The Hidden Costs of Medication
Taking psychiatric medications can really add up, even for those who have health insurance, and even when they can take generic instead of brand-name drugs.
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Psychiatric medications have a lot of potential hidden costs.
We don’t know, for example, how taking them from a young age affects long-term brain and psychological development in kids.
They have myriad of side effects, some serious, like diabetes, high cholesterol, neurological impairment and birth defects when taken in pregnancy.
They carry stigma, both from others and self-imposed.
But I’m not talking metaphorically about costs here.
I’m talking straight-up financial outlays. Taking psychiatric medications can really add up, even for those who have health insurance, and even when they can take generic instead of brand-name drugs.
One big reason is the so-called “medication merry-go-round.”
The medication merry-go-round affects everyone, from those just starting out on meds to those who have been taking them for a long time.
People get on the medication merry-go-round when they try one drug, then another, then another.
It can happen with any kind of medication, but is perhaps most likely with psychotropic drugs, which involve a notorious amount of trial and error to find the right treatment for an individual patient.
There are various possible causes. Perhaps the first medication doesn’t work, or it only controls some symptoms and prompts to the doctor to prescribe a second medication to control the rest.
Alternatively, the doctor might need to adjust the dosage because a low dose doesn’t work, or a patient can’t tolerate a higher dose. Dosage changes often mean new prescriptions, too.
Or maybe the medication causes intolerable side effects, forcing the patient either stop it, or add another prescription medication to counteract those side effects.
Perhaps the medication works for a while and then poops out, requiring the doctor to try a different drug.
Whatever the causes, the medication merry-go-round is demoralizing because it’s hard to sustain hope for an effective treatment when one drug after another disappoints.
But it’s also very expensive.
Often, a patient will use less than a 30-day supply before needing to switch to a new drug, leaving leftover, useless pills.
Adding new prescriptions to control side effects or deal with symptoms not treated by the first drug means additional co-pays.
And if a patient tries one generic drug after another without luck, he may eventually end up trying a medication that’s still on-patent and therefore only available as an expensive, brand-name formulation. Some insurance plans don’t cover brand-name meds at all, or cover only a small percentage of their costs.
A change in medication from a generic to a brand-name, therefore, can cost hundreds of dollars extra per month.
I’ve been on the medication merry-go-round myself on a number of occasions, and the frustration and anxiety I’ve felt over the drugs not working have been magnified by the frustration and anxiety of having to spend money on meds that I have to abandon.
In theory, a doctor could prescribe less than a 30-day supply of pills to see if the new medication works.
But, at least in my experience, the co-pay is the same, no matter how many pills are in the prescription.
Sometimes doctors will furnish patients with free samples, but that’s a short-term solution since the free samples are brand-name drugs furnished by pharmaceutical reps.
If the drug works, eventually the patient will have to get a prescription.
There’s an additional reason why switching from one drug to another really adds up.
When you’ve found a medication that works, and are fairly sure you’ll stay on it for at least a few months, you can send it to an online pharmacy like Medco and get a 90-day supply for the cost of 30 days.
But it’s much quicker, in the case of a new prescription, to drop it off at the pharmacy and pick it up later that day, rather than waiting for the mail-order pharmacy to process and ship the order.
And with psychiatric medications, patients are often faring poorly enough that doctors prefer to get them started on the medications sooner rather than later.
Have you been on the medication merry-go-round, or had relatives or friends who have been?
What was the experience like, and did the extra costs bother you? If you’re a doctor, do you have a way of easing patients’ financial burdens?
Feel free to weigh in!