By Patricia Prewitt

My Personal Rx Adviser

What Are ‘lifestyle’ medications?

Insurance companies often categorize certain drugs as “lifestyle” products. These typically include treatments for hair growth, skin care, men’s and women’s sexual health, and weight management. Because insurers often view these as “quality-of-life” prescriptions – not medically necessary for acute illnesses or for chronic medical conditions, they are frequently not covered, leaving the consumer to pay a high retail cost for the product.

Are there any strategies to save money on these high-cost lifestyle prescriptions?

First: Comparing prices between pharmacies makes sense. Retail prices for the same medication can vary a lot among traditional pharmacies.

Second: Visit the drug manufacturer’s website directly for coupons. Many offer copay cards or one-time savings offers.

Note for Medicare users: While federal law often restricts the use of manufacturer coupons for covered drugs, some brand-name lifestyle products offer separate savings programs for those paying cash. One of my clients was able to reduce her monthly women’s health Rx from $227 down to $87 by using a manufacturer-direct offer.

Third:Since many insurance plans have dropped coverage for the popular GLP-1 products, some pharma manufacturers have responded by offering patients direct access with significant discounts through their websites. This is a major shift to the market in the past four to six months.

Traditional insurance coverage may still be obtained for GLP-1s if patients meet certain medical criteria, and utilize their insurance plans prior authorization procedures.

What are the practical considerations?

Before you switch to a direct-to-consumer website or a cash-pay model, keep these points in mind:

• Insurance and taxes: When you pay cash, these costs do not count toward your insurance deductible. They may not qualify as deductible medical expenses for tax purposes. Always consult with your CPA or tax preparer.

• Digital requirements: These services require a computer or smartphone, an individual online account, and a credit card.

• Prescriber access: Visits are via the internet – inquire how side effects or dosing changes would be managed.

• New prescriptions: You cannot simply transfer your old refill; you will need a new prescription from your doctor sent directly to the online service.

• Planning ahead: Factor in shipping times so you don’t run out of medication.

• Remember: Most of these services do not allow returns and do not handle controlled substances.

Is this a case of ‘buyer beware?’

With the rise of telehealth, it is easier than ever to get prescriptions online. Consultation fees for independent telehealth online services are rarely covered by insurance. Lifestyle prescription products are heavily marketed on television, and social media sites such as Facebook and Instagram. Programs often push for monthly prepaid subscriptions. How comfortable are you with internet-only health services?

Prioritize your safety by ensuring the website is reputable, and a licensed pharmacy is providing the prescription product. Consult your primary physician before starting any new prescriptions. Inform your primary care physician of the new medications obtained through online services.

Content provided is for educational purposes only and is not intended as a substitute for advice from a qualified medical professional. The opinions expressed within are those of the author.

About the Author: Patricia Prewitt is a local Massachusetts resident who spent more than 30 years in  the pharmaceutical industry. Tricia is a consumer education advocate, and loves helping people find ways to save money on their prescriptions. More information and free resources are available on her website at https://mypersonalrxadvisor.com/resources or call her at 508-507-8840. Favorite Quote: “Act as if what you do makes a difference. It does.” – William James