How to talk to your doctor about drug costs

Doctor or physician recommend pills medical prescription to male Patient

We’ve heard it’s important to have a primary care provider and to “talk to your doctor” about your health concerns to stay on top of your well-being and make the most of your visit.

But it’s also important to talk to your health care provider about prescription drug costs as well. Your doctor may not be aware of your financial situation, but they can make more thoughtful choices about your medications if they understand what your needs are.

WellTuned spoke to Dr. Crystal Cooper, a clinical pharmacist for BlueCross BlueShield of Tennessee, to get answers to common questions about the cost of medications – and get tips for talking about it with your doctor.

What are some common reasons people don’t talk to their doctors about medication costs?

Dr. Cooper: High drug costs can be a factor for medication nonadherence. It can be stressful or embarrassing to talk about finances, no matter what sort of circumstances you’re in. So, it’s common to be unsure about when and how to bring up financial concerns, even with someone you trust like your doctor.

It’s also easy for some people to worry their quality of care will be compromised if they feel like they might not be able to afford it – or any medications that come along with that care.

What are the risks of not speaking up?

Dr. Cooper: People often end up skipping doses to make a prescription last longer, cutting pills in half, using expired medication or abandoning the prescription all together, all of which can have a negative effect on their health.

Failing to take drugs as prescribed for chronic conditions like high blood pressure or diabetes, could lead to dangerous health consequences, such as heart attacks or strokes. Missing medication doses for conditions such as asthma, COPD and many others could cause your condition to become worse, leading to poor health outcomes or even hospitalization.

Also, if your doctor is unaware you’re skipping the medication listed in your chart, they may think it isn’t working and is likely to increase the dosage, change the medicine or make a treatment recommendation that doesn’t match your current needs.

How can your doctor help?

Dr. Cooper: Providers rarely have ready access to their patient’s prescription plan details, so they may be unaware of the costs of treatments they prescribe or recommend. But if you make your doctor aware of your circumstances, they can make more thoughtful choices that match your needs.

There’s a good chance a less expensive option is available, and your doctor can offer ideas such as switching a brand name drug to a generic, reducing the number of medications you take, or help you find a medication with a lower cost share.

What determines the cost of medications?

Dr. Cooper: The cost of a medication starts with what the drug manufacturers decide to charge. From there, the cost depends on if the medication is on your drug formulary, which is a list of the drugs covered by your health insurance plan.

Here’s what to know about formularies or covered drug lists:

  1. Your drug formulary provides guidelines on how the cost of the medicine is split between you and your health insurance plan.
  2. Formularies usually have “tiers,” which are groups of drugs classified according to cost.
  3. Your cost for a drug is based on which tier it falls into in your formulary, and in general, the lower the tier number, the less you’ll pay.

Can anything else affect the cost of medications?

Dr. Cooper: Generally speaking, brand name medications can be more expensive than generic medications. And specialty medications usually have the highest costs.

Here are some ways your health plan could affect these costs:

  1. Some drugs have copayments, which is a fixed amount you pay each time you fill a prescription.
  2. Others have a coinsurance, meaning you pay a percent of the total cost of the drug each time you fill a prescription.
  3. Some preventive/maintenance drugs may be offered with lower copays or coinsurance amounts.
  4. Some health plans also have a deductible, which is the amount you must pay for drugs before the plan begins to pay its share.
  5. If a member has Medicare Part D, the drug cost will also depend on what stage of coverage the member is in – drug costs are more expensive if the member enters the Coverage Gap.

5 tips for talking to your doctor about medications.

Dr. Cooper: The most important thing to do is prepare any questions you have ahead of time and have them written down on paper or in the notes section on your phone.

Here are some tips to consider for talking to your doctor about medications:

  1. Be honest about why, if you’re not taking a medication as prescribed.
  2. Be frank and upfront about any financial concerns.
  3. Take your drug formulary with you to your appointment.
    • You can request a printed copy from your health plan, or the formulary can often be found on the health plan’s website.
  4. Know your cost share for each drug tier.
    • If you don’t have this information readily on hand, call your insurance provider ahead of time and ask them your cost share for each tier.
  5. Ask your provider to review your drug list with you to see if a less expensive option is available, if you need it.

Ali Whittier, CHES®

Ali joined the BlueCross BlueShield of Tennessee corporate communications team in 2014 and is a Certified Health Education Specialist (CHES®) through the National Commission for Health Education Credentialing (NCHEC). A native of Iowa, she has more than a decade of experience in health promotion and community engagement, as well as health care communications. When she’s not at BlueCross, she and her husband Spencer are racing their bikes, spending time outdoors or cooking healthy food and treats in their kitchen.

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BlueCross BlueShield of Tennessee members can access wellness-related discounts on fitness products, gym memberships, healthy eating and more through Blue365®. BCBST members can also use tools and resources to help improve health and well-being by logging into BlueAccess and going to the in the Member Wellness Center under the Managing Your Health tab.