If you are taking a medication for a chronic condition (hypertension, high cholesterol, diabetes, etc.), there’s a chance that you might be paying more than you actually need to pay. You might be able to get the same type of drug to treat the same condition for a mere fraction of the cost. And I’m not just talking about choosing generic over brand name. There’s something that’s even better than that, something that most Singaporeans are not aware of.
- Choosing Generic Medications
Yes, you definitely can save tons of money choosing a generic over a brand name drug. Generics have active ingredients that are chemically identical and biologically identical (this means they are made to function the same way) to their brand name counterpart. They are also manufactured and regulated under the same standards. Brand name medications are all recently patented (their “monopoly” hence gives them the ability to charge such a high price), which may imply that there is something extraordinary about their composition or formula, but many reports and studies have shown that the majority of recent brand name medications are just “me-too drugs”. These are drugs that are nearly identical to already existing drugs, but with minor changes that allow it to be classified as “novel” and hence be patentable. For example, when AstraZeneca’s patent for their top selling medicine Prilosec (generic name: Omeprazole) was ending, it found a way to further purify the active ingredient (changing it very slightly and insignificantly) to Esomeprazole. They gave it a new name (Nexium) and a new patent. The efficacy of the two medications are nearly identical but the new one costs a LOT more. For most conditions, generic medications are not only cheaper, they are just as good as the brand name.
- Choosing Formulary Medications
For many medical conditions, there are a variety of prescription drugs that belong to the same class. These essentially do the same thing, but are chemically different (unlike brand and generic which are chemically identical). The formulary is a list of medications which are published on the MOH website that are subsidized for Singaporeans and PRs. Those which are on Standard Drug List #1 are capped at $1.40 per week and $2.10 per week for Singaporeans and PRs, respectively. Those which are on Standard Drug List #2 are subsidized by 50% and by 25% of the retail price for Singaporeans and PRs, respectively. Keep in mind that each polyclinic and specialist outpatient clinic may stock different medications and implement this differently, but this formulary will at least give you a starting point. If you have a chronic medical condition, more than likely there is a medication on the formulary that you can switch to that is highly subsidized. According to MOH, the formulary covers about 90% of the total volume of medication prescriptions. For example, if you have hypertension, and you choose a generic drug, you will still have a big price difference between generic drugs of the same class. Losartan 100mg is $0.40 per pill and Candesartan 16mg is $1.10 per pill. But Losartan is on the formulary Stardard Drug List #2 while Candesartan is not. So that means if you’re Singaporean, Losartan is only $0.20 per pill. Despite both medications being generic medications, one will cost more than $400 per year and the other will only be $73. Choosing generic medications does save you money, but choosing formulary medications can save you even more!
- Splitting your pills
Many pills cost the same despite how much active ingredient there is in the pill. For example, Amlodipine 5mg is $0.20 and Amlodipine 10mg is also $0.20. If you need only 5mg, why not just buy the 10mg and split the pill in half? Many tablets can be split in half, but do not try to split capsules or any time-released or coated medications. If the pill is not scored, always check with your doctor or pharmacist to make sure it is safe to split the pill.
- Choosing Not to Combine Medications
Combination medications are great for convenience, but many of these tend to be brand name medications, such as Caduet, in which Pfizer just put two already available generic drugs together (Amlodipine plus Atorvastatin) to patent a “new” drug. You may want to ask your doctor whether you can take the medications separately, which may allow you to save money, especially since both generic drugs (as in this example) are on the MOH formulary list.
- Shopping Around
As with everything, you should shop around and call your pharmacy since prices will vary. You may be wondering why prices vary in the first place. Like other commodities, the institution or business which purchases the goods have different price arrangements with the suppliers. Larger institutions, in general, have more buying power. There may be other special discounts or costs that affect the price of the medication.
Why doesn’t my doctor just give me the less expensive drug?
Many people think that doctors purposely prescribe the most expensive drug because they get financial incentives. For the vast majority of doctors, this is not the case. Yes, there are some that get kickbacks, but those working in the public institutions are strictly prohibited from this (this is one reason I avoid private hospitals and clinics). The prescribing habits of doctors are just that – habits. They prescribe what they are comfortable with and what they have prescribed in the past. They also place a higher priority on what works for their patients, and have less interest in knowing what cheaper alternatives are out there. It’s like when I ask people which place has the best laksa, they each have their own preference and some places will be a lot more expensive than others. No one ever tells me the cheapest place, unless they extensively research this. There also may be a good reason why your doctor wants you on a more expensive drug. The key is to ask your doctor and engage him/her in a conversation to discuss possible less expensive alternatives. The prices of drugs prescribed for common conditions can be found on the Pharmaceutical Society of Singapore website.
Of course, the best way to save money on medications is to live a healthy lifestyle so you won’t need to be on the medications. Most chronic conditions can be managed or even reversed with lifestyle modifications. How we eat, move, sleep, think, and interact with others can significantly change our health, our savings, and our life.