Finding alternative medications to help patients save money
When Isaac Wiegman reached out to a patient who appeared to be late to fill his prescription, Wiegman, a registered pharmacist with Express Scripts® Pharmacy, learned some distressing information.
The patient had been prescribed Symbicort® (budesonide/formoterol) daily to treat chronic obstructive pulmonary disease (COPD). His wife was also prescribed the same dosage of Symbicort, but due to the high cost of the brand-name drug, the couple was sharing medication and taking less than they were prescribed to stretch their supply.
The patient was in the coverage gap or “donut hole” phase of his Medicare plan, which meant he was still responsible for a large percentage of his prescription drug costs.
This type of situation isn’t uncommon. In a 2022 national survey, 1 in 5 adults aged 65 and older reported that they were not taking their medication as prescribed due to cost.1
A generic medication offers significant savings
Wiegman was able to check the patient’s coverage information and found that Symbicort was a tier 3 drug under the patient’s health plan. He found another medication that was a tier 2 drug — fluticasone/salmeterol, a generic alternative in the same drug class — making it less expensive.
The patient and his wife went back to their doctor’s office, and after consulting with the doctor, made the switch, saving them a total of $441 for each 90-day supply of their medication.
Wiegman said doctors aren’t necessarily thinking about cost and coverage when they prescribe a medication. He described doctors as “diagnostic experts,” whereas pharmacists are “medication experts.” That’s why patients should also turn to their pharmacist for support.
“We’re on the same team as your doctor, working to make sure you get what you need,” said Wiegman.
Brand-name medications often cost significantly more than their generic counterparts do — not because they’re any more effective or of a higher quality. Generic manufacturers don’t have to repeat expensive clinical trials that brand-name manufacturers already did. Also, the U.S. Food and Drug Administration approves multiple generic versions of medications, so the competition in the marketplace helps to drive down costs.
“I keep up to date on what’s available in generic form and let patients know their options,” said Wiegman. “I’m educating patients every day about their medications and giving them the confidence they need to feel their best.”
1 JAMA Network Open: Cost-Related Medication Nonadherence and Desire for Medication Cost Information Among Adults Aged 65 Years and Older in the US in 2022 (May 18, 2023): https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805012.
Posted date: January 04, 2024