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T. Michael Norris, MD, FAAFP, is a volunteer doctor and board member of Clackamas Volunteers in Medicine

Clackamas Volunteers in Medicine Free Clinic in Oregon City has discovered ways to make most prescriptions more affordable that are available to anybody in Oregon, regardless of insurance. Surprisingly, most doctors and patients are not aware of these resources.

T. Michael Norris, MDPrescription medication charges at a pharmacy are mostly related to how much of a discount your insurance company and its pharmacy-benefit-manager partner have negotiated. Like most other medical and hospital charges, the "retail" charge is a wildly inflated number that only those with no insurance or discount card are expected to pay. Your pharmacist doesn't even know your charges until you present your insurance or discount card. Most medications for common diseases come as generic non- brand name medicines at markedly lower prices than branded medicines but have widely variable prices at the retail level.

Fortunately, there are several options for those with no, or poor, insurance for medications. The state of Oregon several years ago created a program where any Oregon resident can essentially pay the price that the insurance company would pay if you had their insurance. This is a huge discount over the regular price.

The Oregon Prescription Drug Program (OPDP) is administered by MODA Health under a contract with the Oregon Health Authority. OPDP will send any resident of Oregon a free card that can be used at the drugstore. Register at oregon.gov/oha/hpa/csi-opdp/pages/index.aspx, where you can look up cost of your medication and find a participating pharmacy (almost all except Walgreens). As an example, a three-month supply of 20 mg of cholesterol drug Zocor (generic: simvastatin) costs $671-$735 for the brand name, $52-$86 for generic or $5.70 with the OPDP card. Enroll by web or by phone 1-800-913-4284. On their website, you can download and print applications in English, Spanish, Russian or Vietnamese to mail back. A few medications are not the best value with this card, such as insulin and levothyroxine thyroid pills. It is best to look up the price before you go to the store; the prices change occasionally.

Walmart has a $4/month, $10/3months program that includes many common generic medications, including levothyroxine, as well as a good deal on some insulins. Regular, isophane and regular/isophane 70/30-mix insulins cost $25 per 10-ml vial, versus over $100 elsewhere. As of last month, GoodRx.com had coupons on Novolin brand insulins at $24 per vial. For most generics, the OPDP card will be better, even at Walmart. Fred Meyer/Kroger stopped a similar $4 program in 2016.

GoodRx.com is a website that compares prices at different pharmacies and provides coupons for discounts. Coupons are often for one time only use. It also has its own discount card, rarely as good as OPDP but sometimes coupon prices are better than OPDP.

NeedyMeds.org is a nonprofit web site that also has a discount card, not as good as OPDP, but also allows you to find available company programs that may provide free or discounted brand name drugs if you qualify.

Walgreens has a membership program for an annual fee that provides discounts but usually not as much as OPDP. Rite Aid has a program for the uninsured by asking the pharmacist, but rarely as good as OPDP. GoodRx explains the RiteAide plan.

Best advice: Never buy a prescription medication without using your insurance card or some discount. Look up the prices on OPDP and GoodRx before you buy. There are dozens of other discount cards available as fundraisers for the organization, or the company sponsoring the card. They include the UnaCard, the Oregon Card (different than OPDP), the Susan B. Komen card, GoodRx card, WellRx, HelpRx, Easy Drug card, etc. They will not match OPDP or $4 Walmart for savings.

Canadian and Mexican prescription drugs are technically illegal to import or bring home, but this controversial law is rarely enforced. There are several legitimate Canadian pharmacies, (and some not legitimate that don't require an RX), that mail to individuals quality medications with a prescription. In Mexico, most medications do not require a prescription. Ventolin (albuterol) inhalers made by Glaxo for asthma in the U.S. cost about $60 and $70, but can be purchased in Mexico for $3 to $5 over the counter as salbutamol (the international name for albuterol). Mexico has some counterfeit drug problems in small shops but has several large chains including Walmart and Costco in bigger cities.

Oregon City resident T. Michael Norris, MD, FAAFP, is a volunteer doctor and board member of Clackamas Volunteers in Medicine. He served as volunteer medical director of the nonprofit free clinic in OC from its founding in 2012 until '17.

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