People’s Pharmacy: Save money on prescriptions by paying cash

Q. I think the electronic system that requires doctors to send prescriptions directly to the pharmacy makes it hard to control drug costs. I now insist that my doctors give me paper scripts.

I have Part D Medicare drug coverage. The cost for two drugs from a major chain drugstore using this insurance was far in excess of the cost at a local pharmacy with no insurance.

For example, my dermatologist prescribed an ointment for athlete’s foot. An 80-ounce tube at the chain drugstore with my insurance was $110. The cost at the pharmacy in my local supermarket with no insurance was $15.

Also, my cardiologist prescribed tadalafil (Cialis) 5 milligrams for my high blood pressure. A three-month supply at the chain with my insurance was $330. The cost in my local pharmacy with no insurance was $45. People should be aware that they can save money by shopping around, but you can’t shop with electronic prescriptions.

A. You have discovered a fascinating anomaly in the way that drug pricing works. Insurance companies often require patients to pay high out-of-pocket drug charges until they meet their deductible. It always makes sense to ask what the price would be without insurance.

Companies like GoodRx offer coupons that can also save consumers money if they don’t use insurance. This applies mostly to generic drugs.

Tadalafil is prescribed for both erectile dysfunction and pulmonary arterial hypertension. Although it is not an ordinary high blood pressure medicine, it can dilate blood vessels. This often results in lower blood pressure. The price for brand name Cialis could exceed $1,000 for a three-month supply. Your $45 cash price is impressive.

Another reader paid $150 for a 90-day supply of the cholesterol drug rosuvastatin using insurance. With a GoodRx coupon, the cost would have been around $25 at some pharmacies.

Q. I take 200-milligram Lyrica daily for nerve pain but I have gained weight. If I cut my dose in half, will I have a corresponding weight loss?

A. Weight gain is among the most common side effects of pregabalin (Lyrica), reported by up to 14% of patients taking it (Federal Practitioner, May 2021). Sadly, we could not find studies demonstrating that reducing the dose results in weight loss.

If you want to lower your dose, please coordinate closely with the prescriber. Discontinuing pregabalin suddenly, or even reducing the dose, could result in a very unpleasant withdrawal syndrome. People may experience headache, nausea, anxiety, insomnia and sweating.

Q. I took terpin hydrate as a kid many years ago. It really worked to calm a nasty cough. I haven’t found anything recently that works as well. Can you tell me where to purchase it?

A. Terpin hydrate was a popular cough medicine from the 1880s till the 1990s. That’s when the Food and Drug Administration decided there was not enough evidence of effectiveness. As a result, it pretty much disappeared from drugstore shelves.

Like you, many people miss this old-fashioned remedy derived from natural sources such as eucalyptus, oregano, thyme or turpentine. Although terpin hydrate is no longer available over the counter, doctors can prescribe it and compounding pharmacies can prepare it.

We have many other natural approaches for calming a cough in our “eGuide to Colds, Coughs & the Flu.” This online resource is available under the Health eGuides tab at www.PeoplesPharmacy.com.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”