<h3>By Judith Treadway</h3>
Over the last several decades, the use of psychiatric medications has greatly increased, and so have the costs.&nbsp;

The average American takes 12 medications compared to seven medications 20 years ago.&nbsp;

According to the National Health Center health statistics, more than 16 percent of Americans age 40 to 50 take antidepressants.&nbsp;

While some generic drugs can be inexpensive, even they can vary drastically in costs in the same community.&nbsp;

While doing research for this article, I found that Venlafaxine ER 75 mg costs $250 for 60 pills at one drug store and the same generic drug costs $40 at a neighborhood store. Switching to an immediate release formulation costs between $4 and $8.&nbsp;

There are simple ways to save money on medications, but there are some possible pitfalls of using some methods.&nbsp;
<p style="text-align: center;"><b>Formulary&nbsp;</b></p>
If you have insurance, look carefully at your plan’s drug formulary. A formulary is a list of the drugs for which your insurance company, Medicare or Medicaid, will pay its part of the cost.&nbsp;

If your doctor can prescribe you a drug that is on formulary, on a low tier and that does not require prior authorization (a special explanation from the doctor), it will likely save time and money.&nbsp;
<p style="text-align: center;"><b>Formulation&nbsp;</b></p>
Simpler forms of medication tend to be cheaper than those that are ending in letters like Xl, XR, etc. These usually designate that they are extended-release in some way.&nbsp;

These medications are not always better than the immediate release, but they are usually more convenient and more expensive. Discuss with your doctor the cheaper immediate release versions, if available.&nbsp;
<p style="text-align: center;"><b>Generic medications&nbsp;</b></p>
Some patients will say that they have to have the brand name medication, but brand name medication is almost always more expensive. Many drug stores now offer a long list of inexpensive generic drugs. Many cost only $4 for a month’s refill.&nbsp;

The FDA requires that all generic drugs contain identical amounts of the same active drug ingredients; however, the shape, flavor, inactive ingredients and release may vary.&nbsp;

Switching to a generic drug may not always be a good idea, for example, for seizure control.&nbsp;

Many of the so-called big box stores have a $4 generic list for a 30-day supply and many are posted online. Some are also offering a 90-day supply for $10.&nbsp;

Two pharmacy chains offer free antibiotics and free Metformin for diabetes and Lisinopril for hypertension with prescriptions. One now offers free Amlodipine.&nbsp;
<p style="text-align: center;"><b>Websites&nbsp;</b></p>
There are websites that may shorten the search for inexpensive generics. These sites are generally run by pharmacist groups.&nbsp;

You enter the name of the medication you are seeking, the strength, your ZIP code and it compares prices at several local drug stores. Note, though, that these search sites do not cover all medicines or search all pharmacies, so you may still not get the absolute best price.&nbsp;

It may be best to phone around to compare prices.&nbsp;
<p style="text-align: center;"><b>Compassionate programs&nbsp;</b></p>
These are programs that are generally need or income-based for people without insurance to help someone who falls into the Medicare doughnut hole. Visit www.needymeds.org or www.ppaRX.org.

Additionally, most large pharmaceutical companies offer assistance for the brand-name medications. Individual websites for the medications also give guidance on how to apply.&nbsp;

Coupons for medications can sometimes be found at the drug company website. These are usually for brand-name medications and are limited to so many per patient each year.&nbsp;
<p style="text-align: center;"><b>Discount savings cards</b></p>
These can be useful for people without insurance. They are generally free. When the patient uses the card, the discount varies.
<p style="text-align: center;"><b>Pill splitting&nbsp;</b></p>
This is the practice of cutting pills in order to save money. It works best with medication that is scored, i.e., has a line down the middle.&nbsp;

The AMA and the Americans Pharmacists Association do not endorse the practice but reportedly acknowledged this can save money if done correctly.&nbsp;

However, there are many medications that should not be split, including those with a hard coating, enteric-coated, time released, birth control or are bitter or crumbly.&nbsp;
<p style="text-align: center;"><b>Mail order&nbsp;</b></p>
You may be able to order via your health plan and save that way. Make sure there is a safe delivery place that is in the shade.&nbsp;

Internet medication orders may be fake, fraudulent or unsafe. The FDA has warned that medications ordered from overseas may not be the same as in the USA.

<i>Dr. Judith Treadway is the chief of psychiatric services at Coastal Empire Mental Health in Beaufort.</i>