NEW YORK (MainStreet) Most people just blindly accept a prescription the doctor hands them, but did it ever occur to you that what's written on that prescription pad is not most effective or even the least expensive prescription drug for your health concerns?
Sometimes your doctor's role as your primary healthcare partner can be compromised by slick drug company marketing materials, biased studies, perks, trips, lots of free samples and other incentives to prescribe the same drugs you see advertised on TV. And your own opinion can be influenced by misleading prescription drug ads you see in TV and in magazines and even by appeals from drug companies that offer discounts and help paying for their drugs, no matter how savvy you think you are.
Drug ads can be purposely misleading
According to the U.S. Federal Drug Administration (FDA), drug companies spend about $25 billion each year promoting their prescription medications in the U.S. Most is spent on promoting drugs to health care professionals, but about one-fifth (and growing) is spent on consumer advertising. You probably think the FDA oversees this pharmaceutical advertising, but it actually only regulates it. In most cases, federal law does not allow the FDA to require drug companies to submit ads for approval before the ads are used. The FDA can only cite companies for violations of FDA advertising rules after an ad has aired or been published, sometimes months later.
"Many new drugs are beneficial but many are not better than the other older, less expensive drugs," says Dr. John Abramson, lecturer in healthcare policy at Harvard Medical School and author of Overdosed America (Harper Perennial, 2008). He explains that "new" only means "recently approved by the FDA" and "better than nothing." It also means, he says, the drug is "not tested on a large number of people taking it over a long period of time." You may think "generic" means "not brand name" or "not as good" but what it really means is that these medications have been on the market for at least seven years so side effects as well as outcomes have been well-documented, notes Abramson. He says prescription medication advertising, both to doctors and to consumers, can be incredibly misleading.
"People definitely pay more money when sick and pharmaceutical costs are one of the fastest growing expenses today," says Dr. Paul Terpeluk, D.O., Cleveland Clinic's Medical director of employee health services about the rising price of advertising-backed pills.
How Obamacare might affect your prescription drug costs
The Affordable Care Act requires drug coverage as an essential health benefit in all new health plans. But consumers' out-of-pocket expenditures for those drugs is likely to increase substantially from the current average expenditure of $758 per person per year, according to HealthPocket, a technology company that compares and ranks available health plans.
Terpeluk explains that as more and more of the initial healthcare costs are shared with the consumer in the form of higher deductibles, co-payments and co-insurance, consumers will need to be more responsible in researching what they will pay.
While the new Affordable Care Act exchange plans will cover a minimum number of drugs for different types of illnesses, if you take a specialty drug (expensive prescription medications used to treat complex, chronic medical conditions such as multiple sclerosis and rheumatoid arthritis), you may find high out of pocket costs for it.
"It's nearly impossible to compare specific medication costs on exchange plans, but it's an important consideration beyond deductibles and premiums for many consumers," explains Jonathan Wu, C.E.O. of Valuepenguin.com, a consumer finance site that specializes in helping consumers make decisions about insurance.
Wu explains that different drugs are categorized differently among different plans, and what you will pay also depends on the structure of the plan.
"If you rely on one of those specialty drugs, don't purchase a new plan on the exchanges without specifically calling up the plan to ask about the cost and how payment for your specific medications will work," Wu said.
In fact, for those who know they face high medication costs, he advises that you look for the exchange plans that have a specific prescription medication deductible, because once you reach that, your plan will begin to pay for medications. If you choose a plan with a high combined deductible for healthcare and prescription costs, you'll be paying for your very expensive medications out of pocket until you reach that combined deductible which could be $10,000 to $12,000 on a Silver plan.
How to talk to your doctor about medications
No matter what health plan you are on and how you pay for your prescriptions, Abramson says to talk to your doctor to find out how to alleviate your symptoms and protect and improve your health outcome for the least amount of money. Instead of asking your doctor about a specific drug you saw on TV, Abramson suggests asking your doctor these three questions every time you are handed a prescription:
- 1. Do I really need a drug at all? What lifestyle changes can I try first that will alleviate my symptoms and improve my health?
- 2. Is there a less expensive drug I can take that is equally as effective?
- 3. Is there a generic version of this drug?
According to Abramson, the solution to improving your health is working on a lifestyle change first, if your doctor agrees.
--Written by Naomi Mannino for MainStreet