Mastering Your Medication Costs

Brad

Hey everyone, welcome back to MedTalk by Galloway-Sands Pharmacy. I'm Brad, and I’ve got Kassidy here with me. We’re diving into something that, honestly, comes up at the beginning of every year - why your medication suddenly seems to cost an arm and a leg at the start of the year.

Kassidy

Yep, hi y'all! For a lot of folks, January can feel like a bad surprise at the pharmacy. One day your meds are $10 or $15, and then, boom—$120 or more. I promise it isn’t us hiding a price jump under the counter. It’s almost always got to do with deductibles. Brad, I know you've got a few stories!

Brad

Oh, plenty. I still remember Mrs. Daniels last winter, came in for her diabetes prescription—December, it was $15... January, it shot up to $120. She thought we’d switched something in the back! But really, it’s the deductible resetting—basically, your insurance makes you cover more of the cost until you hit a certain limit each year. That starts over every single January.

Kassidy

And that deductible means, until you pay that set amount out of your own pocket, your insurance doesn’t really help with the cost. Sometimes, you can also have coinsurance or copays layered in. Brad, explain it in your words—you always sum this up better than I do.

Brad

I’ll try! So, deductible is the amount you pay before insurance starts kicking in. Coinsurance is like a percentage you still owe even after meeting the deductible. Copays are a fixed amount, but sometimes don’t even apply till you’ve crossed that deductible threshold. It’s confusing, even for us sometimes.

Kassidy

And, to get ahead of the common questions—no, your pharmacy doesn’t control what your insurance charges. We see those prices pop up same as you do, usually, so don’t feel like you’re getting singled out or anything mysterious is happening behind the counter.

Brad

Exactly. And I’ll just say—if you feel that sticker shock, let’s talk about it. Nine times out of ten, there’s something we can look at or at least explain. So, if you’re standing at the counter thinking, “Why did my price jump overnight?”—it’s not just you. It’s the system, and it resets every year for everyone.

Kassidy

Now, this brings us to the classic head-scratcher moment—sometimes, paying cash is actually cheaper than running it through your insurance. Folks hear that and just look at us like, wait, what?

Brad

I know, it doesn't make sense at first. But it all comes down to these middle people called PBMs—Pharmacy Benefit Managers. They basically negotiate prices between the pharmacy and your insurance, but sometimes those 'discounted' rates they negotiate actually end up being more than what we could sell a medicine for cash. Crazy, right?

Kassidy

Oh, for sure. I had a patient just last week who needed amoxicillin. On their insurance it rang up at a $35 copay, but if we ran it as cash—it was, like, $6. I told her, “Honestly, skip the insurance on this one.” She was so relieved.

Brad

We see it a lot, especially with antibiotics and certain generics. It’s one of those pharmacy secrets—that really shouldn’t be a secret. And you’re never offending us by asking, “Hey, is there a cheaper cash price?” I actually wish more folks would ask about it, especially early in the year when deductibles bite the hardest.

Kassidy

Sometimes there’s this idea that insurance always means a lower price, but...not always true. Formularies, tiers, and the rates PBMs negotiate change what you pay. We’re happy to run it both ways and show you what’s best, that’s what we’re here for.

Brad

If you’re ever confused about why your insurance copay is more than our cash price, please, just speak up. The answer might save you a few bucks and that’s what we like to see.

Brad

So, you know, when these prices spike in January, some folks just...stop picking up their meds. There’s actually research on this—higher out-of-pocket costs lead to dose skipping, or even stopping medicines, especially for things like asthma or blood pressure.

Kassidy

Yeah, and that’s not just a stat—it’s something we really see at the counter. Delayed refills, people trying to cut pills in half to make a bottle last. I totally get it, but sometimes a small gap in medication can actually cause bigger health issues, especially for chronic conditions.

Brad

And I’ll be honest—I’ve had a few nights where I stay after hours on the phone with someone’s insurance, trying to find a more affordable option for a worried patient. We can check if there’s a generic, see if a 90-day refill lowers the cost, or even see if switching to cash price makes more sense. But we can’t see every situation unless patients talk to us about it.

Kassidy

That’s key. It can feel awkward, but if price is keeping you from taking your meds, tell us! We’d much rather look for an alternative with you than have you stop a medication silently. Sometimes, new programs or changes on your insurance can save the day—we just gotta know about it.

Brad

So if this sounds like your situation, don’t skip doses, don’t just stop taking your medicine. Talk to us, ask about generics, or 90-day fills, or if cash price makes sense. We’re right here to help you figure it out—and if there’s financial help out there, we know how to find it, too.

Kassidy

We get asked about help with cost almost every day, and luckily there’s more out there than most people realize. For folks who qualify, Medicaid can knock medication costs down to almost nothing. There are also discount programs and manufacturer copay cards, sometimes even for common drugs.

Brad

Yeah, I mean, you’d be surprised—some brand medications have programs that slash your out-of-pocket to just a few bucks with the right card. It takes a bit of paperwork, but we can walk you through it. Or, if you’re a Medicare patient, sometimes there are state-level programs to help fill the gaps, especially for certain conditions.

Kassidy

And a lot of people don’t know you can verify pharmacy benefits directly with your insurer, or ask us to do it. If a price seems off or you get a denial, that doesn’t mean you’re stuck. There’s usually a workaround, or at least an explanation—and sometimes it’s just a simple mistake in how something’s coded.

Brad

We act as your go-between, really. If something’s not making sense coverage-wise, let’s look at it together—bring in your cards, any letters from your plan, all of it. Our goal is to help find the lowest possible price for your medications. Don’t be shy about asking, because half the programs out there never get used unless a patient speaks up.

Kassidy

And the more we know—like if your situation changes, or if you moved onto a new plan—the more we can do to help you stay covered and avoid those surprise bills.

Brad

Let’s switch gears to some concrete steps anyone can take to cut down what you pay at the pharmacy. The first one—always ask if a generic is available. No shame, honestly. Generics are the same active ingredient, just way less expensive most of the time.

Kassidy

Absolutely, Brad. And a lot of pharmacies have their own discount programs, or tie-ins with coupon cards, and you don’t have to sign up for a million things online. Just ask when you’re in—sometimes that alone unlocks a lower price. It doesn’t hurt to check mail-order either, for people on regular long-term medications. They can be cost-savers, but make sure your plan plays nicely with them.

Brad

You gotta keep lines open with your doctor, too. If a med is just way out of reach, talk to your provider about alternatives—there’s usually another option, maybe an older med or a different dose, that does the same job for less. And every year, when your insurance resets, give your medication list a quick review. Make sure the stuff you’re still taking is covered as well as possible.

Kassidy

And don’t wait till you’re at the counter in a panic. Catching these things early, especially before the new year or open enrollment, gives you time to make changes and not get caught off guard. It feels like a pain, but reviewing your plan once a year really can save money and headaches down the road.

Brad

The more you ask, the more informed you are—the better chance we have to help you beat those surprise costs. Most of these tips cost nothing but a few minutes of your time and could make a real difference for your wallet over the year.

Kassidy

Alright, so we’ve talked about January surprises. Here’s the flip side—what to do as the year winds down. If you have benefits that reset or expire, you want to make sure you don’t lose out. That means checking your med list, your refills, and your benefits before December ends.

Brad

It’s a good time to refill those 90-day scripts or anything you know you’ll need for chronic conditions. If you’ve met your deductible already, you might actually pay less before January first—so it can be smart to schedule any big refills in advance. You just have to plan a little, and we can help with that mapping out.

Kassidy

And as coverage sometimes shifts—insurers will change formularies, adjust copays—let’s talk about that sooner rather than later. Any letters or notices you get, bring them to us, and we’ll help you sort out what it means. This way, you won’t run into any delays or shortages right when you most need your meds.

Brad

Staying in touch makes a huge difference. Even if you’re just wondering if there’s a better way to time things, or you’re concerned about something changing next year—talk to us or your healthcare provider before January hits. It gives you a chance to adjust and avoid those new-year headaches.

Kassidy

Well, that about wraps up today’s episode. We hope you feel a little less intimidated by all the insurance talk, and a bit more empowered to ask about your medication costs—especially as the year turns.

Brad

Absolutely. Remember, cost questions are health questions, and if you ever wonder what’s going on with your prescription price—we’re your advocates, not just the folks handing out the bottles. Don’t hesitate to reach out.

Kassidy

Thanks so much for joining us. Brad, as always, good chatting with you—and to everyone listening, take care, ask questions, and we’ll see you on the next MedTalk.

Brad

Bye everybody, see you next time!

Kassidy

Feel free to contact us with any questions you might have, we are here to support every one of your health needs. Supply Location: 58 Physicians Drive North West #5, Supply, North Carolina, Open 9 AM – 6 PM, you can call us at (910) 754-7200 and

Kassidy

Southport Location: 1513 N Howe St #8, Southport, North Carolina, Open 9 AM – 6 PM, and you can call at (910) 454-9090. Have a nice day ya'll!