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  1. Be honest about what else you’re taking.
    To avoid harmful interactions, tell your doctor about any other prescription medications, over-the-counter drugs, vitamins or other supplements you’re taking. Also be honest about your alcohol intake, since that can also affect how a drug works.
  2. Ask about interactions and side effects.
    Ask your doctor about any foods or drinks that should be avoided due to interaction with the medication. Find out which side effects are to be expected, vs. side-effects that are a sign of trouble.
  3. Follow dosage instructions with care.
    Never stop taking a drug or change your dosage without checking in with your doctor.
  4. Know how your plan works.
    Most plans pay different benefit levels based on which “tier” a specific drug is in: highest benefits for generics, medium benefits for “preferred” (formulary) brands, and lowest benefits for “nonpreferred” brands. You pay the rest through copays or coinsurance. Note: Some plans require you to meet a deductible before they’ll pick up any drug costs.
  5. Shop for the best deal for each prescription.
    The pharmacy with the best deal on one drug may have higher prices on other drugs. Another twist: It’s possible for a pharmacy to be out-of-network (meaning you pay the full cost), yet their price on a particular drug is less than what you’d pay in copays/coinsurance at an in-network pharmacy. So shop around for each prescription you need to fill.
  6. Ask about generics.
    If your doctor prescribes a brand-name medication, ask whether you could get the same results from a generic, a lower-cost brand, or even an over-the counter medication.
  7. Check the formulary.
    If your medical plan uses a drug formulary (list of preferred medications), check whether your medication is on the formulary before filling your prescription. You can do this by calling the number on your ID card or viewing the formulary at your plan’s website. You can even print out the formulary for your doctor. If the drug is considered non-formulary or non-preferred, ask your doctor about options that may be less costly for you.
  8. Remember mail-order option.
    If your medical plan includes a mail-order prescription service, use it for prescriptions you’ll be taking long-term. In addition to saving money, you’ll have the convenience of home delivery. Note: In rare cases, mail-order may be more expensive than retail, so check prices first.
  9. Consider asking for samples.
    If you expect to be taking a prescription long-term, ask your doctor if he or she has any samples you could try before filling your prescription. A free sample could save you the expense of paying for a drug in the event you discover you can’t tolerate it for some reason. Keep in mind, doctor samples tend to be the newest brand-names, typically more expensive than older versions or generics. So if you tolerate the brand-name sample well, you should still ask about filling your prescription with a generic version.
  10. Find out if your drug can be split.
    For drugs in tablet form: To save money, ask your doctor if it’s possible to prescribe the medication in double strength. That way, you can use an inexpensive drug splitter to split each tablet and take one-half tablet as your dosage. Note: With some formularies, a particular drug may be covered only in a certain dosages. Also, controlled substances cannot be prescribed at higher dosages for pill splitting.

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Health Plan Terms

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Answers to Frequently Asked Questions from the Food and Drug Administration (FDA) about drugs

Look up drugs and supplements at MayoClinic.com

Rx index to full prescribing info and patient education

UnitedHealthcare prescription tools and resources

Drug and treatments at WebMD.com

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Frequently Asked Questions about health insurance

Preparing for your doctor visit

Prices at Wisconsin hospitals

Health care quality ratings

Health risk assessment

Why are health care costs rising?

In simplest terms, spending on health care is the product of two factors: price and utilization.

  • Prices charged by hospitals, physicians, drug companies and other health care providers have risen dramatically – more than the cost of goods and services in general (inflation).
  • Utilization of health care services is up. Despite rising prices, demand for services remains high. More of us are using health care services more often, for more conditions – including some that were not even treated in the past.

Why are medical prices going up, and why are we using more care? Here’s where things get complicated. Experts differ in their conclusions about what – or who – is most to blame, but there’s widespread agreement that certain cost drivers are at work.

Key Cost Drivers

Americans’ lifestyle choices are partly to blame. Unhealthy eating, lack of exercise, smoking, not getting enough sleep, alcohol abuse all put us at higher risk for a host of costly illnesses including heart disease, diabetes, cancer, arthritis and more. Obesity rates in adults and children, while showing signs recently of leveling off, still remain high and suggest health care costs will continue their upward climb. In 2011-2012 approximately 17% or 12.7 million children and teens in the U.S. were obese. Extra pounds put children at an increased risk of developing type 2 diabetes, high cholesterol, heart disease and other expensive health problems for their lifetime. (Source: Journal of the American Medical Association, February 26, 2014, Vol. 311, No. 8.)

Advances in medical technology have led to amazing breakthrough treatments. The research and development costs behind these new technologies must be recovered somewhere – typically through the general cost of medical goods and services. And we’re all paying the high price. Still, Americans want the latest treatment at their disposal, whether it means an expensive bone marrow transplant that may be yet unproven as treatment, or a heart bypass operation at age 85. Our society’s devotion to technological discoveries ensures that costs will continue to rise. No matter what employers do to manage costs, the impact of technology on spending will continue.

Prescription drug costs are rising even faster than medical care overall. Some of the most exciting – and most expensive – developments in medical care involve prescription drugs, specifically specialty drugs. Specialty drugs now account for approximately 20-25 percent of pharmacy spending and the cost of these drugs is expected to quadruple between 2012 and 2020.

Many claim that direct-to-consumer drug ads are prompting patients to request the newest (most expensive) brand-name drug, even when a generic or over-the-counter drug may work just as well. Another concern is that drug ads rarely mention the lifestyle changes or other, non-drug solutions, which are often just as important as drug therapy in improving outcomes. For example, a patient may resist when his physician insists on discussing a low-fat diet, stress management, or allergen avoidance rather than writing a prescription.

Whatever the reason, employees’ usage of prescription drugs, and the cost of those drugs, has significantly increased recent years and is expected to continue rising.

Did you know?

The U.S. and New Zealand are the only countries that allow direct-to-consumer drug advertising that includes product claims.

Source:Abel GA, Penson RT, Joffe S, et al. Direct-to-consumer advertising in oncology. Oncologist. 2006;11(2):217–226

An aging population needs more care. In 2010, there were 40.3 million people aged 65 and older, 12 times the number in 1900. By the year 2030, the older population will number approximately 73 million.
Source: U.S. Census Bureau, report issue June 2014.

What’s the significance of these statistics? Often, as people age, health problems increase. There are more people getting treatment for the types of one-time problems that accompany middle age, such as gallbladder surgery. Just as important, more people now need ongoing care for the types of chronic conditions that may develop with age, such as back problems or adult-onset diabetes. Often, that treatment includes expensive prescription drugs.

The costs associated with older people will not diminish anytime soon. Today’s youngest Baby Boomers will still be in the workforce 15 years from now. As a demographic group, their health costs will balloon as they age and use medicine to live long, active lives. Advances in health care are part of the reason we’re living longer, which in turn is driving our national health care spending even higher.

Did you know?

Approximately one-third of health care treatments, costing $750 billion annually, are unnecessary. Millions of patients receive unnecessary treatments each year, leading to complications, reduced productivity, and significantly higher costs.

Source: Institute of Medicine Report, September 2012.

Consolidation in the health care marketplace means less competition. That gives employers less leverage to negotiate favorable pricing. As a result of consolidation, many health care systems have transitioned services from a not-for-profit to for-profit status, adding the cost of “profit” to medical charges. In addition, there continues to be a great deal of opportunity to streamline the wide range of administrative processes used today in order to eliminate waste from the system.

Governmental factors also play a role in health care cost inflation. Hospitals and doctors receive limited reimbursement from Medicare and Medicaid for patients in those systems. To keep operating at a profit, they must recover those “losses” through the prices they charge commercially insured patients, most of whom have coverage from their employers. Ultimately, it’s the employer and covered employees who end up footing the bill for low reimbursement levels by Medicare and Medicaid and the uninsured.

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