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Astral Codex Ten Podcast

Apr 27, 2018

Everyone knows medical care in the US is expensive even with insurance and prohibitively expensive without it. I have a lot of patients who are uninsured, or who bounce on and off insurance, or who have trouble affording their co-pays. This is a collection of tricks I’ve learned (mostly from them) to help deal with these situations. They are US-based and may not apply to other countries. Within the US, they are a combination of legal and probably-legal; I’ve tried to mark which is which but I am not a lawyer and can’t make promises. None of this is medical advice; use at your own risk.

This is intended for people who already know they do not qualify for government assistance. If you’re not sure, check and look into the particular patchwork of assistance programs in your state and county.

I. Prescription Medication

This section is about ways to get prescription medication for cheaper. If even after all this your prescription medication is too expensive, please talk to your doctor about whether it can be replaced with a less expensive medication. Often doctors don’t think about this and will be happy to work with you if they know you need it. They may also have other ways to help you save money, like giving you the free sample boxes they get from drug reps.

1. Sites like This is first because it’s probably the most important thing most people can do to save money on health care. For example, one month of Abilify 5 mg usually costs $930 at Safeway, but only $30 with a GoodRx coupon. There is no catch. Insurances and pharmacies play a weird game where insurances say they’ll only pay one-tenth the sticker price for drugs, and pharmacies respond by dectupling the price of everything. If you have insurance, it all (mostly) cancels out in the end; if you don’t, you end up paying inflated prices with no relation to reality. GoodRx negotiates discounts so that individual consumers can get drugs for the same discounted price as insurances (or better); they also list the prices at each pharmacy so you know where to shop. This is not only important in and of itself, but its price comparison feature is also important to figure out how best to apply the other features in this category. Even if you have insurance, GoodRx prices are sometimes lower than your copay.

2. Get and split bigger pills. Remember how a month of Abilify 5 mg cost $30 with the coupon? Well, a month of Abilify 30 mg also costs $30. Cut each 30 mg pill into sixths, and now you have six months’ worth of Abilify 5 mg, for a total cost of $5 per month. You’ll need a cooperative doctor willing to prescribe you the higher dose. Note that some pills cannot be divided in this way – cutting XR pills screws up the extended release mechanism. Others like seizure medication are a bad idea to split in case you end up taking slightly different doses each time. Ask your doctor whether this is safe for whatever medication you use. Do not ask the pharma companies or trust their literature – they will always say it’s unsafe, for self-interested reasons. Contrary to some doctors’ concerns, this is not insurance fraud if you’re not buying it with insurance, and AFAIK there’s no such thing as defrauding a pharmacy.