The practice of raising drug prices on new — and old — medications is common and widespread, notes Consumer Reports.
From a nationally representative telephone poll conducted by Consumer Reports Best Buy Drugs in March, it learned that 3 in 10 Americans (about 32 million people) were hit with price hikes within the previous 12 months, costing them an average of $63 more for a drug they routinely take — and a few paid $500 or more. Consumer Reports also found price increases on everything from longtime generics used to treat common conditions such as diabetes, high blood pressure and high cholesterol to new treatments for diseases such as hepatitis C.
The poll shows that when people were hit with higher drug costs, they were more likely to take unhealthy measures such as skipping doctor appointments, tests or procedures, or not filling their prescriptions or taking them as directed.
The forces of profit
Consumer Reports' analysis suggests that high prices for generic and brand name drugs stem in part from a battle over profit between mammoth industries — big pharma and insurance companies — with consumers caught in the middle.
Drug companies can charge whatever price they want. For Medicare and commercial health plans, no government body — including the Federal Trade Commission, the Food and Drug Administration and the Centers for Medicare and Medicaid Services — has rules or laws that dictate or restrict the price a pharmaceutical company can set for a drug. And in most cases, there's nothing that restricts how much a company can raise that price.
Insurance companies are also charging you more. The only way left for insurers to provide coverage for a drug but maintain their profit margins is to reduce how much insurance coverage — and thus protection from high prices — they offer to a consumer. That can happen in at least one of four ways: by raising your deductible; by increasing monthly premiums; by increasing your co-pay by putting drugs into more expensive "tiers"; or by making you pay "co-insurance," where you pay a percentage of the medication's cost, usually one-third or more.
Courses of action
Although much of drug pricing is out of consumers' hands, Consumer Reports offers these tips to find the best deals at the pharmacy:
• Talk to your doctor about the cost of the drug she is prescribing. For less expensive alternatives, ask about generics, which can cost up to 90 percent less. Your doctor might consider "therapeutic substitution" — a different drug that works as well. If your insurance drops or reduces coverage of a drug, your doctor can also help by appealing to your insurance company for an exception to cover the drug anyway.
• Shop around and negotiate. Consumer Reports' secret shoppers have found that retail drug prices can vary widely, even within the same ZIP code. The shoppers also found that asking, "Is this your lowest price?" could get you further discounts.
• Check online. If you pay out of pocket, check GoodRx to learn a drug's "fair price." You can also fill a prescription with a low-cost online pharmacy based in the U.S., such as HealthWarehouse.com. Be careful of fraudulent websites: Use only an online retailer that operates within the U.S. and displays the VIPPS symbol to show that it's a Verified Internet Pharmacy Practice Site.
• Choose a plan that covers the medications you need. Compare plans during your open-enrollment period because coverage may change from year to year. Keep in mind that high-deductible plans have lower premiums but require you to pay a larger chunk of your drug costs.
To learn more, visit ConsumerReports.org.