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Prescription medicines are expensive, especially if you have to pay full price. However, even if you have a prescription drug card that helps pay for your medicines, many of your prescriptions will seem expensive. This is mostly because drug benefit plans usually have different tiers, for each of which they pay a different amount.
For example, a tier 1 prescription (usually generic drugs) will have the lowest copay. Some plans are even moving to Zero copay for generics, so these medications will essentially be free if you can get on such a plan.
This copay increases for tier 2 (brand name drugs on the plan's preferred drug list) and is the most for tier 3 prescriptions (brand name drugs not on the preferred drug list).
So, when you need a medicine, it will be the least expensive for you if you are prescribed a tier 1 or tier 2 drug.
One of the main problems with this is that there aren't a lot of generic drugs used in Pediatrics. After amoxicillin, there are not too many generic antibiotics that are used for sinus and ear infections in children.
Here are some of the preferred drugs to fight infections from one large insurance plan:
- +amoxicillin
- Amoxil Chewtab 200mg
- +ampicillin
- Augmentin, ES, XR
- Biaxin, XL
- +cefaclor
- +cefadroxil
- Cefzil
- +cephalexin
- +cephradine
- Cipro
- Cleocin 75, 100mg
- +clindamycin
- +dicloxacillin
- +doxycycline
- +erythromycin
- +erythromycin w/sulfisoxazole
- Floxin
- Gantrisin
- Levaquin
- Macrobid
- Macrodantin 25 mg
- +metronidazole
- +minocycline
- +nitrofurantoin macrocrystal 50mg, 100 mg
- +penicillin VK
- Priloprim 200 mg
- +tetracycline
- +trimethoprim
- +trimethoprim/sulfamethoxazole
- Velosef 500mg
- Zithromax
Of these drugs, only the ones with a '+' are generic and only the ones in bold are commonly used in Pediatrics, but not all are used for every type of infection. And your choices are even more limited in your child is allergic to penicillin or amoxicillin.
If your child has a resistant infection, which is common in kids with ear infections, after amoxicillin, you don't have too many inexpensive choices. You best bet would likely be either high dose amoxicillin (at almost twice the usual dose) or Augmentin ES, which is going to be 2nd tier though on this plan because it isn't generic. If that doesn't work, Ceftin, Vantin and Omnicef, other antibiotics commonly recommended for resistant ear infections, are not preferred on this plan and will likely be tier 3 with a large copay.
To get preferred medications, you should bring your list of preferred medications with you to your doctor visits. It is almost impossible for doctors to keep up with these, as most plans have different preferred drugs. You can get this list of preferred medications or the plan's formulary by calling your insurer or checking their website.
How much will you pay for these medications if you have to pay full price? Here are some examples (based on the dosage needed for the average 2 year old who is about 28 pounds):
- amoxicillin - $7.99*
- Augmentin - $57.99
- Augmentin ES - $58.99
- Ceftin - $63.64
- Omnicef - $63.85
- Vantin - $59.65
- Zithromax - $31.55
In addition to being prescribed the least expensive drug that is both safe and effective for your child's infection, it can also help save money by shopping around. Quickly checking drugstore.com, walgreens.com and eckerds.com, I found prices for Vantin ranging from $59.65 to $77.61. So if you have the time, shop around for the best price. Or ask your Pediatrician what antibiotics he or she most likes to use and price them in advance at different pharmacies in your area, so that you are ready to get the best price the next time you get a prescription. Most national pharmacy chains let you check prices online, including:
You might even get a better price from a local or discount pharmacy, so check around if the price of your medications is a concern.
If your child is on chronic medications, like for allergies or asthma, a 3 month supply from a mail order pharmacy might be even less expensive (and more convenient) than getting your prescriptions refilled each month.
If you do have to pay full price for your child's medications, you might ask for the least expensive medication that will work for your child, but you could also ask your doctor if they have samples. Drug reps commonly leave samples of popular medications at doctor's offices, and most Pediatricians are usually happy to give them out when needed.
Choosing Medicines
Although there aren't too many generic antibiotics, there are for some other Pediatric medications. This short guide will help show you some options you have when being prescribed a medication.
ADHD
There are generic versions of Ritalin and Adderall, at least for the short acting forms that children usually have to take twice a day. Newer, long acting ADHD medications aren't generic and are more expensive, but they are more convenient, since kids only take them once a day. Most plans make one of the long acting ADHD medications preferred, either Adderall XR, Concerta, Ritalin LA or Strattera.
Allergies
Many insurance companies are now trying to push patients to take Claritin, since it over the counter now. If your child does take Claritin, to save money, you might try the generic version, called Alavert. If your copay for other allergy medications is higher than you would pay for Alavert over the counter, you might ask your doctor about switching.
Most plans make one or two of the main allergy medications a preferred prescription, either Allergra, Clarinex or Zyrtec, so check which ones are covered if your child has allergies. Steroid nasal sprays are also usually covered, but find out which brands are preferred.
Asthma
Most preventative asthma medicines, such as Advair, Pulmicort, and Singulair, etc. aren't generic. If prescribed these medicines, ask your Pediatrician to choose one on your formulary plan.
Albuterol, for asthma attacks, is available in generic forms. Keep in mind that Proventil HFA is not generic, and that prefilled vials of Albuterol soln for nebulizers is usually about twice as expensive as the regular Albuterol nebulizer solution that you mix yourself. Xopenex is also not generic.
Eczema
Most of the popular eczema steroid creams aren't generic, such as Cutivate and Elocon. A similar strength steroid cream, Triamcinolone Acetonide 0.1% Cream is generic and less expensive, however it isn't once a day like the other creams. You can get a 454g jar of it for $11.81 though, as compared to $49.64 for a 60g tube of Cutivate or $42.58 for a 45g tube of Elocon.
Another commonly used steroid cream, Westcort, is available as a generic, but it costs $40.64 for a 60g tube, which is not much cheaper than the $47.81 for brand name Westcort.
Newer, non-steroidal eczema medications, like Elidel and Protopic, aren't generic, so just check which is preferred by your insurance.
*Most of the drug prices were taken from drugstore.com on February 25, 2003, and is meant to show general price differences between medications and not as a reference for drug prices.
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