THREAD: Everything I know about getting medications as cheaply as possible without insurance, in the US. (Though perhaps that was obvious from the "without insurance.")
If this thread helps at all, or you think it would be helpful to others—and you truly have it to spare—any donations are appreciated.
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SKIM LEGEND:
ℹ️ Background [3]
❤️ Getting a prescription from a doctor [6]
🧡 Prescription cost reduction [17]
💛 Patient assistance programs [29]
💙 ADHD-specific medication tips [34]
💚 Trans-specific medication [47]
💜 Medicaid [53]
ℹ️ Background [3]
❤️ Getting a prescription from a doctor [6]
🧡 Prescription cost reduction [17]
💛 Patient assistance programs [29]
💙 ADHD-specific medication tips [34]
💚 Trans-specific medication [47]
💜 Medicaid [53]
ℹ️ It's been a challenging year, and the full extent of my considerable scrappiness has had to kick in. One of my partners and I are both on a number of meds, some controlled and rather expensive, all necessary to our functioning. 1/
ℹ️ Through a variety of methods, I've managed to bring the cost of everything from a no-insurance price of almost a thousand bucks a month, to just under a couple hundred, for two people, including doctor visits. 2/
ℹ️ Everything I'm sharing is legit and safe, to the best of my knowledge, but it's worth noting that I have no moral qualms whatsoever gaming an uncaring system if it gets you through a tough time. That viewpoint may show up here and there. 3/
ℹ️ It's also worth noting that privilege is absolutely relevant when engaging with biomedical institutions in any way. Even being a trans woman, I'm still white and middle class-presenting, and that adds a BIG bonus to my patient self-advocacy and bureaucracy navigation rolls. 4/
ℹ️ I can't disentangle those effects well enough to tell you what to do if you aren't those things, but know that I'm keeping it in mind as I write. 5/
❤️ First, finding a cheap doctor. Obviously, if you already have prescriptions you just need filled, that's ideal, and you can skip ahead. But maybe you moved towns, or you can't see the doctor you used to for other reasons, and you need to start over. 6/ 
❤️ For getting prescriptions, you have a couple options: apps, and local doctors. Both have advantages and disadvantages. The most relevant is that telehealth docs *can* be cheaper, but usually won't prescribe controlled substances, such as the ones on this list. 7/
❤️ One of the cheapest telehealth apps I've found is heydoctor, provided by GoodRx. They have a $50 short-term refill option, but it's mostly gap coverage for prescriptions you already have. You should be able to get in and out for <$70. 8/
heydoctor.com/services/refill
heydoctor.com/services/refill
❤️ Other promising-looking apps: heal.com ($79/visit), HealthTap ($10/month), PlushCare ($99/visit or $15/month). This list might also be useful. (Disclaimer: I have not tried to establish prescription care with a telehealth app.) 9/
healthline.com/health/best-te…
healthline.com/health/best-te…
❤️ All that said, I've actually found it fairly cost-effective to establish self-pay primary care with a local doctor. There's a few things that can help you with that process. 10/
❤️ First off, you can always just search or call for the cash pricing of pretty much any doctor or medical center. It's not always friendly, but I've been very pleasantly surprised by local community clinics. Relevant search terms: self-pay, direct pay. 11/
❤️ An example: here in Atlanta, Druid Hills Primary Care (a wonderful, queer-friendly team of NPs) offers $125 cash-pay visits, and in pandemic-times they're also doing them over webcam. I only see them every 3 months, so it's just $40/month. 12/
❤️ There are also providers specifically invested in offering transparent, affordable cash-pay care. Most notably are those in the Direct Primary Care movement, which has a number of orgs with directories. Check out DPC Frontier, DPC Alliance, and: 13/ aaps.wufoo.com/reports/m5p6z0/
❤️ Before any doctor visit, have a complete list at the ready of all your prescriptions and doses. In my (privileged!) experience, most docs will simply write scrips for what you tell them you've been on most recently. I really hope the same is true for you as well. 14/
❤️ This also means—questionable safety/ethics note here—you have exactly one chance to slightly adjust your medications or dosages to your liking, since IMPE, they don't usually call your last doctor. Take care of you, just don't do anything that would get a nurse mad at me. 15/
❤️ It's also a good idea to cross-reference the meds you want with what's cheapest to get sans insurance, and ask for those formulations or brand names specifically. Which brings us to the next section. 16/
🧡 So, cool, you got your prescription. Where to fill it cheaply? For the most part, your options are using discount cards at big box pharmacies, building a relationship with a local community pharmacy, and taking advantage of other interesting pharmacy startups/orgs. 17/
🧡 The very biggest help to me in getting prescriptions filled cheaply has been GoodRX.com. They provide coupons for 60-80% off at most grocery store chain pharmacies. You can search for meds on their site, and it'll tell you where to get them cheapest. 18/
🧡 They also have a Gold.GoodRX.com membership plan ($6-10/month), with even more cost reduction. But—here's the weird kicker!—for some meds, the regular ol' GoodRx coupons are still WAY cheaper. Always check both sites to figure out what to use your Gold card on. 19/
🧡 If you live in an area ruled by Kroger, there's also the Kroger Savings Club ($36-72/year), which appears to be a partnership with GoodRx. Again, weirdly, some meds will be cheapest on only one of the two membership cards, or simply regular GoodRx. 20/
KrogerSC.com
KrogerSC.com
🧡 Of the 6-7 meds I pick up at Kroger, about half are cheapest on GoodRx, and the other half are split between GoodRx Gold and KrogerSC. Sometimes the difference is negligible; sometimes it's a lot. 21/
🧡 GoodRx will also tell you if Costco has your meds for cheap. It's worth noting that you do NOT need to be a Costco member to take advantage of their pharmacy. (Or to buy alcohol, but that's a different thread.) 22/
🧡 GoodRx mainly works for chain pharmacies, and most community pharmacies can't take it. BUT! A lot of them will try and price match anyway, and can get really close. They also tend to offer other perks like free delivery, and are just generally awesome, compassionate folks. 23/
🧡 If you live in an area with AHF Pharmacies, I can recommend them. There's usually a community pharmacy in every city that really takes care of the queer population; find them if you can. 24/
🧡 Depending on your med, you might also be able to take advantage of a compounding pharmacy, which "assembles" medication from base ingredients to suit the individual patient. If your dosage or delivery method is uncommon in any way, it might work out way cheaper. 25/
🧡 There are also online pharmacies with various business models that can get you meds for mega-cheap, albeit sometimes only a limited selection. One such is rxoutreach.org, a non-profit pharmacy with a fairly impressive price sheet, as well as telehealth services. 26/
🧡 BlinkHealth.com seems to be somewhere inbetween GoodRx and a regular pharmacy; they have a discount program, but also make volume purchases of drugs directly from manufacturers. You can pick up your prescription at many chain pharmacies. 27/
🍑 This one is just for Georgia residents: GoodPill.org somehow gets their hands on medication sample packs, and resells them for ridiculously cheap. Their med list is pretty short, but their prices are among the best for the meds they have. 28/
💛 But there's one price you can't beat: free. For some, this may be the most valuable part of the thread, especially if you have a medication that costs way way more than all the others. (For me, that's Vyvanse, at ~$320/month.) 29/
💛 Some pharma co's offer patient assistance programs that can reduce or eliminate the cost of their meds. Cynically, it's usually the ones that don't have available generics, with competition in the market. e.g., Shire benefits from keeping me on Vyvanse, away from Adderall. 30/
💛 You can search '<med> patient assistance program' or '<pharma co> patient assistance program' and you might get lucky. Unfortunately, the paperwork for those things is often complex, with triangulation between you, them, and your doctor. Which is where this tip comes in: 31/
💛 AdvocateMyMeds.com is a startup that specializes in helping you navigate patient assistance programs. They charge $99 to start, then it's $40/month. They bundle everything into a paperwork packet, walk you through completing it, then keep renewing your meds for you. 32/
💛 Could I save $40/month by just completing the application myself? Sure could—and that paperwork's been sitting in my closet for 2 years waiting for me to do it. At the end of the day, 'executive function' is one of the things I have the least qualms about purchasing, ever. 33/
💙 These next couple sections are about saving money on specific kinds of meds by either trying to make them last longer, or getting them from alternative sources. 34/
💙 I would file the forthcoming advice under "actions of last resort for scrappy people who refuse to die." Whenever we step out of a normative process, it calls us to greater caution, for we bear more fully both the potential gain, as well as the potential risk. 35/
💙 Since I started talking about Vyvanse, I'll share a few things that have been helpful in terms of making ADHD medication last longer. At times I've had to ration my doses to make daily pills last a week. 36/
💙 Obviously, if you're taking instant-release drugs in the form of pressed pills, those are easy to split with a regular pill splitter. But what if you're taking an extended-release med, which usually comes in capsule form? 37/
💙 Adderall and Vyvanse both work a bit differently. Adderall XR is basically Adderall IR, but in tiny time-release microbeads. The capsule just holds the beads. Vyvanse is inherently XR, and the capsule is just active ingredient + filler, all in powder form. 38/
💙 You're gonna wanna get a milligram-sensitive scale, which can be found for <$20 at a variety of online retailers. Search for 'milligram scale' and make sure the sensitivity says 0.01g or 0.001g. Also order some size 1 gelcaps. Don't worry; it won't put you on any lists. 39/
💙 To properly split a capsule, you need to know how much is inside it. I do this by weighing 3+ caps at once, then averaging the weight. Then empty each cap to the best of your ability, and get the average of the empty caps. Subtract avg(empty) from avg(full). 40/
💙 I like knowing the weight of the caps, because they're a lot more similar to each other than the amount of med in each one. Also, if I want to, I can refill the same caps with a different amount of med and know how much it should weigh. 41/
💙 Splitting Adderall XR is easy: once you know the weight of the contents, divide it to your desire and recap that amount. *Don't* do *anything* to the microbeads. 42/
💙 For Vyvanse, note that each dosage (20mg, 30mg, etc.) has a different ratio of active ingredient:filler. Treat each dosage like a different drug. For both Adderall and Vyvanse, don't expect the weight of the contents to match up to the supposed dosage in the slightest. 43/
💙 Example: My 40mg Vyvanse dose weighs 160mg. I recently took a tolerance break, so I'm slowly titrating back up starting at 7.5mg, by weighing out 30mg of powder. Conveniently, this means one pill will last me around 5 days. 44/
💙 Besides weighing, volumetric dosing is a popular way to split powders that dissolve. For example, 100mg in 100mL warm water makes 1mL = 1mg. Do NOT do this with Adderall XR. You can do it with Vyvanse, but don't be thrown off by some of the fillers refusing to dissolve. 45/
💙 Do be aware that taking any med dissolved in liquid form will change the shape of its effects somewhat. For most, it makes it hit faster and harder and leave your body quicker. For Vyvanse, some people report that it smooths out the response curve and makes it last longer. 46/
💚 This part is about acquiring trans HRT when you're having difficulty affording it, or getting a prescription. I am going to be treading carefully here, for a variety of reasons. 47/
💚 For one, people have a variety of feelings about acquiring meds outside of pharmacies. I firmly believe it's possible to self-med safely; I don't know if it's possible for YOU to self-med safely. Please, please, please keep this in mind. 48/
💚 For another, there are two major sex hormones that trans people take, and one of them is, extremely unfairly, a highly controlled substance. I can't give you direct advice on acquiring that one. 49/
💚 And lastly, I don't want to risk a tragedy of the commons. I will simply say this: self-medding communities are amazingly resourceful, and contain people who step up to provide for the community. I will also say there's a community on reddit that's all about trans DIY. 50/
💚 Search the posts, look for the sources people are talking about and reviewing. There's currently 2 major ways to get safe injectable estrogen: one with a Japanese name, and one run by a single person. I source from the latter, and it works great at a fraction of the cost. 51/
💚 You will very likely also learn things about testosterone in those communities. I'm sorry, I hate being cryptic in the slightest, but the benefits of this weird little platform I have also bears obligations. 52/
💜 And finally, I want to talk a little bit about state insurance. I don't know much about Obamacare, but my transition would have gone 10x rockier if not for California Medicaid, aka Medi-Cal. 53/
💜 I'm living in Georgia now, and hooboy, it's a different beast. I haven't started the application process yet, but I'm not looking forward to it. 54/
💜 Regardless: if you haven't applied yet, you GOTTA give it a shot. The bureaucracy sucks, and is specifically designed to sap you of energy and dignity. But the benefits of having even basic coverage for meds and doctors can be the difference between surviving and thriving. 55/
💜 Outside the scope of this thread, but while you're at it, apply for food stamps too. You can usually do it on the same application, and they help a LOT. 56/
💜 Every state's different, so I can't do much other than give you a push to investigate. Search '<state> medicaid phone number' and call that number. Tell them you're in crisis and ask them to walk you through an application. If you apply online, still follow up via phone. 57/
💜 And finally, the most controversial advice in this thread, that might help you the most: you know your financial situation better than anyone. You know how numbers on paper differ from human reality. You know the system has failed you, yet makes you rise to its challenges. 58/
💜 I can't say there won't be consequences, although in my experience, gov't agencies don't talk to each other very well at all. I still can't do the ethical assessment or risk calculation for you. 59/
💜 But I CAN say that is extremely difficult to verify a reported income of $0, and that most who ask do not try. 60/
💖 That's all I got for now—I hope this helped. As for me, my income is truly not high right now, and there are a few people who are currently counting on me. If this advice saved you money— or you have it to spare—anything would be appreciated. /61
ko-fi.com/adapowers
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whoops; the list on this tweet actually got put on the tweet above it. i'm sure you figured that out already.
