10 Ways to Lower Prescription and Treatment Costs

Where you fill your prescriptions can affect how much you pay for medications. Many health plans have in-network pharmacies, where prescriptions cost less. They could also have preferred pharmacies that offer even lower copays or coinsurance.

To find the best price, check your plan’s pharmacy network. If you use Medicare, check the Medicare Plan Finder tool to compare costs at different pharmacies. A pharmacy’s location and whether they offer mail-order options also matter in saving money.

Most prescriptions come with an out-of-pocket cost -- the average for a brand-name drug is around $30, while the cost for a generic medicine is five times less at around $6. A generic drug matches a brand-name drug in quality, how it works, safety, and other important aspects.

Ask your doctor or pharmacist whether your brand-name medication comes in a generic form. You can also search the Drugs@FDA or the FDA’s Orange Book websites to see if the drug has a generic version available.

Prescription discount programs can help lower the cost of your medications, but they work in different ways. Some pharmacies offer store discount cards, while other programs provide coupons or memberships that lower the cash price of prescriptions.

These discounts usually apply when you don’t use insurance, so they may or may not be cheaper than your copay. Be sure to compare prices, coupon terms, and pharmacies that take part in prescription discount programs.
 

Online pharmacies can sometimes help lower the cost of medications. Some accept health insurance, but others don’t, so it’s important to check with your insurer to see if the pharmacy is in your plan’s network. Even if it isn’t, the cash price may still be lower than your copay.

You should also confirm that the pharmacy carries your medication. Most online pharmacies deliver prescriptions to your home, so remember to factor in shipping costs when comparing prices.

If you have health insurance through your employer or a marketplace plan, you can review and change your coverage during the open enrollment period. And if you have Medicare, you can compare prescription drug and Medicare Advantage plan costs at Medicare.gov.

You can also call individual plans to ask for more details about their coverage and costs. For free help comparing plans and understanding your options, contact your state’s State Health Insurance Assistance Program (SHIP).

Check with your employer to see if they offer a health savings account (HSA) or flexible spending account (FSA). These savings accounts let you put aside money for health care expenses and withdraw it tax-free when you need it for eligible medical expenses.

The difference between the two types of accounts is that you own an HSA and can transfer it to a new employer, plus it earns interest. An FSA is interest-free, and your employer owns it. You must also use the funds within the calendar year.

When you have an illness or injury, you can save money by deciding how serious it is and how soon you need medical care. This will help you figure out whether to visit an urgent care clinic or go to the emergency room.

Go to the ER if you: 

• Could lose your life 
• Be injured or harmed for good 
• Have a fever of 104 degrees F or higher 
• Take medication that suppresses your immune system
• Have a history of cancer 

But if you need care that can’t wait until the next day, you should go to urgent care. Plan ahead by knowing which urgent care center is near you.

Like a monthly budget, review how much you spend on health care costs to help you prepare for expenses and figure out if there’s a better health care plan for you and your family. Be sure to look at:

• Monthly fees, which include the regular premium you pay for insurance.
• Routine care, which covers predictable costs such as doctor visits, prescriptions, copays, or coinsurance. 
• Other health needs, like glasses, dental work, or services not fully covered by your plan.
• Unexpected care, such as emergencies, hospital visits, or major procedures, which can lead to high out-of-pocket costs.

Understanding your health insurance plan’s rules can help you avoid unexpected medical costs. Some insurers require their approval before certain procedures or treatments. If you don’t get it in advance, they may refuse to cover the cost.

Some plans also require a referral from your family doctor before you can see a specialist. If you visit a specialist without it, your insurance may not pay for the visit. Learning these rules ahead of time can help prevent denied claims and extra out-of-pocket expenses.

Another way to lower your health care costs is to take care of your overall health. This way, you’ll need fewer medical services. Ideas include quitting smoking, managing your weight by eating nutritious foods and exercising, and avoiding pollution.

In recent decades, some health improvements have helped lower health care spending. These include fewer hospital stays for heart disease and lower rates of certain cancers, including lung and colorectal cancer. But conditions like chronic pain are on the rise and can be costly.