After nearly four decades working in pharmacy, Vicki O’Connor, R.Ph., understands the unique needs of the community she serves at Jewel-Osco in Huntley, Illinois, a suburb of Chicago. With a large older adult population, O’Connor is an expert at navigating the ins and outs of Medicare coverage and finding creative solutions to help her patients save money on their prescription medications. And that dedication hasn’t gone unnoticed: After earning multiple nominations from her patients, O’Connor was named the 2022 Best Pharmacist for Savings Award in SingleCare’s Best of the Best Pharmacy Awards.
As part of our Savings Education Week, we spoke with O’Connor about the rising costs of prescriptions and how important it is for her to help patients with savings.
SINGLECARE: Over your 36 years as a pharmacist, how have you seen prescription costs change?
VICKI O’CONNOR, R.PH.: Copays are much higher. Deductibles are higher, as well as out-of-pocket expenses and coinsurance. Insurance used to cover a lot more than it does now. All of that plays into what people actually pay for medication. Obviously, inflation has impacted the cost some, but that only accounts for so much of what we see now.
As a result of that, are you finding that people in your community are having a harder time paying for prescriptions?
People are more surprised at the price of medications. We have a very large 55-and-older community, so we have a lot of Medicare customers. Medicare used to cover a lot more, with patients having to pay very little out-of-pocket. Now that everybody has to have insurance, Medicare plans for Part D, specifically, have very limited formularies. And people are told, “Oh, yes, your insurance will cover it,” but they don’t have the different tiers explained to them. As the tiers go up, it gets much more expensive.
Before people would think, “I’ll hit the donut hole in June, but I know that come August, I’ve spent enough money that I’ll pay zero.” That doesn’t happen anymore. People have deductibles, they have coinsurance, and they’re hitting the donut hole in April because medicine is so expensive. What’s really helped is Medicare changing coverage for diabetic medications and insulin with the new $35-a-month pricing. It’s been wonderful, but it doesn’t help everybody.
Are there specific medications that your customers are continually surprised by how much they cost?
Yes, brand-name blood thinners, like Eliquis or Xarelto. At the beginning of the year, you can pretty much guarantee they’ll cost over $500 because many customers have a very high copay—which they haven’t hit yet—and then they have their deductible on top of it.
RELATED: 5 ways to save on Xarelto
With all of these high copays and deductibles, it sounds like savings are more important for patients than ever.
Sometimes people will opt not to even use their insurance because they’re not really getting the cost savings. In order to afford the premium, they have to make sacrifices on deductibles and coinsurance. So, when people get hit with expensive medication, they turn to a pharmacy discount card like SingleCare. Customers don’t care that it’s not going toward the deductible because it saves them that much more money by not using their insurance.
How do savings help patients with adherence?
When patients can afford their medication, they’re going to buy it and take it as prescribed. When they can’t afford the medication, they’re going to stretch it out as long as they can. So, if they forget a day, they’re not going to worry about it because they know they can’t afford it each month anyway. But patients shouldn’t be skipping their meds—especially when it’s for something vital, like heart or blood-pressure medication—so that’s where a discount card really comes in handy.
Are there other ways you help patients save money, besides a discount card?
With medications that are expensive and/or not always covered by insurance, we always try to help people find alternatives. For example, I recently had a patient who was coming out of the hospital and needed Eliquis, a blood thinner that is very expensive. The manufacturer offers a 30-day free prescription, so we worked on getting the patient that so we had time for the patient to explore alternatives, whether it be getting prior authorization with insurance or asking the healthcare provider to change the medicine.
Is generic medication always cheaper than name brands?
Most of the time, there is a significant savings with generic medication, especially with a discount card. But there are some insurances that cover specific brand medications instead of the generic. Examples of that include inhalers (where the generics are newer) and insulin. Generic insulin has been trying to make a comeback again, and we’re not seeing many insurance companies that will pay for it.
RELATED: Are generic drugs as good as brand-name medicines?
Obviously, the price reduction for insulin was a game-changer: Are there any other big developments you see as far as prescription costs go?
Not so much for medications right now, but the other area we’re seeing really good coverage for, as far as cost savings with insurance companies, are the immunizations that are available. They really do a big push now. Pneumonia has come out with a new vaccine; Shingrix, which is the shingles vaccine, is now being covered by a lot more insurance companies. From that aspect, immunizations are really starting to get covered more than they have been in the past.
Do you think that’s due to the COVID-19 pandemic bringing vaccination back to the fore?
I think that had a big impact. It seems more important that healthcare providers want their patients up to date.
Is there anything else patients should know as far as prescription savings go?
Make sure to really look into your insurance. Don’t just sign up. It’s easy to take somebody’s advice and never read the policy or the formulary.