and access tools to make prescriptions more affordable, even when insurance can’t help. Some pharmacies have created programs to discount limited lists of prescriptions. Manufacturers are beginning to provide discounts and assistance programs to help reduce costs for cash-paying patients. And, over the past decade, pharmacy benefit managers–the companies that actually negotiate prices between manufacturers, insurers, and pharmacies–have launched discount cards that offer lower prices. Together, all of these discounts can provide significant savings; up to 75% off more expensive generics. The company I co-founded, GoodRx, has brought the same technology used to compare prices for plane tickets and TV’s to healthcare. We built a comprehensive database of all available discounts that shows consumers to the best available discount based on pharmacy and location, free of charge. It’s just one solution among many that are needed.
Every year, more Americans are diagnosed with chronic conditions, adding to the 50% of Americans currently coping with such diseases. These are conditions where medicine can’t promise a quick cure, but more typically offers years of coping through one or more medication. For these Americans–which sooner or later will include most of us–it’s essential that any solution coming out of Washington, or out of the drug industry, look beyond the headlines about expensive brand-name drugs, and include the vast number of drugs taken by the vast majority of Americans. If we’re really going to address the high cost of drugs in America, we need to understand the real problem.
This piece first appeared on Quartz
GoodRx has been focused on helping Americans for more than 6 years. This month, as hurricanes hit Florida and Texas, we realized that our mission to help goes beyond healthcare, and we wanted to do our part to help.
A few days after Hurricane Harvey, we sent members of the GoodRx team to Houston to help relief efforts. GoodRx employees spent the night NRG Stadium, a massive shelter in Houston. The following day, our team visited local shops and markets in affected areas, paying for food and prescriptions for local Houston residents. You can read more on how #GoodRxHelps Houston here and here.
Just one week later, Hurricane Irma hit the Caribbean and Florida. GoodRx pledged to make a significant donation to help those affected by Hurricane Irma, but we asked for your help. We asked visitors to GoodRx.com which charities they though most deserved assistance, and we received hundreds of responses.
GoodRx is sending $5,000 donations to 3 charities that were selected by you. To learn more about these charities or make your own donation, see below:
ASPCA (American Society for the Prevention of Cruelty to Animals). The ASPCA transported sheltered animals out of Irma’s path before the storm, and are now working hard to find and help abandoned and injured animals in the aftermath. They are also continuing efforts in Texas post-Harvey.
ShelterBox USA. ShelterBox provides everything from supplies like water and blankets to tents and more—that can help make cramped shelter quarters bearable, and help people who’ve been displaced by disasters. They are on the ground in the Caribbean, and still working in Texas.
MedShare. MedShare is coordinating with local medical organizations in Florida and the Caribbean to get medical supplies and equipment to those in need after the storm. They are also continuing efforts and coordination with charities in Texas.
With millions still without power in Florida, Georgia, and the Carolinas, an enormous amount of rebuilding ahead for Texas and the islands in the Caribbean—and now, the potential for more trouble from Hurricane Maria—there’s still so much to do. We want to thank you for helping us continue to make a difference. We’ll continue to do everything we can to help Americans in any capacity we can.
GoodRx wants to help Americans in need. Last week, we deployed a team of employees to Houston to help locals clean up and get their prescriptions. Unfortunately, another hurricane is coming—this time to Florida—and we can’t just sit on the sidelines.
For every new download of the iOS or Android GoodRx mobile apps on Monday, September 11th, and Tuesday, September 12th, GoodRx will donate a $1 to charities that will be helping victims of Hurricane Irma.
Which charities should we help?
We want your help to decide which charities most deserve our money. We expect to raise thousands of dollars, and we’d like to give it to the charities that GoodRx customers feel are best. Please post your recommendations in the comments.
Download the GoodRx mobile app for iOS or Android now to help Irma victims.
Terms and conditions
Update: as of Friday, September 8, hurricane warnings and watches have been extended up Florida’s east and west coasts, with the storm expected to impact the Florida Keys starting early Sunday morning. Stay safe!
As Hurricane Irma heads towards Florida, it’s important to know that Florida passed a state law in 2006 that allows for early prescription refills in any county that is under a hurricane warning.
What does this law do?
Most insurance policies will not pay for prescription fills until a few days before your prior prescription is supposed to run out. For example, if you have a 30-day prescription and you filled it on March 1, most insurance policies will not let you refill that prescription until close to the end of March—perhaps the March 26th or 27th in our example. If you attempt to fill your prescription prior to that time, your insurance company will not cover it and you’ll be forced to pay a much higher price.
This Florida law mandates that insurance companies need to allow an early 30-day fill in any county where a hurricane warning has been declared. The goal of the law is to ensure that people do not run out of important prescriptions during and after a hurricane impacts the area.
How do I get an early refill?
If you have important meds and you have less than a 2 week supply, now’s the time to act. Call your local pharmacy and check with them to ensure that you’ll be able to fill your prescription. Keep in mind that you’ll need to have available refills on that prescription, and also note that controlled substances may have additional restrictions.
Other ways you can fill a prescription early
If a hurricane warning hasn’t yet been declared or if you’re having issues with your insurance at the pharmacy, you may want to consider using a GoodRx discount instead.
If your insurance won’t cover a prescription, you will be paying a MUCH higher price—often 10 times what your co-pay would be. GoodRx coupons can provide discounted prices that may be similar to your co-pay. With GoodRx there are no early refill restrictions. Please note that most pharmacies have their own restrictions regarding quantities and refills – you’ll want to check with the store.
My pharmacist hasn’t heard about this law—tell me more
Here’s the full text of the law, as well as a link to the official Florida legislature website where it is posted. We hope this helps.
Emergency-preparedness prescription medication refills.—All health insurers, managed care organizations, and other entities that are licensed by the Office of Insurance Regulation and provide prescription medication coverage as part of a policy or contract shall waive time restrictions on prescription medication refills, which include suspension of electronic “refill too soon” edits to pharmacies, to enable insureds or subscribers to refill prescriptions in advance, if there are authorized refills remaining, and shall authorize payment to pharmacies for at least a 30-day supply of any prescription medication, regardless of the date upon which the prescription had most recently been filled by a pharmacist, when the following conditions occur:
(1) The person seeking the prescription medication refill resides in a county that:
(a) Is under a hurricane warning issued by the National Weather Service;
(b) Is declared to be under a state of emergency in an executive order issued by the Governor; or
(c) Has activated its emergency operations center and its emergency management plan.
(2) The prescription medication refill is requested within 30 days after the origination date of the conditions stated in this section or until such conditions are terminated by the issuing authority or no longer exist. The time period for the waiver of prescription medication refills may be extended in 15- or 30-day increments by emergency orders issued by the Office of Insurance Regulation.
This section does not excuse or exempt an insured or subscriber from compliance with all other terms of the policy or contract providing prescription medication coverage. This section takes effect July 1, 2006.
Nobody ever said doing good deeds would be easy.
As we watched Hurricane Harvey bear down on Texas last week, we knew that GoodRx needed to do something to help. Houston is the fourth largest city in the USA and many people who live in the area struggle to afford their prescriptions—and that was before a major hurricane. We desperately wanted to help, even if we’re not experts on disaster assistance.
On Wednesday, we came up with a simple plan: GoodRx would go to Houston, volunteer at a shelter, and pay 100% of the cost of prescriptions and basic necessities for as many people in need as we could reach.
We immediately realized some of our biggest challenges. The airport was closed. Hotels were booked . . . or just closed. No rental cars were available and ground transportation is limited. Undeterred, we bought plane tickets to arrive in Houston on Sunday. We had a basic plan and would figure out the details upon arrival.
The night shift: volunteering at NRG Center shelter
After a very early flight from Los Angeles, we arrived in Houston and immediately headed for NRG Center, one of the largest shelters helping individuals and families in the Houston area. The shelter had recently received supplies and generous donations from all over the country.
NRG has welcomed thousands of people since Hurricane Harvey hit. This huge shelter has separate areas for single women, families, single men, and pets. Guests are fed and provided clothing, basic necessities and inflatable beds or cots to sleep in. Police and medical staff are also available to assist.
Team GoodRx volunteered in the “department store,” where clothing donations are distributed to shelter guests. Many of these people were evacuated because they were in the path of the hurricane or resulting floods.
We spent all of Sunday night working at the shelter. Over the course of the night, we met many wonderful people, including local volunteers who offered us rides, a place to sleep, and more after they learned we had flown into Houston to help.
When our shift ended at 5 am the next morning, we went to a friend’s house to get a brief rest before the next part of our relief efforts.
“GoodRx pays for your prescriptions and groceries”
A few hours later, we headed to southwest Houston, an area that had been hit pretty hard (as we learned the night before). We found many stores that were closed, had no power, or had very limited supplies.
A Kroger in southwest Houston was one of the few open stores. We approached Adrian, the pharmacist on duty, and asked if we could pay for people’s prescriptions that day. No strings attached. (It’s important to note that at no time did we use or promote GoodRx discounts; that’s not what this trip was about.)
Adrian was happy to have us help, and together, we began paying for people’s prescriptions. We literally just swiped our business and personal credit and debit cards to pay for as many people as possible. Adrian called patients who had left earlier because they could not afford their prescriptions and asked them to return because he had a “nice surprise” for them. We met a mother whose house had suffered significant roof damage, a father with a son in the ICU, a grandmother, and dozens of others.
All in all, we managed to help hundreds of people in just a short time in Houston. Everyone we met was so hopeful, appreciative of our efforts, and receptive. We were so humbled by the dedication of the volunteers and the positive spirit of the community.
Our trip to Houston was one way for us to give back. Now, we’re looking at other ways we can expand #GoodRxHelps to have a greater impact at the community level.
For more information on how you can help the Houston area, see our previous article.