Many of you have experienced the sticker shock filling a prescription, especially if you don't have prescription insurance. Unlike the cost of most goods and services in a free market economy, which are kept in check by competition and other free market forces, the cost of medications has been skyrocketing because of the lack of these controls. So where most goods will cost twice the wholesale cost and four times the cost of production, medications often cost 64,000 percent more than the cost of production!

Meanwhile, the cost of the exact same pill can vary by over 1000 percent from one drugstore to another. In addition, the cost to somebody without health insurance is often five to ten times as high as what the insurance company needs to pay, as they have been able to negotiate down the drug prices. So if you don't have insurance, and even if you do, you may walk out of the drugstore feeling, well, financially wiped. Unless you know these tricks!

1. Compare prices at different pharmacies before you buy. For example the medication Ambien, which is often needed to help sleep in people with CFS and fibromyalgia, costs about $4 for each 10 mg tablet. So if you need 90 tablets and your insurance company won't pay for it, it will cost you about $360. So say you decide to get the generic instead. For the exact same tablet, the price will vary from nine cents per pill at Costco, to over $3 a pill at many other pharmacies. This is the case for many medications. So with a simple phone call, you can end up paying $8 for the three months of Ambien instead of $270.
   In general, you'll find the best prices at Costco, with Walmart having a number of common medications that they price very low, while they charge very high amounts for others. So call and ask. Another helpful tip? You don't have to be a Costco member to use the pharmacy. When they ask for your Costco card at the entrance, simply tell them you're going to the pharmacy, and they will waive you right in.
2. A wonderful tool? Get a free app called GoodRx or go to www.goodRx.com. Type in the medication name, strength, and quantity, and they will give you the negotiated price they have obtained for the pharmacies near you. Very often, I have found this to be over 90 percent less than what you would pay otherwise. And it will save you a bunch of phone calls. This app/website is outstanding.
3. An important thing to know? For most medications, including compounded medications, you pay by the pill, not by the pill strength. So as an example, for the medication Viagra, it will cost over $50 a pill for a 100 mg tablet. It will cost almost exactly the same amount for a 25 mg or 50 mg tablet. So if you're getting 50 mg tablets, you can save 50 percent by simply getting 100 mg tablets and cutting them in half. This is the case for almost all medications. So a simple $7 pill cutter can save you thousands of dollars.
4. In the vast majority of cases, the generic medication is exactly the same as the expensive brand-name. When I get medications, I will get the generic. Some people will find though, that the brand name will work better. A simple approach? Simply get the first month worth of the medication as the brand name, and then get the generic for refills. This way, in the rare event that they are not working the same for you, you will know.
5. Medication patents are supposed to expire after 20 years, at which time the medication can go generic. But some medications are so profitable that the drug companies will either pay the generic companies not to make a generic, or will file expensive legal action against companies that try to make a generic. For example, the medication Viagra is over 20 years old, but still not available in generic. But here is the secret. Although not available in generic for erectile dysfunction, it is available as a 20 mg generic for pulmonary hypertension. So ask your doctor to write for Sildenafil 20 mg instead of Viagra. These will cost 60 cents a pill using the GoodRx App or website. So even if you need five of them to get the 100 mg dose, this will cost you $3 instead of $50!
6. For many medications, market manipulations going on in the pharmaceutical industry has resulted in even the generics costing way more than they should relative to the cost of producing the pill. For some medications, here is another trick. See if your compounding pharmacy is able to make that medication and what it would cost them to make it.
   So where fluconazole (Diflucan) 200 mg used to cost about $30 for 50 tablets, it now costs over $300 at most pharmacies, even for the generic. Using the GoodRx app will bring it down to $103. But if a compounding pharmacy makes it, you can often get it for under $30. The hack? The doctor has to order some difference in how it's made that sets it apart from what you can find in the drugstore for them to legally be able to make it. So your doctor can order a 210 mg tablet, or have a capsule made with low allergen components.
   For example, when you heard all over the news about the one pharmaceutical company trying to gouge the public by charging obscene prices for an old antiparasitic, what you didn't hear about was that compounding pharmacies were making the same pill for less than a dollar each. Where 50 mg a day of testosterone cream can cost over $500 a month, compounding pharmacies can make it for $15–$30 a month. Simple!
7. Often the best option is to work with a holistic practitioner to find natural alternatives, which are commonly more effective, generally much lower cost, and almost always much safer.
8. As you feel better, remember to ask the doctor if you can lower the dose or stop the medication. Doctors are often too busy to think about this unless you remind them.

With these life hacks, you can slash your medication costs!

Dear Pharmacist,

I have a bedroom problem. I took Viagra for several years, and it stopped working, so I was put on Cialis. Sometimes that helps, sometimes not. I'm too embarrassed to ask my doctor again, she says this is a part of aging because I am 58. Any suggestions?

Answer: I have many! I'm stunned that she's never mentioned bio-identical hormone replacement for you, as in testosterone or "T." The reason most men develop erectile dysfunction in the first place is because they are low in their natural 'manly' hormone, which starts to decline with age. The declining T causes a relative increase in circulating estrogen, a hormone found in higher concentrations in women. Restoring testosterone or "T" puts balance back, so it's my best recommendation for increasing mojo.

Giving a man one of those super sex pills like Viagra, Levitra or Cialis is the equivalent of jump starting the car every two miles, rather than just fixing the battery. Why do men medicate themselves every weekend, when they can fix the root cause by balancing hormones? It's a good question isn't it? A good physician should evaluate your hormones and neurotransmitters and decipher if it's low testosterone, low dopamine, high cortisol, high estrogen, low progesterone, high insulin, low DHEA or oxytocin. If you're a man or a woman, and you've 'lost that lovin' feelin' that's what you need to evaluate and replenish. Prescribed sex pills, as useful as they are, can't balance hormones.

There's another reason I get hot under the collar about this topic. Men are dying every day from heart attack and stroke that may have been prevented. The clue that you're headed for trouble is erectile dysfunction. Think that out, it's not hard to understand... if the blood isn't effectively flowing down south to your penis, it isn't flowing up north either, to your heart. The blood vessels are clogged and that could cause erectile dysfunction years before a massive heart attack occurs. What does conventional medicine do? Prescribe a quick fixer upper, so you can have a night of fun, instead of helping you clear your arteries, improve vessel flexibility, correct hormonal imbalances and manage cholesterol (they don't even measure it correctly but that's another column).

I think there is an incomplete knowledge or understanding of physiology or hormones because sex pills should not be your go-to drug for erectile dysfunction. You think it's just me saying that to alarm you? Not a chance, I would never scare you, that's not how I roll.

A study published in March 2010 in Circulation concluded, "Erectile dysfunction is a potent predictor of all-cause death and the composite of cardiovascular death, myocardial infarction, stroke, and heart failure in men with cardiovascular disease." There's no doubt, low testosterone is a risk factor for heart attack. Replacement therapy is controversial. Some studies suggest the very use of testosterone increases heart attack risk, but I find flaws with those studies. Balance is key.