When a prescription costs more than you have
Skipping doses quietly is the most expensive way to save money. Here is what to say instead, and to whom.
The pharmacist tells you the total and it is more than you expected. There are three prescriptions on the counter and there is a number in your head that is smaller than the one you just heard.
So you say the thing almost everybody says. Just this one for now. I will come back for the others.
You are not the first person to say it today, and the pharmacist knows that. What happens next is the part worth talking about.
The quiet version is the dangerous one
Cost is a common reason people stop taking a medication, and it is one of the least often raised at the next appointment. It gets handled privately instead: a pill split in half to make the bottle last, a dose taken every other day, one of three prescriptions filled.
The problem is that blood pressure and blood sugar do not tell you when they have drifted. If you stop a blood pressure medication, nothing happens today. Nothing happens next week either. You feel exactly the same for months, right up until the point where something has changed that cannot be changed back easily.
So the medication that gets rationed is usually the one with no symptoms attached, which is very often the one doing the most quiet work.
The pharmacy counter is not a good place to make a clinical decision by yourself.
What a care team can actually change
This is the reason to say something out loud. Cost is one of the few problems in a clinic that often has a real, immediate fix, and most of the fixes are invisible from your side of the counter.
- A different medication in the same family. Most classes of blood pressure and diabetes medication have several members. Some are old and inexpensive, some are new and are not. Often there is one that does a similar job for a fraction of the price.
- The generic version. Chemically the same active ingredient as the brand, usually much cheaper, and a pharmacist can often make this switch directly.
- A different strength. Sometimes a larger tablet, taken as half, costs the same as a smaller one. This only works for certain tablets. Extended release, enteric coated and capsule forms must never be split, and splitting one can release a whole day’s medication at once. It is a question for your pharmacist, not something to try with a knife in the kitchen.
- A longer supply. A ninety day fill usually carries one dispensing fee instead of three. Dispensing fees also vary from pharmacy to pharmacy, and you are allowed to ask what yours charges and to move.
- A combination pill. Two medications in one tablet can mean one fee instead of two.
- Stopping something. Occasionally the honest answer is that a medication has done its job or is no longer the right one, and the review that starts with cost ends with a shorter list.
None of that is a decision to make alone. All of it is a decision someone can make quickly once they know the problem exists.
Coverage you may not know you have
The rules here depend on where you live and they change, so this is a map rather than an answer.
Every province and territory runs some form of public drug coverage, and who qualifies differs in every one. Some programs go by age, some by income, and several exist for people whose drug costs are large relative to what their household earns, such as Ontario’s Trillium Drug Program and British Columbia’s Fair PharmaCare. There is also federal coverage through Non-Insured Health Benefits for eligible First Nations and Inuit clients.
Two more routes exist that people rarely find on their own. Prescribers can apply for coverage of a medication that is not on the standard list, through what is usually called special authority or exception drug status. And several manufacturers run patient support programs for their newer medications, which sometimes cover part of the cost.
Your care team and your pharmacist know which of these apply where you live. It is a short conversation, and nobody will ask you to justify having it.
The words, because the words are the hard part
Most people know they should say something. What stops them is not knowing how to start without it sounding like a confession.
At the pharmacy counter: “This is more than I can pay right now. Is there a lower cost version, or can you talk to my prescriber about an alternative?”
To your prescriber or your care team: “I want to keep taking this. It is about this much a month and I cannot manage that. What are my options?”
If it has already happened: “I have been taking this every other day to make it last,” or “I filled two of my three prescriptions this month.” Say which one you skipped. They are not equally urgent, and the person you tell can sort that in seconds.
You do not owe anyone an explanation of your finances. A number and a sentence is enough.
What not to do on your own
Do not stop a medication abruptly to make it last. With some blood pressure medications this is genuinely risky. Beta blockers such as metoprolol, atenolol and bisoprolol can cause a rebound rise in blood pressure and heart rate when they are stopped suddenly, and that matters most for people with heart disease. If a medication has to stop, there is often a safe way to do it, and it is not the same for every drug.
Do not split what should not be split, as above, and do not open capsules.
Do not buy prescription medication from a seller you cannot verify. Health Canada warns that drugs sold by unauthorized online sellers may be counterfeit, contaminated, or the wrong strength. Insulin and heart medications are not a place to gamble on a supply chain.
Do not stretch insulin. If insulin is the medication you cannot afford, that is a same-day call, not a next-appointment conversation.
Worth a call, not a wait
Contact your care team the same day if you have already been without a blood pressure or diabetes medication for more than a few days, or if you have been rationing insulin at all.
Go to emergency for chest pain or pressure, a sudden severe headache, weakness or numbness on one side, trouble speaking, or vision changes. Also for vomiting with abdominal pain and fast breathing, or blood sugar that is high with heavy thirst, constant urination and drowsiness.
One small place to start
Photograph the receipt. Just the total and the medication names.
Send it to your care team in the app with one line: this is what it costs and it is too much. That is enough to start the review, and it is easier than saying it out loud at a counter with a line behind you.
If you are a 360Care member, we will go through the list with you and tell you plainly which items have a cheaper equivalent, which have a coverage route, and which one you should never let run out.