Struggling to pay for your prescription medication?
You're far from alone: Studies show roughly a quarter of patients don't take medicines they need because they cannot afford them.
There are plenty of ways to save big on medicines, but the complexity of finding the best deal can be a huge headache.
Along with patient assistance programs, there are countless coupons, and discount cards are available. Prices change often and vary dramatically among pharmacies, even within the same chain, so it's often very difficult to compare all the deals.
Here are some guidelines and sources to try:
For starters, when a doctor is about to write a prescription, jump in with key questions:
. Are free samples available?
. Is the drug generally covered by insurance plans? Sometimes very costly medicines or some brands in categories with multiple drugs are excluded.
. Is there a cheaper drug that will work as well?
. Is there a generic version?
An unprecedented number of blockbuster drugs, those with annual sales exceeding $1 billion, have recently begun to face generic competition or will by next year. That includes cholesterol fighter Lipitor, blood thinner Plavix and four of the other 20 best-selling drugs in the world.
Many of these drugs are taken daily for years by millions of people. Once multiple generic versions hit the market, they are often priced up to 90 percent below the brand-name medicine's cost.
A patient assistance program may be able to help. They generally have income limits and other eligibility rules, but some are fairly generous, particularly for newer drugs for cancer or rare diseases that can cost $20,000 a year or more.
. Drugmakers almost always offer patients help, as their commercials note. Check out the website for the company or the drug.
. The pharmaceutical industry's Partnership for Prescription Assistance, at www.pparx.org or 1-888-4PPA NOW, directs uninsured patients to individual programs that can supply drugs for free or nearly free.
. Patient advocacy groups focused on one disease often can help patients or point them in the right direction.
. The nonprofit Patient Advocate Foundation, at www.patientadvocate.org, helps patients find co-payment assistance, navigate problems with insurance and deal with medical debt and related problems.
Also, many government-subsidized health clinics provide prescriptions for free or at a discount based on the patient's income.
If you don't qualify for help, here are some other ways to save:
. Several national discount stores, including Target, Kmart and Walmart, as well as large grocery chains, offer hundreds of widely used generic drugs for just $4 to $10 a month. They're hoping shoppers will also buy other merchandise.
. If you're insured, don't assume your prescription plan offers the best price. Some high-volume discounters, such as Costco, offer great deals for cash-paying customers, particularly on generic drugs.
. Prescription coupons from the makers of brand-name drugs typically offer a first prescription free, or $50 to $100 off for anywhere from a few months to a couple years.
Some are only for patients with insurance and can reduce co-payments to as little as $4; others offer the same discounts to anyone paying cash. But coupons cannot be used with Medicare, Medicaid or other government insurance.
. Check out Internet pharmacies, particularly www.healthwarehouse.com. A report last year by Consumer Reports on the big differences in prices among pharmacies noted a limited survey found the best online prices at that site.
HealthWarehouse holds costs down by getting volume discounts directly from manufacturers. It sells about 3,500 drugs for people as well as pets, including refrigerated medicines. On the third Friday of each month it offers a free prescription worth up to $500 to new customers or patients submitting a new prescription.
If you're shopping online, avoid sites that don't require a prescription. That's illegal, and they are likely to be selling potentially dangerous counterfeit drugs.
Stick with sites with a blue-and-red Verified Internet Pharmacy Practice Sites seal. They have been checked out by an association of state boards that license U.S. and Canadian pharmacies. The group lists approved Internet pharmacies at www.nabp.net/programs/accreditation/vipps/find-a-vipps-online-pharmacy.
Scores of discount cards are available online, generally for free. Most are good for a variety of medicines, including generic drugs, at tens of thousands of U.S. pharmacies. But each card could offer a huge discount on one drug and only a couple dollars or nothing at all off another.
The pharmacies provide discounts so they'll remain competitive, particularly with cards offered by huge groups such as AARP and AAA. The prices generally are negotiated by third parties such as prescription benefit managers that already work with a huge network of pharmacies, according to consumer advocate Edgar Dworsky.
"Different stores, different cards, different drugs all yield different prices," sometimes varying by 100 percent or more, noted Dworsky, who runs the site www.consumerworld.org.
He just completed a survey, at www.consumerworld.org/pubs/prescriptiondrugcardsprs.pdf, showing how difficult it can be to compare prices using different discount cards for specific drugs.
Most pharmacists won't do multiple price lookups because their automated systems usually require them to first enter all the doctor, patient and medication information and sometimes charges them for each lookup. So first promise you will fill the prescription.
. One of the cards with the best prices, Dworsky said, is at www.needymeds.org. Its president, Dr. Richard Sagall, said the site's discount card has average savings of 45 to 50 percent and also covers some pet and nonprescription medicines.
The site also has links to more than 1,000 discount coupons, scholarships and camps for children and adults with a particular disease, and more than 10,000 clinics providing medical care for free or low cost.
Given the huge variation in prices with different programs, do as much comparison shopping as possible.
Some state health departments run websites that enable residents to comparison shop at pharmacies in their area, but they may not include information on manufacturer coupons or available discount cards.
Another option is www.goodrx.com. After you enter your drug name and ZIP code, it lists prices at area pharmacies, along with printable coupons needed to get those prices.