“Doc, every time I go to the drugstore, I feel like I got a gun in my back. Prescription costs are robbing all of my savings!”

     Mr. Merton was a retired service-station owner. He had saved diligently for his golden years, amassing what should have been an adequate nest egg. He had Medicare and a good supplemental insurance plan. His hospitalization a year and a half earlier and the placement of two coronary artery stents had been completely covered by insurance. But his medications were not a covered benefit, and they were costing him $680 per month! He calculated that at the present rate he would deplete his retirement savings in six years.

     I looked over Mr. Merton’s drug list. The prescribing, mostly by his cardiologist, was impeccable. Only one problem—the patient was drowning in pharmacy bills.

     After an examination, we explored ways to make his treatment more affordable. We discovered that he had completed the usual course of one expensive drug that could now be stopped. Two medications were from classes that had cheaper generic members that could be substituted, and we found that another was available in a higher-strength tablet that could be split. Then I called his cardiologist. Not only was the specialist sensitive to our patient’s plight, but he encouraged us to go ahead with the treatment changes.

     Pleased with the prospects, Mr. Merton left the office with the new prescriptions. He returned weeks later, again feeling well. His blood pressure was excellent, cholesterol superb, and there were no side effects. He had even seen his cardiologist, who was fully satisfied with the treatment. Then came the shocker:

     “The new prescriptions only cost me $84 a month.”

     Amazing, $600 in savings for a month of medication! How could this be? Simply by making careful medication choices, this man could now afford to continue the treatment he needed.* From then on, I paid closer attention to how prescribing practices could maintain the same high standard but also save patients money. I realized that it is not a coincidence that we physicians prescribe expensive drugs—it is not just tough luck if your doctor chooses costly medicines for you. The system is designed this way.

     You see, doctors are seduced into expensive prescribing habits by a multibillion-dollar drug industry intent on maximizing profits. A barrage of promotions arrives daily in our offices. Medical journals packed with glossy drug advertisements stack up on our nightstands. We are invited to sponsored lectures, posh dinner meetings, and paid teleconferences, all pushing expensive drugs. Sales representatives bearing gifts and catering lavish luncheons constantly entice us. They fill our offices with bright sample boxes of the latest pharmaceutical offerings—usually good products, but always patented and always expensive. If these work well enough, we soon forget previous years’ remedies, and we may not bother to become acquainted with less costly ones.

     With a little analysis it became shamefully obvious that—with the generous assistance of the pharmaceutical companies—our prescribing practices had become exorbitant. We were accommodating the steady depletion of our patients’ savings. We were helping to hold that gun in Mr. Merton’s back! But it doesn’t have to be that way. Excellent and up-to-date treatment can be provided substantially cheaper if doctors and patients make it a priority. But to make it happen, patients need knowledge, and they need a plan of action.

* [Mr. Merton’s medication changes with direct price comparisons are provided in detail on the Savings Examples page of this website.] 

      Take Control of Prescription Costs

      What if you asked your doctor, “Is there a reason you are choosing that particular cholesterol-lowering pill? Is there a cheaper equivalent that would be appropriate for me?” Those questions could save you 58 percent on a new prescription.* Calling around for the best local price, using a mail-order pharmacy, or buying via the Internet can save another 50 percent. **

     Better yet, challenge the recommendation with, “I understand that my total cholesterol is 295, doctor, but since my ten-year risk assessment for cardiovascular disease is less than 1 percent, I do not need to take a cholesterol-lowering drug.” This bit of knowledge saves you 100 percent of the prescription cost! ***


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* The average retail price for ninety 10 mg generic lovastatin tablets is $126, versus $298 for ninety 10 mg Lipitor.

** Drugstore.com sells 10 mg lovastatin tablets in quantity at ?56 percent less than the average retail price.

*** According to the National Cholesterol Education Program website risk calculator, a forty-year-old nonsmoking female with average systolic blood pressure of 110 and total and HDL cholesterol of 295 and 72, respectively, has a ten-year cardiovascular disease risk of less than 1 percent.