No, the title of my article is not a typo or a weird loophole. This is a story about real savings, based on having an educated conversation with my doctor. 

Earlier this year I decided to make a career change, which meant a change in my insurance. It was a good time to make sure I fully understood what was being covered by my current insurance plan and what I would need to cover in the future. As I reviewed my monthly prescriptions I discovered that although I was paying $13 a month for one of my prescription drugs, the real cost was $626 a month. What? Can that be true? How did I never know this? 

It was true! Although it was my insurance plan, I ignored any responsibility because “insurance was paying for it” – and my highly-respected doctor prescribed it. I spent countless hours researching my new washer/dryer, reviewing multiple websites to ensure I was getting the best deal. Yet I blindly took prescription drugs without asking any questions and I purchased them without ever looking at the price tag. Well, I can wallow in my poor healthcare consumerism choices, but at least my clothes are clean with high-energy efficiency!

Here’s what I realized from this experience: we all need to be better healthcare consumers! A new study from Mayo Clinic researchers reveals exactly how many Americans are on prescription drugs — and it’s A LOT of us. Nearly 70% of Americans are on at least one prescription drug. More than half of Americans take two prescription drugs, and 20% of Americans are on at least five prescription drugs. 

Below are 5 questions I’ve learned we need to ask our doctors when they are writing a prescription drug:

1. What happens if I take this prescription drug?

I once had a doctor respond that the prescription drug she was writing was a preventive medication. I discovered she prescribed this medication because 2% of people with my condition would have a complication this drug would prevent. This particular medication was full of side effects and would require me to take it twice daily. Weighing my options, I chose not to take the medication. While I based my decision on a personal preference to avoid a preventative medication for a side effect experienced by just 2 out of 100 people, it might be peace of mind for you. The important thing is to have the information and make the decision for yourself.

2. What happens if I do not take this prescription?

Understanding the risk of not taking a medication is very important! If the medication leads to significant reduction of risk factors or helps ease daily symptoms, it is important to know when making your decision. It is estimated that up to half of all prescription medications are either not taken correctly or at all. In fact, many of us don’t even fill our prescriptions. More than one in five people fail to fill their prescription after learning they need a medication to prevent a future heart attack, stroke, kidney failure, etc. 

3. Why is this particular drug being prescribed and what is the effectiveness track record?

I learned a lot more about my treatment options once I knew more about a specific drug. As I asked questions about suggested drug, I was able to research expected results. In addition, asking these questions lead to a bigger conversation about comprehensive treatment. I found that the effectiveness of my medication dramatically decreased if it was not paired with lifestyle changes. I found significant improvement in my results when I understood the comprehensive treatment plan, expected effectiveness and why one drug was suggested over another.   

4. Are there alternative options?

This is the question I didn’t originally ask my doctor. As I was researching my new insurance plans, I knew my budgetwasn’t going to allow $628 a month. Thankfully, I have a Doctors Online service, so I was able to get a second opinion from an unbiased specialist. 

I simply sent an email with the details of my condition and the current drug I was taking, and asked if there were alternatives. The doctor wrote back to get more info about why I was prescribed this injectable option vs. a very inexpensive, long-standing, reliable pill that cost about $26 a month. In the end, he educated me and I took my new knowledge back to my doctor. I learned that the expensive injectable drug was prescribed because it was new and the other options had a history of increasing my weight by 2 - 3 pounds (to which I replied, “Like, 2 – 3 pounds every month OR over my lifetime?”). Not only was my new alternative less expensive, it actually works better! My Doctor was great, but she favored the latest and greatest – not taking into account that I favored tried and true (and simple, and affordable).

5. What is the long-term plan or the end game?

I personally have found it very important to understand the long-term plan. I learned that, in some cases, I could change my lifestyle and come off a prescription drug. I want my doctor to help me achieve those goals and ensure we are both comfortable with a long-term game plan that gets me off the prescription drug. This question leads to a great conversation where we work on a plan together to achieve my goals.

We’re living in a time when healthcare costs and insurance premiums are out of control. The only way for Americans to take back some control is to make a concerted effort to learn to be better healthcare consumers. To do that, we must have tools to help and then actually use them to make good decisions.

Now it’s your turn! Brokers, are you recommending tools that help employees become better healthcare consumers? Are you partnering with providers that offer both solutions and member education? Comment below or email me at tonia@freshbenies.com.