The Price of Pain 

Alice Austin shuffles to her desk pushing a walker. Four years ago she was an expert skier. Then she took a nasty fall at her home. Now, at 51, she’s partially paralyzed with a spinal cord injury. Before her devastating fall, she overlooked a payment on her health insurance policy and it lapsed. She was injured while she was looking for another insurance company. Now, she has no insurance.

In addition to her astronomical hospital bills, Alice pays about $700 a month for prescription drugs. She’ll need these drugs indefinitely. Despite her disability, Alice works seven days a week to pay her bills and still volunteers at an elementary school where she teaches English as a second language. Alice doesn’t want personal details in print and asked that her real name not be used. Many people are embarrassed to admit they can’t afford medical care.

You may think a serious illness could never happen to you. That’s what Salt Lake nurse Pam Duncan thought. While cleaning her basement, she felt something and slapped her leg. She wasn’t aware she’d been bitten by a deadly Brown Recluse spider. When she woke up aching with a rash the next day, she thought it must be allergies or the flu. By the time her condition was diagnosed over a month later, she was near death. Pam had gone into kidney failure and developed an autoimmune condition. She went into premature menopause, requiring hormone replacement. She was taking Prednisone and chemotherapy daily, among other medications.

Pam’s prescriptions cost several hundred dollars a month for almost two years. She was off work for 14 months and could work only part time for another nine months. “I was lucky; I didn’t need a kidney transplant. I was also lucky to have insurance,” Pam says.

Alice Austin is not so lucky. She is one of thousands of people in Utah, and millions in the nation, who don’t have insurance to cover prescription drugs. The elderly are among the hardest hit by skyrocketing drug prices. Many low-income workers don’t have health insurance, and some middle-income folks have such large deductibles on their policies that they can’t afford to pay for prescriptions. Even people who do have insurance sometimes don’t bother to file claims. People are being ripped off because they don’t know how to avoid prescription drug scams.

I’m one of them. As a self-employed writer, I buy health insurance through the Farm Bureau. Even though I’ve never milked a cow, I qualify because I live in Summit County, a rural area. But I pay almost $3,000 a year for this insurance, even with a $1,000 deductible. So the cost of prescriptions comes out of my own pocket. Despite three published books, I’m not Danielle Steele.

Most of us without insurance for prescription drugs are paying more for them than we should. I discovered that people could save hundreds of dollars on prescription drugs just by choosing a different pharmacy.

Huge Price Differences

You’d probably expect to pay more for houses, gourmet meals and boutique items in Park City, but did you know you might also pay more for prescription drugs, even at chain stores like Wal-Mart? I didn’t until I refilled a prescription at the Park City Wal-Mart and was shocked at the price increase. I checked around and was astonished at what I found.

There are vast differences in prescription drug prices in Utah, not only for brand name drugs but also for generics. Whether you live in Salt Lake or Park City, your pharmacy may be charging more for prescriptions than another pharmacy a few blocks away. Prices vary among cities, among pharmacies in the same city and sometimes among stores in the same chain. The good news is that a little effort can save you a lot of money.

I compared the cost of my own prescription, Premarin, an estrogen supplement, at various pharmacies. The more pharmacists, doctors and nurses I talked to, the more ways I found to save money. From now on, I’ll be saving more than a third of what I’ve been paying just for Premarin.

To get the lowest price, you must practice comparison shopping each time you fill a prescription. Prices change constantly. For example, you can save $29.49 a month—about 25 percent—by buying Prozac at the Wal-Mart in Salt Lake City instead of Rite-Aid. In four months, you could save over $100. And if you buy in larger quantities, you can save even more. Differences in price can be even more drastic on generic drugs and non-prescription medications.

Don’t rely on the pharmacist’s assurance that his or her price is the lowest. I told the pharmacist at the Park City Wal-Mart that my income was limited and asked if I could get Premarin for less anywhere else in Park City or Salt Lake City. She looked me right in the eye and said, “No.” But I discovered the drug was cheaper at both the Wal-Mart on State Street and the one in Murray, as well as Costco and AARP—and that all pharmacies, including Wal-Mart, regularly monitor prices of their competitors.

Don’t assume that a pharmacy in a large chain store is always cheaper than the small independent pharmacy in your neighborhood. High Mountain Pharmacy in Kamas has lower prices on some drugs than Albertson’s, Smith’s and Wal-Mart.

Park City Pharmacy, another independent, beats most local prices and some in Salt Lake. Owner Tom Strebel says he’s competitive. “How do I do it? I try to be as fair as I can with everybody. Some of the chains don’t care. I just did a price check the other day on cough medicine because I was concerned that I was way low, because I was selling so much. And I’m way under—others were more, except Dan’s which was about the same. I kept my price. If you came in and gave me a lower price, I’d match that price. I have prices in my computer, but I can adjust them. I don’t need to make money on everything. It’s my own store.”

Some other pharmacies will also match the price of their competitors if it’s above wholesale cost. But you have to ask.

I assumed independents had higher prices than chains, but Strebel explained that isn’t necessarily the case. “That used to be true before the chain stores ran the independents out of business by selling prescriptions below cost. But after most independents went out of business, the chains decided to charge more and not to continue to use their pharmacies as loss leaders. Now the big stores are going to make money on drugs. They no longer have the best prices. I can compete again.”

Tips for Shopping

1. Check prices on each prescription. The same pharmacy or mail-order house may have a low price on one prescription and a high price on another.

2. Check prices every time you refill a prescription. Prices change frequently. The pharmacy with the lowest price today may have the highest price on the same drug tomorrow.

3. Buy in large quantities. If you take a drug continuously or over several months, ask your doctor to prescribe the largest quantity and buy that amount all at once. Generally larger quantities are cheaper per pill than monthly quantities. You’ll also save shipping charges on mail or online orders if you buy larger quantities. Warning: If you have insurance, check your coverage. Some insurance companies will only cover prescriptions for 30 days at a time.

4. Buy generic drugs whenever possible. Generic drugs are required by law to be the exact equivalent of the brand-name drug. Dr. Debra Martin, an emergency room physician in Salt Lake City and a volunteer at the People’s Health Center in Park City, recommends generics in most cases. “Generally it’s cheaper to buy generic drugs,” she said. “You should ask your pharmacist or doctor if a generic is available. Most of the time it’s perfectly acceptable. But in a few instances, a designer or name brand can make a difference. Your doctor can tell you if a generic is right for you.”

It’s even more important to compare prices on generics than on brand-name drugs, warns a pharmacist at Albertson’s in Salt Lake City. “Pharmacies usually don’t make money on high-priced brand name drugs such as Prilosec. Insurance companies barely pay for the pharmacy’s cost of the drug. Pharmacies have to make money on the drugs they can buy cheap, usually generics. So it’s especially important to shop prices for generic drugs because the price difference can be great. Lortab, a painkiller, is one of most popular drugs, and there’s a generic equivalent that can be much cheaper, depending on where you get it.”

5. Physicians get free samples from drug company reps who want doctors to give them to patients. Ask your doctor if she or he has free samples of the drug you need. It doesn’t cost doctors anything. They end up throwing out a lot. You just have to ask.

Mail order and online pharmacies

The benefit of mail order and online pharmacies is that you don’t have to leave your home, which makes them ideal for people who are disabled. The down side is that you can’t get medication right away. There are dozens of mail order and dot-com pharmacies, and prices vary widely. Some advertise certain drugs with extremely low prices. But these may be loss leaders, drugs sold at a loss to lure customers. Prices for other drugs may be among the highest.

One web site, www.pharmcor.com, compares its prices with those of other online pharmacies. But always do your own online research. Also keep in mind that the lowest price today may not be the lowest when you refill your prescription.

Some pharmacies may seem to have low prices, but high shipping and handling fees wipe out the difference. Some shipping and handling fees increase based on the dollar amount or weight of an order. Add up the total cost carefully when you do your survey.

Although it was not possible to check all pharmacies for this survey, one is worth mentioning because prices on the drugs I surveyed are exceptionally low. AARP, the American Association for Retired Persons, is affiliated with a mail order pharmacy called AARP Pharmacy Service. Unlike the organization itself, the pharmacy is not non-profit.

The AARP Pharmacy has two programs: a mail order program and the Members Choice Program. In order to use either program, you must be a member of AARP. To be eligible, you must be at least 50 years old, although your spouse can be younger. Children are not eligible. The annual AARP membership fee is $10 for both you and your spouse. Shipping and handling is $1.50 per order, regardless of the cost or weight.

Savings on the Members Choice Program (MCP) are even greater, but this program has an additional annual fee of $15. MCP includes a prescription card you can use at any pharmacy in the United States. The catch on the card is that if you use it at another pharmacy, you don’t get the MCP mail order prices. You pay either that pharmacy’s price or the mail order price plus $3, whichever is lower. The advantage of the card is that you can get your prescription filled quickly in an emergency. But it’s still wise to shop around for the cheapest price in your neighborhood.

I told Alice Austin about the low prices I found at AARP. But when she checked on her drugs for paralysis, which were not on my survey, Alice found that AARP’s prices were higher than those at Albertson’s in Park City.

The bottom line: Check prices before you refill prescriptions. If a price is low, buy the largest quantity you can.

Government and Private Programs

You may be able to get help with prescriptions through government or private programs. Medicare, a federal government program for people over 65, covers some prescriptions, but there are many exceptions. Pam Duncan worries about elderly patients in the hospital where she works who don’t have insurance to supplement Medicare. “Some patients want to go home but can’t because Medicare won’t pay for their drugs unless they’re in a hospital or skilled nursing facility (SNF).” One of her patients, an elderly man with a heart infection, needed one daily intravenous antibiotic. “He wanted to go home and have a home health nurse come in once a day to give him the IV. But the cost of his daily dose was $170 to $200, depending on the pharmacy, and he needed it long-term. He couldn’t pay for it. I had to send him to a SNF so Medicare would pay for his antibiotic. It doesn’t make sense. Medicare has to pay more for patients to stay in the SNF than for a daily visit by a home health nurse. And most people do better at home, especially older people who get confused in a strange place. Medicare should cover all prescriptions. “

She mentioned a patient, Jim, who has been forced out of the home he’s lived for over 20 years because he can’t afford to stay there and pay for the medicine he needs to keep him alive. Medicare restrictions on prescriptions force him to live in a cramped room in an impersonal nursing facility with a terminally ill roommate.

A Medicare representative said, “A high number of our calls are about prescriptions. There’s a vast need for help for the elderly. Some people on Social Security have to choose between food and medicine.”

Several Utah state programs provide medical assistance, including prescription drugs, but eligibility requirements are very restrictive, and many people don’t qualify. If you don’t qualify for a state program, you may qualify for a local or private one. According to Sister Karen at St. Mary’s Catholic Church in Park City, many members of their congregation can’t pay for expensive prescriptions. St. Mary’s and other churches—including the LDS church—will pay prescription costs for members who need help. Check with your pastor, bishop, rabbi or priest.

Some areas have non-profit clinics. A People’s Health Center operates a mobile clinic “on wheels” in Heber and Park City, for residents who can’t afford medical care and do not qualify for government programs.

Elena learned about the center when her daughter became ill. Elena is a 25-year-old single mother who works three minimum-wage jobs to support herself and her daughter. Day care for her daughter uses up all of the income from one job. Elena doesn’t own a car and relies on the Park City shuttle bus or walks. She tries to be with her daughter as much as possible and doesn’t have time to sleep much. Although she’s been a U.S. citizen for three years, Elena is afraid of calling attention to herself and didn’t want her real name used. She’s proud of being able to support her family and reluctant to ask for help. But when her daughter got bronchitis that developed into pneumonia, Elena had to get help. She took her daughter to the center: “I not go for me … not for me, you understand. I go for my baby. They are so good to me, so good. I am thanking them for helping my baby. I ask God to bless them.”

Patients are seen on a first-come, first-served basis and may wait for hours to see a doctor. They pay $3 for the doctor’s examination, which includes the cost of prescriptions from the Park City Pharmacy, and instructions in Spanish.

Lynne Finney, J.D., M.S.W., is an attorney, retired therapist, and author of several books, including Clear Your Past, Change Your Future. Visit her web site at www.lynnefinney.com.