How this Philly doctor helps patients to save on the cost of medications | Expert Opinion
Here are some tips to help you navigate a system rife with irrational and unfair pharmaceutical pricing.
In medical school, I was taught to choose medications based on how well a medication works and its risk or side effects. Cost was rarely mentioned, as if safety and efficacy were the only factors in the equation.
But to patients, cost is not negligible. Money spent on medications or healthcare will not be there for something else — whether putting food on the table, childcare, or other needs.
In my dermatology clinic, I see cost as an important “side effect” to pay attention to, and often the biggest reason for patients not filling their prescriptions.
Consider a couple examples of how the exact same hair loss treatment can cost more in one form compared to another:
The most common and effective over-the-counter hair loss treatment is topical minoxidil, best known under the brand name Rogaine. Forms of topical minoxidil marketed for women can cost 40% more than the exact same medication labeled for men — my colleagues and I published a study to prove it.
Another medication, finasteride, is commonly prescribed in 1-milligram tablets to treat hair loss in men, and in 5-mg tablets to treat enlarged prostates. According to GoodRx, 30 tablets of finasteride 1 mg cost about $30 for a one-month supply, and 30 tablets of finasteride 5 mg also cost $30.
I’m always looking for ways to save my patients money. So like many other doctors, I have prescribed the finasteride 5-mg tablets and directed patients to cut them in fourths with a pill splitter.
I often advise women to use the minoxidil marketed for men, because it’s cheaper for the same medicine. Why should women pay more for the same thing — a pink tax?
Here are some tips to help you navigate a system rife with irrational and unfair pharmaceutical pricing:
Co-pays can be based on the number of pills, or number of fills. Ask your doctor if you can save money by splitting pills (note: not all pills can be split), or by getting longer-term medications prescribed as a 90-day supply.
Many pharmacies offer a $4 (or other discount) formulary price for a 30-day supply. For instance, without insurance or any other program, you can usually get common prescription steroid creams for $10 for a 90-day supply. A full month of terbinafine, the common medication for toenail fungus, can cost around $10-15 without insurance. Strangely, sometimes certain medications may cost more out of pocket with insurance — it never hurts to ask.
Some over-the-counter prescriptions can be just as effective as more expensive prescription options. For acne, topical adapalene is similar to topical tretinoin, and an excellent option if you don’t have insurance.
Discount programs may offer coupons, and some pharmacies may offer discounts, e.g., GoodRx discounts and Mark Cuban’s Cost Plus Drugs pharmacy.
The pharmacies we use matter — for instance, if you use a telemedicine app like Hims or Keeps, it will likely cost you $90 every three months to get minoxidil or finasteride. My latest hot tip: In most states, Costco does not require membership to let anyone use their pharmacy, and instead of perhaps $360/year from Hims or Keeps or even regular pharmacies, for a full year supply of finasteride, it may only cost you $50-60.
The same prescription can carry dramatically different costs, depending on the pharmacy, the formulation, or a discount program. Before deciding you can’t afford a medication, ask your doctor or pharmacist if they know of a less expensive way to get the same treatment. My tips can save you hundreds of dollars a year.
Editor’s note: This story has been updated to clarify the cost of terbinafine without insurance.
Jules Lipoff practices as a board-certified dermatologist and Pennsylvania medical director for The Dermatology Specialists and serves as a clinical associate professor (adjunct) in the Department of Dermatology, Lewis Katz School of Medicine.