WebMD Ask the Pharmacist

Saving Money on Medicine: Ask the Pharmacist

Jan. 19, 2010. Pharmacist Kristen Binaso, RPh, answers your questions about how to save money on medicine.

Question:

I've heard that pharmaceutical companies sometimes offer discounts on drugs. How would I get access to those discounts and how would that affect my insurance coverage?

Answer:

This is a common question I receive from patients. You've probably seen many commercials on TV offering assistance to patients who cannot afford their medications. Many pharmaceutical companies offer prescription assistance programs, which can include free or discounted medications. I recommend you work with your health care provider to identify the right medication for your condition, and then contact the pharmaceutical company who manufactures that medication to see if you qualify for the prescription assistance program. Contact the Partnership for Prescription Assistance at www.pparx.org or by calling 888-477-2669.

Question:

Is it OK to cut this pill in half? I have 20 milligram pills.

Answer:

Tablet splitting or pill cutting is a practice that involves patients obtaining higher-strength tablets and breaking the tablet in half, quarter, or whatever smaller portion they can in an effort to save money. The FDA has issued a statement on this practice. Splitting tablets are risky for several reasons. 1.) You might get confused about the right dose, especially if you forget to split the tablet; 2.) Splitting a tablet does not guarantee an equal distribution of medication; 3.) Some tablets are hard to split and may even crumble when attempting to split; 4.) Not all pills are safe to split, especially capsules and those with specially formulations to control drug release. I suggest not splitting any medication unless you and your health care provider have discussed the risks and benefits.

Question:

Hi, my husband has prostate cancer that has already metastasized to the bones. His four-month shot of Lupron seems to be losing its ability to control the PSA. The doctor has said that the next step would probably be a pill called diethylstilbestrol. Will Medicare cover that medication or will any prescription drug insurance company cover it? The insurance he has now does not cover it. Thanks for any help.

Answer:

This is a great question. Luckily, Medicare provides a great web site for folks to check out what’s covered and what isn't covered in its list of medications or formulary. Check out www.medicare.gov, and click "Formulary Finder" 2010 Plan Data, and then select your state of residence in the drop-down menu. Then type in the medication you wish to learn about.

Question:

Are brand-name drugs superior in quality to their generic equivalents?

Answer:

Great question. Many patients think that more expensive brand medications are better than their cheaper generic equivalents. The FDA requires pharmaceutical companies to prove all brand and generic drugs meeting specific requirements for not only safety and efficacy, but also related to identity, strength, quality, purity, and potency. Scientific tests and procedures are undertaken to demonstrate generic drugs can be substituted or be therapeutic equivalent to their brand-drugs counterparts. Generic drug products must contain the identical amounts of the same active drug ingredient as the brand-name product, but can differ in shape, flavor, preservatives, and other inactive ingredients, along with how they are "released" into the body (especially for extended release products).

Question:

Where can I find coupons for nicotine patches?

Answer:

Quitting smoking is a great way to save money and it also is great for your health. There is free service that can help folks successfully quit smoking by providing resources and tools and even free or discounted nicotine replacement products. Visit http://1800quitnow.cancer.gov or call 800-QuitNow for more information.

Question:

My health insurance will no longer cover my prescription for Allegra-D. Is there anything over the counter that works as well?

Answer:

This actually happened to one of my family members, especially as drug formularies change at certain times of the year. Allegra-D is comprised of two drugs: fexofenadine (an antihistamine) and pseudoephedrine (a decongestant) available by prescription. There are several antihistamine/decongestant combinations that are available over the counter but you need to see the pharmacist in order to purchase, like Zyrtec-D, Claritin-D, and Alavert-D. I recommend you talk to your pharmacist to see what one may be best for you since some may cause drowsiness and others do not. Also, be sure to work with your pharmacist, and bring your medication list to help determine if there are any drug-drug interactions with other medications you might be taking.

Question:

Since my fiancé, age 51, lost his job he's unable to afford the Viagra prescribed by his doctor. He is considering ordering from a Canadian online pharmacy. Is there a way to make sure the pharmacy is legitimate or is there another alternative medication that would be affordable? He has normal BP and is physically healthy and takes no other medications.

Answer:

Thanks for the question. Medications for erectile dysfunction (ED) are expensive and are generally not covered by insurance. I generally do not recommend ordering medications from online pharmacies because it’s hard to ensure these pharmacies are legitimate or are dispensing safe and effective medications. If you do want to order online, however, the National Association of Boards of Pharmacy has a VIPPS program that verifies and accredits online pharmacies. Check out http://vipps.nabp.net/verify.asp for more information.

Question:

Is it safe to take generic allergy medicine?

Answer:

It is fine to take a "generic" version of an allergy medicine. The generics contain the same active ingredient as the brand. They may vary by the way they are released and they may contain different salts, sugars, colors, etc.

Question:

What could my husband take for neuropathy because we can’t afford Lyrica?

Answer:

It sounds like your husband is taking Lyrica for diabetic neuropathy. If you have insurance, contact you insurance company to receive a list of medications they will cover for this condition. Your health care provider can choose the right medication for you. If you do not have insurance, check out the Lyrica web site at http://www.lyrica.com or contact the Partnership for Prescription Assistance at www.pparx.org or by calling 888-477-2669.

Question:

Is there a supplement that will work like penicillin for a tooth problem? I am unemployed and do not have insurance.

Answer:

This is a great question as patients seek alternatives to medications and health care. Drug supplements are not regulated by the FDA like prescription and over-the-counter medications, which have to prove their safety and efficacy. I generally do not recommend supplements because they are risky.

If you have a tooth problem and do not have insurance, I recommend you check out the Health Resources and Services Administration (HRSA) web site for federally funded health centers near you: http://findahealthcenter.hrsa.gov. These health centers exist in urban and rural settings and provide medical care, preventative care, and dental care and prescription drugs for folks without insurance. Payment is based on your income and what you can afford.

Question:

My sister was prescribed Zetia. She is on a fixed income and her insurance paid part of this medicine; however she still owed $100. Is there anywhere we can get her help with this medicine, she cannot continue to pay this price.

Answer:

Great question. Since your sister has insurance, I would recommend she call her insurance company to determine what medications are available to her at a lower co-pay or "tier." Then provide this list to her health care provider, so that the right medication is chosen for her. Patient assistance information is available through Zetia's web site. Check out http://www.zetia.com/ezetimibe/zetia/consumer/index.jsp or contact the partnership for prescription assistance at www.pparx.org or by calling 888-477-2669.

Question:

I am in my drug doughnut period of Medicare. My Plavix is much too expensive. Can you give me a less expensive comparable medication as an anticoagulant?

Answer:

Great question, but I have to ask if you also spoke with your doctor about this? I would suggest letting them know because the other factor that comes into play here is what the diagnosis is. What is selected for drug therapy will really depend on that. If you medication cannot be switched, you may want to look at the Plavix web site for programs they have to help offset the cost of the medications. It is very important that you don't just stop taking the medication because that could lead to you ending up in the hospital (and a bigger health care bill!)

Question:

Is Pristiq more costly then Paxil? Does Pristiq come in a generic brand?

Answer:

First, Pristiq and Paxil are medications in two different drug classes. If you are taking Paxil, I would ask if this medication is controlling your symptoms. If not, Pristiq might be a better choice. Some insurance companies might cover Pristiq if previous therapies are not controlling your symptoms. There is no generic available for Pristiq; however, Paxil is available in a generic version, paroxetine. You can contact your insurance company to see if they cover Pristiq. If not, they can provide you with a list of medications they cover, so that your health care provider can prescribe the right medication for your condition. If you have no insurance, contact the partnership for prescription assistance at www.pparx.org or by calling 888-477-2669.

Question:

I was on Aceon and due to the expense my doctor changed me to lisinopril. Does it protect the liver and kidney?

Answer:

Aceon (perindopril) and lisinopril are related and belong in a class called angiotensin-converting enzyme (ACE) inhibitors. There are studies that show ACE inhibitors play a role in providing protection against the progression of kidney disease in patients with diabetes. Thanks for the question.

Question:

Is there a generic for Cymbalta?

Answer:

Cymbalta is not available as a generic. Prior to making a recommendation to your health care provider, I would ask for what reason are you taking Cymbalta. Depending on your condition, you might consider asking your health care provider to prescribe you a drug within the same class as Cymbalta that has a generic version. Thanks for the question.

Question:

Is there a generic to Diovan 160? It's available from a Canadian pharmacy but not in my town. Or is there something else that is the same ingredient? I need to cut my costs.

Answer:

I have a few thoughts on this question. First, there is no generic approved in the United States for Diovan. You need to be very, very careful when looking into purchasing medications off the Internet from Internet pharmacies from places like Canada. There is an excellent chance that the medication is a fake and may actually cause harm to you. Have you spoken to your doctor about your financial issues?

I understand that you need to cut costs but you really need to be careful. Not taking your medication or taking something that does not contain the actual drug (counterfeit) will make you sicker and you may possibly end up in the hospital. In the end, you will actually end up paying more from all the additional doctor and hospital bills. You may want to also consider looking into "patient assistance" programs that may be available from the manufacturer at www.diovan.com.

Question:

I want to find another drug that is cheaper than what I am taking: Protonix 40 milligrams.

Answer:

Great question. Protonix is now available as a generic, so you may want to talk to your pharmacist to see if it is available and if your health care provider will approve the generic for you to try. It may be a little cheaper and it has been on the market for a few months.

If you are taking Protonix for gastroesophageal reflux disease (GERD), you might also consider lifestyle modifications that could reduce your risk of heartburn. 1.) Eat small, frequent meals; 2.) Avoid foods (e.g. spicy, fatty, acidic foods) and drinks (caffeinated and carbonated beverages) that trigger acid reflux; 3.) Wait at least two hours after meals to lie down; 4.) Elevate your bed a few inches; 5.) Lose weight; 6.) Avoid smoke and alcohol consumption; 7.) Avoid tight-fitting clothing; 8.) Avoid stress; 9.) Keep a heartburn journal of your acid reflux events. Also, there are certain medications that can contribute to heartburn. Keep a personal medication list and review this list with your pharmacists and your health care provider against the list of medications that can contribute to heartburn.

Question:

What is Zocor used for and are there any generic brand names for this medicine?

Answer:

Zocor (which is the brand name) is a medication that is used to treat high cholesterol. The generic name for Zocor is simvastatin and is available if your health care provider wants you to be on this medication and approves the generic.

Question:

What happens if you use expired medication?

Answer:

Great question. Medications will work properly when stored in an environment away from light, heat, and moisture. Medications improperly stored can expire before the expiration date. Using expired medication is very risky. Expired medications are not only less potent, but some medications become toxic when used beyond the expiration date. Taking expired drugs can cause an unwanted visit to the emergency department as well having an unnecessary medical bill.

Question:

I desperately need to find generics to treat my asthma and high blood pressure. I'm currently taking Symbicort, Singulair, and Hyzaar oral. I have Medicare Advantage.

Answer:

This is a common question I get at the pharmacy. The first thing I ask is if they have spoken with their doctor or health care provider about this and do they know you are having a hard time paying for your medications. If your conditions, especially the asthma, are being well controlled with the medications, switching to a generic or another class of medications that has a generic may not be an optimal choice. If you get switched, you may end up seeing the doctor more often or have more emergency room visits, which in the end, drives up health care costs. Many of the companies have assistance programs so you may want to look at contacting Merck and AstraZeneca, who manufacture the medications you are currently on.

Question:

I lost my cephalexin prescription. Can I use my tetracycline in place of the cephalexin?

Answer:

Many of my patients keep a stock supply of antibiotics they don’t finish from a previous infection, in an effort to save time and money. You should always finish your medications when you have an infection, even if you feel better. What many people do not know is that when you don’t complete your full course of antibiotic therapy, you can actually get a more severe infection because the medication did not fully fight all the infection the first time. Rather than using tetracycline that may or may not treat the infection you have, I would recommend receiving another prescription from your health care provider. It is better use the right drug to fight the right bug.

Question:

Hi, is there an over-the-counter medication to help get my blood sugar down. I lost my insurance and prescription plan. I know that I can keep it down with diet.

Answer:

Great question. No, there are no over-the-counter medications that help lower blood sugar. If you have been diagnosed with diabetes, it is important that you still try to see a health care provider for evaluation. Depending on your condition, you may be eligible for some classes of medications that are available generically and are lower in cost. You want to make sure you do not ignore this because you can end up in the hospital if your diabetes goes untreated.

You are on the right track though, diet, exercise and lifestyle modification are important factors in helping lower blood sugar. I encourage you to visit the American Diabetes Association web site at www.diabetes.org for more information and tips. Talk to your pharmacist too, they may be able to help you choose a more cost-effective meter to test your blood sugar at home.

Question:

My father is 94 and is taking Keppra for seizures. Since taking it he has not had a seizure in almost two years. However, this drug is so expensive that it is breaking them financially and they are on such a budget that it is creating a huge problem. Is there a generic for Keppra or what is your suggestion?

Answer:

Seizure control is important; your father should be commended for being seizure-free and compliant with his medications. Keppra is available in a generic, levetiracetam. However, managing seizures is as much of an art as it is a science. Some patients who start on the brand medications and switch to the generic medications for seizures sometimes have episodes. Other patients who switch from brand medication to the generic are fine -- a good friend of mine just made the conversion with no problem. I suggest your father work with his health care provider to explore treatment options for his specific type of seizure.

Question:

My 8-year-old son currently takes 10 milligram Metadate CD. Our insurance is no longer going to cover this and suggested we switch to Focalin XR. Is this a generic form of Metadate or completely different? Just FYI, my son had a poor reaction to Adderall XR.

Answer:

Great question. Focalin XR and Metadate CD are brand medications of methylphenidate. In the sibling analogy, they are considered "twins." With Metadate CD, you get both "twins" and with Focalin, you get the stronger of the "twins" only. If your insurance company is covering Focalin XR over Metadate, your son should be OK with the switch. Due to the formulation, Focalin XR is more potent than Metadate and may require a lower dose. Focalin XR and Medatate CD are in a different class than Adderall XR, which is mixed amphetamine salts (or amphetamine and dextroamphetamine).

Question:

My husband passed away in September. He had heart problems and other problems. We have a lot of medication left. What do I do with it?

Answer:

This is another great question. Medications should be disposed of in a safe and environmentally protective manner. There are several steps you can take to protect children and pets from potentially harmful effects. 1.) Pour medications into a sealable bag. Crush it or add water to dissolve it. 2.) Add kitty litter, sawdust, or coffee grounds to the plastic bag. 3.) Seal the plastic bag and put into trash. 4.) Remove and destroy all personal information from medication containers prior to recycling or throwing them away. There is a small number of medications the FDA recommends disposal by flushing. For more information about safe medication disposal, please visit http://www.smarxtdisposal.net.

Question:

What is the difference between Lovaza and the OTC fish oil products?

Answer:

Good question and one that I have to answer a lot because many people don't know that they really need to get the prescription filled! The FDA-approved dose of Lovaza is four capsules per day. It could take up to 14 capsules per day of an omega-3 supplement to provide the same amount of active ingredients proven to lower very high triglycerides.

Omega-3 dietary supplements have not been approved by the FDA to treat any specific disease like very high triglycerides. Supplements also do not go through an FDA approved manufacturing process. If you have any other questions, talk to your pharmacist, it’s worth the extra time.

Question:

I take Synthroid daily, I do not recall taking my dose today, should I be concerned or is it OK just to resume tomorrow? I did not want to chance possibly taking a double dose if I did take it and can't remember.

Answer:

If you miss a dose of your Synthroid, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. It is very important that you do not take two doses at once. If you ever have any questions around missing a dose of your medication, talk to your pharmacist, we are happy to help you.

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