If a prescription costs too much, ask about cheaper ways before you skip it

The price at the pharmacy counter may not be the only price. The same medicine can cost different amounts depending on whether it is a brand or a generic, how it is paid for, and on help programs a person may not have heard of. When the first price is too high, a person can skip a dose, stretch the supply, or leave without it. Before that, a few questions are worth asking.

If a prescription costs more than you can pay, ask the pharmacist and the person who prescribed it about a generic, the other prices and any help program before you skip a dose or stretch the supply.

This page covers the US and the UK, and it cannot tell you what you would pay or whether you qualify. If you are out of a medicine you need today, or seriously unwell, the box above comes first.

Three questions for the pharmacy

Ask whether there is a generic. The FDA says FDA-approved generic medicines work in the same way and give the same clinical benefit and risks as their brand-name counterparts, and that they tend to cost less. Some medicines have no generic; if yours has none, ask the prescriber whether a different medicine would do.

Ask what it costs each way you could pay. Ask what the price is on your insurance, with a discount card, and as a plain cash price. Some people say a card or a cash price at a particular pharmacy can come out cheaper than insurance, especially with a high deductible or for something insurance does not cover. One person says pharmacists may not mention discount-card prices, so it is worth asking. Some people also compare a pharmacy that publishes its prices and ships by mail. This page cannot check any such service. The FDA says an online pharmacy is likely safe if it requires a doctor’s prescription, gives a physical address and phone number in the US, has a licensed pharmacist to answer questions and is licensed with a state board of pharmacy, and it lists “deep discounts or prices that seem too good to be true” as a warning sign.

Ask whether there is a help program. The next sections cover that.

In the United States

Savings from the maker. Many people suggest looking on the website of the company that makes a brand-name medicine for a savings card or a help program, and say these can cut a copay or cover it. One person suggests that if the drug’s own page lists nothing, searching the drug name with “patient support program” may find a wider program run by the parent company. The NeedyMeds website keeps lists of programs that help pay for medicine, and 211 can point you to local help.

If you have Medicare, Medicaid or another government plan, a copay coupon is a different matter. The US Department of Health and Human Services’ Office of Inspector General (OIG) says in its September 2014 bulletin that manufacturers offer copayment coupons to insured patients, that when the item can be paid for under a Federal health care program, including Medicare Part D, the federal anti-kickback statute is implicated, and it describes an OIG report finding that all the manufacturers surveyed put notices on at least some of their coupons saying that Federal program beneficiaries are not eligible to use them. One person says a company’s separate help program may still be open to a person on government coverage, and that they got two brand-name medicines free through one while on Medicaid. Each program sets its own rules and can change them, so ask the program. Call 1-800-MEDICARE (1-800-633-4227) or your State Health Insurance Assistance Program (SHIP, 1-877-839-2675) with Medicare questions, or your state Medicaid agency for Medicaid.

Extra Help with Medicare. Medicare says Extra Help is a program to help people with limited income and resources pay Part D premiums, deductibles, coinsurance and other costs, that some people qualify automatically (for example with full Medicaid, a Medicare Savings Program or Supplemental Security Income) and others apply, and that the income and resource limits may go up each year. Its page says you can contact your local SHIP for free help applying. Read the limits on Medicare’s own page, not here.

Insulin. If you have Medicare, its insulin page says: “The cost of a one-month supply of each Part B- and Part D-covered insulin product is no more than $35, and you don’t have to pay a deductible for insulin.” If you take insulin and cannot afford the next supply, phone the prescriber or a pharmacist today, before you cut back.

Discount cards and cash. Medicare says discount cards are not creditable coverage and that buying with one instead of your Medicare plan does not count toward the plan’s deductible or out-of-pocket maximum; see the first question below. Medicare’s page also says to learn if the Medicare Prescription Payment Plan might be able to help you manage your costs. For a private plan, ask your insurer.

Refills before coverage ends or a trip. Some people say asking for a refill early, sometimes called a vacation supply, before a trip or before coverage ends is common and often allowed, and that talking to the pharmacist, not a pharmacy technician, can get more flexibility. One person says a refill-too-soon rejection can need a call to the plan, and one says some plans want a reason such as travel. The plan and the pharmacy decide. Give the real reason. A controlled medicine is different: in the US, 21 CFR 1306.12 says the refilling of a prescription for a Schedule II controlled substance is prohibited, and one person warns that asking early for a controlled medicine can be flagged by a pharmacist. 21 CFR 1306.12 is a US federal rule and covers only that strictest group, so ask the pharmacist whether yours is in it.

In the United Kingdom

Prescription charges differ by nation. NHSBSA says that in England most working-age adults pay, that the charge is £9.90 for each prescribed item, and that contraceptives and medicines for hospital inpatients are always free. It also says prescriptions in Scotland and Wales are free. nidirect says all prescriptions dispensed in Northern Ireland are free of charge for everyone.

In England, NHSBSA says you are entitled to free NHS prescriptions if you are under 16, aged 16 to 18 and in full-time education, or aged 60 or over, and lists others, including some people on Universal Credit (it depends on your take-home pay in your last assessment period), people with a valid medical or maternity exemption certificate, and people with a Low Income Scheme HC2 certificate. It says some benefits do not give free prescriptions automatically, and that an HC3 certificate gives partial help.

If you pay for many items, the NHS says a prescription prepayment certificate (PPC) may be cheaper: £32.05 for 3 months, which it says saves money if you need more than 3 items in 3 months, or £114.50 for 12 months, which it says saves money if you need more than 11 items in a year. The PPC order line is 0300 330 1341. The NHS Low Income Scheme (0300 330 1343) gives help if your income is low.

For advice on benefits and money problems: Citizens Advice in England (0800 144 8848), Wales (0800 702 2020) and Scotland (0800 028 1456), and Advice NI in Northern Ireland (0800 915 4604).

Who this page is not for

If you are out of a medicine you need today, phone the prescriber or a pharmacist today. In England, the NHS says that if you have completely run out, you can use the 111 online emergency prescription service, or call 111 if the medicine is not on a repeat prescription; that pharmacies can provide certain emergency medicines without a prescription, though you may need to pay; and to go to A&E if it is an emergency. Elsewhere in the UK, a pharmacist can tell you the route where you live. This page is not about buying medicine from another country, or sharing or reselling medicine; this page does not cover those routes. If you live outside the US and UK, your own country’s rules apply. If the price is the whole problem, ask the prescriber whether a different medicine would cost less.