By Cindy Krischer Goodman | [email protected] | South Florida Sun Sentinel
With Florida ranking fourth in the nation for prescription medication spending, residents are scrambling to find innovative ways to reduce their costs.
Last year, prices increases for more than 4,200 drugs with an average hike of about 15%, according to Definitive Healthcare, a healthcare data analytics company. Floridians living with cancer, prediabetes or diabetes, and heart disease incur some of the highest out-of-pocket costs for medications.
Most Floridians are quick to admit drugs developed over the past 20 years have improved their lives, but the costs make it difficult for some to keep taking those life-saving drugs.
Research shows when consumers encounter shocking prices at the pharmacy counter, they often walk away without their prescription.
"Drug costs ranked higher as a concern for our members than housing costs, and that says a lot in Florida," said Jeff Johnson, state director of AARP Florida. "Too many drug companies are able to name their price and don't have to deal with the impact it has on real people."
Across the Sunshine State, patients, pharmacists, and physicians are getting creative, using various methods to keep their spending as low as possible.
The South Florida Sun Sentinel asked readers to share their prescription medication experiences. Readers responded by email, describing their struggles with drug prices and the strategies they use to reduce costs.
Medication prices can vary widely from county to county or even among locations within a chain. Florida modernized its MyFloridaRX Prescription Drug Price Locator last year, adding more medications and geographic areas within the state. The site uses an interactive map that illustrates the differences in prescription drug costs across Florida's counties.
Cherie Davidson, of Weston, says she always checks prices across pharmacies.
"I always ask for a paper script. Then, I use it to see who has the best price. Usually, it's Costco," she said. "I use Costco with my insurance, but always have a coupon handy."
Davidson says she clicks on the best price on GoodRx and prints a coupon. "It costs nothing to belong. It's free."
For antibiotics, she goes to a Publix pharmacy. Although Publix has ended its free prescription program, Davidson says the prices on some antibiotics are low enough to be practically free. For example, a 14-day supply of Amoxicillin is $7.50.
Davidson also checks Canadian prices. Medication prices typically are lower in Canada, partly because the country has negotiated maximum pricing, something the United States has not done.
"My husband uses a Canadian company for his eye drops. USA price: $100 per tiny bottle. Canadian pharmacy: 3 bottles for $120," Davidson said. "Each time he renews, he checks several pharmacies."
"We are both A students because we DO OUR HOMEWORK," she said. "People who don't do their homework PAY MORE."
Jeff Hamilton, who moved from Pompano Beach to Sebastian, uses a multi-faceted approach to medication shopping. Hamilton, 61, has insurance through the Affordable Care Act. First, he uses an independent pharmacy that matches competitors' prices. "Any meds not covered by insurance, I check the manfacturers' plans and have been lucky in getting that subsidy. The benefit of this part is that I am credited with the full insurance cost against my deductible while paying only a fraction," he said.
He also shops with online pharmacies. For example he likes Mark Cuban's Cost Plus Drug Company, an online pharmacy that touts affordable medicines with transparent prices. "A psoriasis drug that used to be $1,200 for 30 pills, that I have found for $200 for 30, is available from his online pharmacy for $59 for 30," Hamilton said.
Amazon Pharmacy does not require users to be members of Amazon Prime but offers deeper discounts and incentives for those who do join. Prime members get free two-day delivery and savings when paying for medications without insurance. The company says its Amazon Prime prescription savings benefit saves members up to 80% off generic and 40% off brand-name medications.
The U.S. Food and Drug Administration said buying medicines safely from an online pharmacy is possible, but not all websites are the same. The agency suggests using its BeSafeRx page to ensure a seller has high safety standards and sells medication with the right active ingredient.
"Online pharmacies have the opportunity to be valuable, " said Johnson at AARP. "But many sellers are doing it outside the system without quality controls." He advises anyone buying prescription drugs online to resist buying from companies that send a flashy text or email. Those sites may or may not be legitimate.
Floridians with or without health insurance rely on drug company savings programs as well as coupons and discount cards to fill expensive prescriptions, particularly those for chronic health conditions. Pharmacists say these coupons and discount cards have effectively made prescription meds affordable. However, it's important to note that Medicare does not allow manufacturer coupons.
For example, using RxSaver, a coupon for CVS can bring the price of an Albuterol inhaler down to $20.06 from its average retail price of $47.06.
Pharmacists caution Floridians not to assume that having insurance means receiving the best price. Sometimes, cash and coupons are better.
"Sometimes it will actually be cheaper than your insurance price," South Florida consultant pharmacist Saskia Madison said.
Donna Weyd, of Pompano Beach, regularly uses GoodRx to check for the best price and get coupons. However, It's still not enough for her to afford some medications. So, she stretches her doses. "If a drug is prescribed twice a day, I use it once a day," she said. "It does affect my health in a negative way. But if I have to decrease the dosage, it is because I have no choice at that point."
Weyd said one time, her insurance co-pay for an asthma medication was $75 for a 30-day supply.
"I stretched that one out almost three months," she said. "But then, because I wasn't using the maintenance medication as prescribed, I had to use another type of immediate medication more frequently if I was having asthma symptoms."
Weyd said she enlists the help of her doctors when medications are expensive. "I have found that doctors are willing to write a prescription for a different medication if insurance doesn't cover the cost for the doctor's first choice," she said. "Of course, that means the insurance company is deciding how to meet my medication needs, not the doctor."
Dr. Jason Goldman, a Coral Springs internist, says don't be afraid to go back to your doctor to ask for a different prescription or a substitution if your prescribed medication is too expensive. Doctors may be unaware of what patients will pay for drugs they prescribe.
"Unfortunately, it comes down to the patient's insurance plan," Goldman said. "I will try to find generics as much as possible, but there are only so many options out there."
Madison said pharmacists are also willing to help and will even call a physician to ask for alternatives to a costly medication if the customer desires. "We are absolutely a resource for you. No one knows medicine like we do."
Over the last few years, Madison says she has seen more rebates and vouchers become available for brand-name medications. Using them can be tricky though, she said: "Are you going to be able to use that voucher every month, only for three months, or is it possible to qualify for the year?" She encourages customers to reach out to pharmaceutical companies and ask for help with costs.
"Floridians should persist on knocking on every potential door for savings," said Johnson with AARP. "Your pharmacist, your physician, your health plan all know about special programs and discounts. There may be charitable programs that fund drug costs, too. Look around for anywhere to save money without sacrificing safety on medications your doctor says you need."
For the first time, the federal government has negotiated drug prices on behalf of the Medicare program and its beneficiaries. In August, the administration announced the first 10 medications subject to price negotiations, including some of the most widely prescribed or expensive drugs for conditions like heart disease, diabetes and autoimmune conditions. Floridians won't see those cost savings, however, until 2026.
Until then, some Medicare enrollees should see relief from drug prices in a new rule starting in January 2025 that caps their annual drug spending at $2,000. Previously, no limit existed on how much a person on Part D could have to pay in a given year, and some Medicare enrollees on expensive drugs faced out-of-pocket costs that exceeded $10,000 per year.
Florida leaders are also working to lower prescription drug costs. Florida Gov. Ron DeSantis has gained federal approval for a plan to import a limited set of brand drugs from Canada, where prices are lower. For now, Florida plans to import drugs solely for public health insurance programs, including Medicaid. The list of drugs that the state plans to import includes treatments for HIV, mental health, and cancer.
Steve Seefchak, of Fort Myers, says he is wary of negotiations to lower drug prices. "It seems that while some prescriptions have been negotiated down, others have been raised to make up for it ... Xigduo (a diabetes medicine) cost well over $500 on my latest script," he said. "I asked my doctor if he could stop that medication, but he prefers not to. The cost without insurance is well over a thousand dollars. It really has become a crime to be sick."
Carl Fowler, of Pembroke Pines, has a proposal he believes will lower drug costs: "Get rid of the loud, annoying pharmaceutical advertisements that serve no viable purpose." he said. He wants to see the U.S. reinstate the ban on direct-to-consumer ads and require drug manufacturers to redirect their advertising budget to lower the cost of prescription drugs. "I trust my doctors to prescribe the drugs that are right for me, not some TV ad with an over-the-top production number."