Although offers for free or nearly free brand-name drugs can be tempting, those promotions are usually for costly treatments that might not be the best first choice for your condition. And there also may be less expensive options available. Here are three potential traps to avoid:
1. Drug-manufacturer coupons. In advertisements on TV or in publications, drug companies offer to give away a free month’s supply or pay for part or all of your co-payment. The promotions are effective: 16 percent of Americans who regularly take a prescription medication have used coupons in the last year to save money, according to a 2011 Consumer Reports national survey. But the offers are usually available for a limited time, after which prices go back to regular. For example, the manufacturer of the cholesterol-lowering drug Crestor (rosuvastatin) offers a 30-day free trial, and then will pay up to $50 of your co-pay for 12 prescriptions filled within a 14-month period. After that you’ll be responsible for either the full co-pay or the entire retail price of the medication (about $175 a month), depending on your insurance coverage. And those with Medicare or Medicaid coverage are often not eligible for the deals.
2. Free drug samples. Drug-company reps give samples of brand-name products to doctors to distribute to their patients. But once the freebies run out, you’ll be stuck with the full cost of the medicine. Instead of taking the samples, ask your doctor to prescribe a generic.
3. Pricey drugs disguised as cheap generics. The best example of this is Pfizer’s cholesterol drug Lipitor (atorvastatin). When a generic version became available last November, Pfizer struck deals with some Medicare Part D plans to offer Lipitor as a tier 1 drug—the least expensive—with a co-pay similar to those charged for generics. Sounds good until you realize that your plan was charged the entire cost of the drug, not just the co-pay. Those charges put you closer to Medicare’s “doughnut hole,” which you hit once your prescription-drug costs total $2,930 in a calendar year, a risk for people who take multiple medications. Inside the doughnut hole, you’ll pay 50 percent of the cost of brand-name drugs and 86 percent of the cost of generics until you and Medicare together have spent $6,658. Once you’ve reached that level, you’ll pay 5 percent of your drug costs until the end of the year.
One plan we found, Cigna Rx1, charges participants a $3 co-pay for Lipitor but the plan pays $167 a month, the full cost of the drug. When we checked, generic atorvastatin was not even covered by the Cigna Rx1 Part D plan, though it’s getting even cheaper as more companies start to manufacture it, and it’s already on some formulary lists as a tier 1 co-pay. More than a dozen well-known drugs are scheduled to become available as generics in the coming months, and we expect that some manufacturers will follow Pfizer’s lead and strike similar deals with Part D plans.
Bottom line: If you’re enrolled in a Medicare Part D plan, beware of low co-pays on brand-name drugs. Check with your plan during open enrollment to see how well it covers all your prescriptions, since plan guidelines and drug prices change regularly.