Many of you with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) have experienced the sticker shock of filling a prescription, especially if you don’t have adequate prescription insurance coverage. Unlike the cost of most goods and services in a free market economy, which are kept in check by competition and other free market forces, the cost of medications for ME/CFS treatments has been skyrocketing because of the lack of these controls. So where most goods will cost twice the wholesale cost and four times the cost of production, medications often cost 64,000% more than the cost of production!
Meanwhile, the cost of the exact same pill can vary by over 1000% from one drugstore to another. In addition, the cost to somebody without health insurance is often five to 10 times as high as what the insurance company needs to pay, as they have been able to negotiate down the drug prices.
So how can you pay for the cost of treatment if you don’t have insurance? And even if you do, you may walk out of the drugstore feeling, well, financially wiped. But the following tricks may help you move forward with ME/CFS treatments in a more sustainable, manageable way:
Managing the Cost of Treatment
1. Compare prices at different pharmacies before you buy. For example, the medication Ambien, which is often needed to help sleep in people with MECFS and fibromyalgia, costs several dollars (estimates range from $2 to over $12) for each 10 mg tablet. So if you need 90 tablets, and your insurance company won’t pay for it, the cost can quickly add up to several hundreds of dollars.
Say you decide to get the generic zolpidem instead. For the exact same tablet, the price will vary from 9 cents per pill at Costco, to over $3 a pill at many other pharmacies. This is the case for many medications. With a simple phone call, you can wind up paying $8 for the three months of Ambien instead of $270. In general, you’ll find the best prices at Costco, with Walmart having a number of common medications that they price very low, while they charge very high amounts for others. So call and ask. Another helpful tip? You don’t have to be a Costco member to use the pharmacy. When they ask for your Costco card at the entrance, simply tell them you’re going to the pharmacy, and they will waive you right in.
2. Get a free app called GoodRx or visit GoodRx online. Type in the medication name, strength, and quantity, and they will give you the negotiated price they have obtained for the pharmacies near you. Very often, I have found this to be over 90% less than what you would pay otherwise. And it will save you a bunch of phone calls. The app and website are outstanding.
3. You pay by the pill, not by the pill strength. An important thing to know is that for most medications, including compounded medications, you pay by the pill, not by the pill strength. So if you’re getting an ME/CFS medication in, say, 50 mg tablets, you can save 50% by simply getting 100 mg tablets instead and cutting them in half. This is the case for almost all medications. A simple $7 pill cutter can save you thousands of dollars.
4. Consider a compounding pharmacy. For many medications, market manipulations going on in the pharmaceutical industry has resulted in even the generics costing way more than they should relative to the cost of producing the pill. For some medications, here is another trick: See if your compounding pharmacy is able to make that drug and what it would cost them to make it. Take the antifungal fluconazole (Diflucan), for instance, which may be prescribed to individuals whose ME/CFS symptoms are related to Candida overgrowth.
Both the generic and the brand-name can be pricey, but if a compounding pharmacy makes it, you can often get it for a much lower price. The hack? The doctor has to write the order specifying some difference in how it’s made that sets it apart from what you can find in the drugstore for them to legally be able to make it. So your doctor can order tablet in a certain dose or have a capsule made with low allergen components. Simple!
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Are Generic Medications the Same as Brand-Name Drugs the Same?
In the vast majority of cases, the generic medication is exactly the same as the expensive brand-name. When I get medications, I will get the generic. Some people will find though, that the brand name will work better. An easy approach? Simply get the first months’ worth of the medication as the brand name, and then get the generic for refills. This way, in the rare event that they are not working the same for you, you will know.
Ultimately, medication patents are supposed to expire after 20 years, at which time the medication can go generic. But some medications are so profitable that the drug companies will either pay the generic companies not to make a generic, or will file expensive legal action against companies that try to make a generic. But here is the secret: Although some medications aren’t available in generic for one diagnosis, it may be available as a generic for another medical condition. So ask your ME/CFS doctor to check if a brand-name drug is available as a generic for another medical condition. It could save you a ton of move down the road.
Still can’t get the medications you need? Often, you can also work with a holistic practitioner to find natural alternatives, which are commonly more effective, generally much lower cost, and almost always much safer. As you feel better, remember to ask the doctor if you can lower the dose or stop the medication or supplement. Doctors are often too busy to think about this unless you remind them.
With these life hacks, I hope you can slash your medication costs!
Love and blessings,
This article was first published on ProHealth.com on May 17, 2016 and was updated on October 23, 2019.
Jacob Teitelbaum, MD, is a board certified internist and nationally known expert in the fields of chronic fatigue syndrome, fibromyalgia, sleep and pain. He is also Director of the the Practitioners Alliance Network (PAN) and author of numerous books including The Fatigue and Fibromyalgia Solution (Avery), the best-selling From Fatigued to Fantastic! (Avery Penguin), Pain Free 1-2-3 — A Proven Program for Eliminating Chronic Pain Now (McGraw-Hill), Three Steps to Happiness! Healing Through Joy (Deva Press), the Beat Sugar Addiction NOW! series (Fairwinds Press), Real Cause, Real Cure (Rodale), and the popular free iPhone and Android application “Cures A-Z.” He is the lead author of four studies on effective treatment for fibromyalgia and chronic fatigue syndrome, and a study on effective treatment of autism using NAET.