Most adults take prescription medications, either on a regular basis for a chronic condition or on occasion for acute problems. If you live in the U.S., you should be aware that you are going to pay 2-3 times what residents of most other countries pay for the same medication.

            If you are wealthy and have great health insurance, you can stop reading and worry about something else. If you are like most of us, you may occasionally be faced with “sticker shock” at the pharmacy counter.

            As health care costs and the cost of health insurance keep rising, one of the ways employers and insurers have reacted is by raising the co-pays that even those with health insurance are required to pay.

            Many older adults and those with less-generous insurance plans have responded by skipping medication – simply not taking a prescribed remedy or trying to stretch it out by taking it less often than prescribed. This can result in seriously bad health outcomes.

            How can you cut your prescription costs without risking your health? There are multiple ways.

            First, be open with your doctor. Tell them if cost is a concern, as there are many things that the doctor can control. If you are prescribed a brand-name drug, ask if the same or a similar drug is available in a generic. There is usually a huge difference in price.

            If the need for a medication is borderline, see if lifestyle changes can substitute for a prescription. For such conditions as mild high blood pressure or borderline diabetes, exercise and dietary changes may avoid the need for a drug. Obviously, only do this with careful monitoring and discussion with your doctor.

            If only an expensive brand-name drug is needed for your condition and you have commercial insurance, ask about the drug-company provided co-payment cards, which your doctor will either have or can request. These are typically used as enticements to get doctors to prescribe new expensive drugs and are a last resort when the drug truly is best for you. (Note: these are not allowed under Medicare, only commercial plans).

            Shop around! There will often be dramatic differences in price between different pharmacies. Local non-chain pharmacies (if you can find one!) and the big-box stores will usually have lower prices than CVS or Walgreens for identical products.

            Use GoodRx for coupons. A large majority of prescription drugs are available this way.

            Check out the Cost Plus Drugs online pharmacy, which sells many generic drugs at substantially lower prices than you will find at retail pharmacies.

            Before reaching for your insurance card, ask the pharmacy what the cash price is. For many common generic medicines, this may be less than the co-pay you will be charged if you use your insurance.

            If you are in Medicare with Part D coverage or in a Medicare Advantage Plan, be careful to scrutinize the plan’s formulary every open enrollment period. Just because your medications are covered this year does NOT guarantee they will be next year.

            Don’t be passive and accept sticker shock. A little work can pay big dividends.

            Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.

What Does The Doctor Say?

By Dr. Edward Hoffer

            The presidential election is finally upon us. Some folks have already voted by mail and others will vote early at town hall. Still, others will wait until actual Election Day. They can anticipate a large turnout so expect to deal with long lines at the polls, unless Mother Nature doesn’t like any of the candidates and sends us a drenching rain. Or, heaven forbid, a late-season hurricane that will surely keep people home, especially the undecided (are there still undecideds?).

            I, for one, have already cast my ballot, mainly because I don’t like long lines. Plus, a nearby restroom is a prerequisite for this old guy to stand in any line for longer than five minutes.

            I’ve been keeping a close eye on the candidates for what seems like a lifetime. You may have noticed that they all make promises and lots of them. Some presidents are able to keep their promises, but most cannot. Some offer pie-in-the sky just to gain votes. Others are sincere when they promise to do this or that, but then must face the reality that Congress actually calls the shots. There have been many promises kept while many never materialized.

            During his campaign, Democrat Lyndon Johnson promised to “never let our boys” go to war. His successor, Republican Richard Nixon, promised that he “had a secret plan to end” the Vietnam war. How’d that work out?

            Do you remember “Read my lips, no new taxes.”?  That was Republican George H. W. Bush’s famous promise. He based that promise on projections that the economy would grow. Instead, a recession began.

            Democratic candidate Woodrow Wilson promised to keep the United States out of war in Europe. Alas, 34 days after being elected to a second term, he signed a Declaration of War against Germany. Circumstances often control whether a promise can be kept.

            Republican Herbert Hoover is famous for promising “A chicken in every pot and two cars in every garage.” That was “fake news.” He never said it. The slogan, however, took on a life of its own and Hoover won the election.

            President James Polk, a Democrat, promised to resolve the border problem between Oregon and Canada. He did. He promised to reduce tariffs on foreign goods too. Any of this sound familiar? He also promised to serve one term, which he did, then died three months into it.

            Presidential campaigns produce so many promises it is hard to keep up. Promises, promises, and more promises!

            I have a few promises I have been waiting to hear from the current candidates.

            When I was a teacher, one school I worked at would play a game called “Bombardment” in phys. ed. class. It was actually dodgeball which surely has a different meaning than bombardment. I would like one candidate to promise to create a Department of Peace. The Department of Defense was once called the Department of War. Which do you prefer?

            Another promise that would have gotten my vote is to offer a large tax break to cover my annual cost of eating. Food prices are so high.

            And how about forgiving the loan I will be taking out when I install a new lawn next year. My lawn is a national disaster thanks to all the dogs that have stopped by to visit. Do you know how much grass seed, soil, and fertilizer cost?

            I am not greedy. One last promise that would have insured my vote, a nice warm malassada Portuguese pastry waiting for me at the polls.

            Didn’t happen. Oh well. Be sure to vote if you haven’t already!

            Mattapoisett resident Dick Morgado is an artist and happily retired writer. His newspaper columns appeared for many years in daily newspapers around Boston.

Thoughts on…

By Dick Morgado