Cost-cutting measures are creeping into the medicine cabinet

We split pills in half or take the drugs every other day to stretch our doses. We stop filling the prescriptions for our most expensive drugs. We buy prescriptions from online pharmacies with questionable credentials.

As patients pay more for their prescription drugs - whether it's through higher insurance co-pays or shouldering the full costs - many people decide to opt out of taking the drugs altogether. But there are safer ways to cut costs than skimping on - or skipping - the medicines you need.

More emergency room visits, severe and uncontrolled asthma attacks, and an upswing in heart attacks and strokes are just some of the poor health outcomes associated with skipping a prescription due to its cost.

For a chronic disease like high blood pressure where the symptoms are not obvious, skipping the drug may seem like no big deal, according to Rebecca Snead, executive vice president of the National Alliance of State Pharmacy Associations.

But, "we don't want someone who can't afford a medicine to become someone who can't afford bypass surgery," warns John Michael O'Brien, a prescriptions cost expert at College of Notre Dame of Maryland.

That's exactly what happened with to Karen Merrill, who has heart disease. She felt worse when she stopped taking her prescriptions for a while after her heart attack, "and I ended up back in surgery for a bypass," she said.

When patients decide to stop taking a prescription or otherwise alter their doses without informing their doctors, they may put themselves at risk for overdose or harmful medicine interactions.

"A doctor may think a patient is taking a drug when he really isn't, and may prescribe another drug when it appears that the first drug isn't working," says Michelle Fritsch, a pharmacist and chair of the clinical and administrative sciences department at the College of Notre Dame.

Savings Plan

But maybe your insurance doesn't quite stretch to cover a brand-name antidepressant, or maybe you are stuck in Medicare's Part D "doughnut hole," waiting for your annual cap on prescription coverage to roll over. Maybe you have no insurance and no cash to spend at the pharmacy. How should you handle the costs?

"Every time you fill a prescription, talk to your pharmacist about lowering your drug costs," O'Brien advises. "Your pharmacist can explain your options and help your doctor choose a medicine that meets your needs."

However, "I don't know about you, but I know I would have a hard time standing in line with my pharmacist and saying, 'I can't afford this,'" says Merrill, who now works with the American Heart Association as a survivor-advocate.

In many cases, insurance companies directly notify pharmacies about less costly options in a class of cholesterol drugs, for instance, or a new generic version of a drug. "And if a generic is available for a drug you've been prescribed, you should take it," O'Brien says.

People who think generic drugs "are like generic toilet paper" can rest assured that the Food and Drug Administration certifies generic medications as having the same dose, strength, safety and efficacy as their brand-name counterparts, Fritsch says.

Free prescription drugs are available for people who can't afford their medicines through patient assistance programs or PAPs.

Janet Walton, deputy program director at RxAssist, says it's not always the uninsured or the poor who are seeking help: "People who are underinsured are calling."

Merrill sets aside money in a special health savings account to pay for her prescriptions throughout the year, "but come November, December, I'm in my doctor's office begging for free samples," she says.

"Samples aren't a replacement for continuity of care," says O'Brien, who notes that irregular use of samples can make it difficult for pharmacists to catch drug interactions. Doctor office samples also tend to be expensive brand-name drugs, not generics, "so if you start on a brand-name drug, you'll soon get a prescription for a brand-name drug."

Snead and others advise against buying cheaper prescription drugs from Canada, Mexico, and other foreign markets. "The incidence of counterfeit drugs is rising exponentially," Snead warns. Your online pharmacy may be stamped with a maple leaf flag, "but how do you know that the Web site is really in Canada?" she asked.

Speak Up - and Cut Back

"One of the questions that I've trained my 77-year old mom to ask is, 'if I get a new medication, which one of these other medications can I stop taking?'" Snead says.

O'Brien and Snead both recommend a yearly review of all medicines, in consultation with your doctor and pharmacist.