When we write a prescription for a patient, we always try to match the best medication for the problem, along with the best price. But sometimes we get a surprise.
Generic Drugs are not always Cheap
Unfortunately, these days, it is possible to write a prescription for a generic drug and still have it not covered by your insurance. And, the generic drug might even cost $200 or $300. How can this be? Aren’t generic drugs supposed to be better and cheaper?
Unfortunately, this is not always the case.
Insurance companies usually cover medications in tiers. Tier 1 are the cheapest medicines with the lowest copay. Tier 3 could be higher cost medications with a higher copay. Usually, the higher cost Tier 3 medications are brand name drugs.
It seems that this year, a lot of insurance companies have moved a number of generic drugs to their higher cost tiers and they now need prior approval. Or worse yet, they are not covered at all!
Generic Drugs might not be covered by your Insurance
Some generic medications that have been around for 30 years or more are now coming back as not being covered by insurance companies. Patients will call saying that the medication they were prescribed will cost them hundreds of dollars and to please call in a prescription for something less expensive – which we gladly do.
You would expect generic drugs, especially drugs being used for decades, would be inexpensive – at least less than $100 – but not so anymore. Generic drugs can cost lots of money today.
The Generic Drug your insurance covers might not even work
Unfortunately, what some people don’t realize is that the covered medication might not be as good – or might not even work. We always try to match the best medication for the problem you have – and when there is a generic alternative that we feel will treat the problem properly, we always prescribe the generic drug first.
But, when you or your pharmacy calls us and says that the generic drug prescribed is too expensive, sometimes the medicines that are covered are significantly inferior to the one we first prescribed. And our first priority is to get you better.
A Cheap Generic Drug just became an Expensive Brand Name Drug
Some generic drugs are good and cost less – but we have seen some generic drugs revert back to expensive brand name drugs. A good example of this is the gout medicine colchicine.
Colchicine has been around for years and was very inexpensive (10 cents per pill) for many of those years. A few years ago, colchicine became the brand name drug, Colcrys, costing hundreds of dollars for a one month prescription ($5.00 per pill). The FDA had created a program where drug companies that do more research on a drug were allowed to convert the drug to brand name again. In this case, all generic versions of colchicine had to be removed from the market.
Sadly, colchicine did not have a suitable alternative – so many people had to go with this expensive drug.
Colchicine reverted back to generic last year, but prices still hover around $100 for 30 tablets (a two week supply).
Brand names can cost less
Many drug companies offer incentives for their new medications. Sometimes these incentives offer a free one month supply, with copays for refills subsidized to a much lower amount. This can actually save some patients a lot of money.
Also, newer medications can be much more effective in treating certain conditions. So, don’t always think generic is the best solution in all circumstances.
By David Schlam
Hollowbrook Foot Specialist serving the Hudson Valley from Wappingers Falls