Why Drug Costs Keep Rising—and What You Can Do About It

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Last year, Jerry Pancake was paying $6 for a three-month supply of pravastatin, a drug he takes every day to lower his cholesterol.

But when the 62-year-old Californian recently refilled his prescription, his cost had jumped to $49.

"When I saw the price, I immediately called my insurance company and the pharmacy benefit manager, but they weren’t able to tell me why the price of my drug went up," he says.

Pancake is not alone. An estimated 28 million Americans—or 25 percent of those who regularly take prescription medications—saw a price increase in the past 12 months, according to the latest Consumer Reports Best Buy Drugs nationally representative survey of nearly 1,000 adults who regularly take prescription medication.

Rising drug costs is not a new issue, of course. Yet despite all the attention it has gotten in recent years, Americans continue to shell out more for their medications. Here’s a look at why the problem persists and what you can do about it.

Three Reasons Drug Costs Keep Climbing

High-deductible insurance plans. The average deductible, according to figures from the Kaiser Family Foundation is $2,295 for an individual; $4,364 for a family. Until you have met your deductible, it means you’re stuck paying the full price for a drug. (See how to survive a high-deductible insurance plan.)

"Having one of these plans with increased cost-sharing and copayment makes it so that consumers directly feel the high prices," says Aaron Kesselheim, M.D., J.D., M.P.H., an associate professor at Harvard Medical School whose research analyzes the cost of prescription drugs.

About 30 percent of people in the U.S. who have insurance through their employers have health insurance with a high deductible. And according to research from Kaiser, that number has steadily increased in the past 10 years.

Changes to your formulary. Second, insurance companies might simply stop covering your medication, so you wind up having to pay the entire amount. Last year, for example, Express Scripts, one of the largest pharmacy benefit managers in the U.S., announced it would stop coverage for more than 85 medications.

When Express Scripts announced it would no longer cover those medications, the company said that it was still covering other, similar drugs that could be used instead. But it noted that if a person preferred to stay on their original medication that was no longer covered, they would have to pay the drug’s full price.

Insurance companies can also move a medication from a lower, cheaper "tier" of coverage, where you may only pay $10 or $15 co-pay, to a higher, more expensive tier, where you may have to pay $40, $50 or even a percentage of the total price.

That could cause you to pay hundreds of dollars more for a single medication.

"Increasingly, as drug prices go up, there’s a tendency by insurance companies to move your medications to a higher-cost tier," says Stephen W. Schondelmeyer, Ph.D., Pharm.D., a professor of pharmaceutical economics at the University of Minnesota. "That forces you to either pay the higher cost or switch medications."

Insurance companies make most of these coverage changes at the start of each year, but they can also change the level of coverage for a drug even after you’ve already signed up with their plan. One survey found half of insurance plans made significant changes to the drugs they covered midway through the year—reducing drug coverage or dropping a drug altogether.

If you’re covered by Medicare, your insurer is required to give you 60 days' notice before any changes they make in the drugs they cover, including any they are planning on dropping.

One way you might avoid surprise changes, says Schondelmeyer, is to confirm that your drugs are covered by your insurance plan before you sign up or renew coverage during open enrollment period—usually in October, November or December of each year.

A few extremely high-priced drugs push up costs for everyone. Although fewer people take medications like the rheumatoid arthritis drug Humira (retail price: about $4,500 per month) or the multiple sclerosis drug Copaxone (also $4,500 per month) than more common medications for high cholesterol or high blood pressure, the high price tags on those drugs can push up costs for everyone in an insurance plan, says Schondelmeyer.

In fact, 72 percent of drug spending comes from just 10 percent of brand-name medications, according to a 2016 JAMA analysis.

Insurance companies pass the high costs on to all customers in the form of higher monthly premiums and a lower percentage of coverage for other, less expensive drugs.

The effect is that your monthly premiums might increase, and the amount you pay, even for generic medications, can also be higher.

"Those high prices are part of why insurance companies continue to raise your out-of-pocket costs and premium," says Schondelmeyer.

Why Don’t Doctors Prescribe Less Costly Meds?

You might also be paying more money at the drugstore because your doctor isn’t aware of how much medications cost, and so doesn’t pick the least expensive treatment for you.

A previous Consumer Reports poll of 200 internal medicine physicians from April 2016 showed that although doctors acknowledged the burden of high costs on patients, and were concerned with affordability, at least half reported having difficulty finding drug cost information. Doctors also reported that they discussed drug costs in a typical week with only about 25 percent of their patients, and said they did not have enough time to discuss costs otherwise.

"Unfortunately, many physicians don’t discuss drug prices with patients and many patients don’t think to ask," says Kesselheim.

Not only do doctors not discuss costs with patients, research suggests that they frequently don’t steer patients toward cheaper alternatives.

A 2013 study published in JAMA Internal Medicine found that nearly 40 percent of doctors said they sometimes or often prescribe a pricier brand name drug at their patient’s request, even when a generic version of the drug is available.

It’s such a problem that the American College of Physicians recently called for all doctors to prescribe generic medications "whenever possible" in place of more expensive branded drugs.

How to Get Lower Prices

Not surprisingly, the perfect storm of sky-high drug prices, insurance companies charging more, and doctors not speaking up enough about costs, leaves some consumers in a financial bind.

In our survey, 14 percent of people decided not to fill their prescription when they found out their out-of-pocket cost increased. That can put people at obvious risk of not getting essential medications to treat their conditions.

At the same time, other consumers are speaking up, asking questions, and looking for discounts—40 percent of people facing higher drug costs said they asked their doctor or pharmacist for a less expensive drug or asked their pharmacist for a lower price on the same drug.

Others used a discount coupon or shopped at a different pharmacy or even online for a lower price.

Asking your doctor for a cheaper drug is one way to save, says Kesselheim. "The good news is that generic drugs are still for the most part inexpensive, and represent one of the best deals in the entire healthcare marketplace."

"Consumers should ask their physician when they receive a prescription whether there might be a generic drug available that would work just as well," notes Kesselheim.

Here, some additional strategies that can help you rein in your drug costs:

Do a drug review with your doctor or pharmacist. Previous CR Best Buy Drugs surveys show adults who said they currently take prescription medication take on average about five of them. If that sounds like you, ask your doctor or pharmacist to review all the medications you take, and cut out drugs you no longer need.

Consider nondrug options for what ails you. Ask about nondrug options that may be just as safe and effective for your condition. For example, consider cognitive behavioral therapy (CBT) for sleep problems, and physical therapy, exercise, or acupuncture for treating back pain.

Try a cheaper alternative. If there’s no suitable nondrug option and no generic, ask your doctor about a less expensive "therapeutic substitution," which is a different drug that works just as well. For example, where your doctor says it’s appropriate, switch from pricier Humulin insulin to Novolin, or from an EpiPen auto-injector to generic Adrenaclick.

Don't always use your insurance. Ask your pharmacist if you could save by not using your health insurance. Chain pharmacies and big-box stores offer hundreds of generic drugs through discount programs for a few dollars a month for "cash-paying" customers, and more programs are starting to offer discounts on brand-name drugs.

Ask for a lower price at the pharmacy. Previous Consumer Reports secret shopper surveys found that when you aren’t using insurance, asking pharmacists for the “lowest possible price” sometimes yielded deeper savings in through the use of discount programs, cards, and coupons.

Shop around. Instead of refilling his prescription for pravastatin through his insurer’s mail-order program, Pancake decided to check other pharmacies for a lower price. Costco told him they’d fill his prescription for $31, significantly cheaper than the amount his insurer’s mail-order program charges. But by checking price-comparison website GoodRx.com, Pancake was able to find an even better deal—$16, through Rite Aid’s generic discount program.

Where CR Stands on High Drug Costs

Consumer’s Union, the policy and mobilization arm of Consumer Reports, is supporting several pro-consumer bills to make prescription drugs more affordable. They include:

• A bill sponsored by Senator Amy Klobuchar (D-MN), called the Medicare Prescription Drug Price Negotiation Act (S. 41), that would empower the government to negotiate the prices it pays pharmaceutical companies under Medicare. 

• A bill sponsored by Senator Bernie Sanders (I-VT), the Affordable and Safe Prescription Drug Importation Act (S. 469), which would permit importation of prescription drugs at lower cost from Canada and other approved countries with certified safety and quality requirements, including monitoring.

• A bill by Senators Klobuchar and Chuck Grassley (R-IA), the Preserve Access to Affordable Generics Act (S. 124), which prohibits "pay-for-delay" schemes where a pharmaceutical company pays off the maker of a less expensive generic medication to delay entering the market.

• A bill by Senators Patrick Leahy (D-VT), Grassley, Klobuchar, Mike Lee (R-UT), and others, the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act (S. 974), which ensures that generic drug manufacturers have access to brand-name drug samples needed for developing generic versions.

For everyday advice on how to handle increasing drug costs, additional tips and tricks, plus treatments that could save you hundreds if not thousands of dollars a year, Consumer Reports Best Buy Drugs has just released "Best Drugs for Less," its handbook of ways you can save. Find it in English and Spanish for free at: CRBestDrugsForLess.org.

Editor's Note: This article and related materials are made possible by a grant from the Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

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