The high cost of prescription drugs has left many patients in financial and medical despair. Here are some small ways to save big on drugs.

• Lifestyle changes first, meds second. Lifestyle changes like regular exercise and weight loss are an effective first-line defense against arthritis pain. “People who take care of themselves have better outcomes with their condition, develop fewer health problems, and spend less money on medical services,” says Daniel Clauw, MD, a rheumatologist and professor of medicine at the University of Michigan in Ann Arbor.
  
  
• Newer isn’t always better. “Studies show that inexpensive diuretics are as effective as pricier meds at lowering high blood pressure,” says David Nganele, PhD, author of The Best Healthcare for Less (John Wiley & Sons, 2003). For relief of Osteoarthritis pain, many experts recommend that you start off with good ol’ acetaminophen – at about $12 for 500 generic pills – before requesting a prescription for the newer, pricier treatments you see advertised.
  
  
• Buy in bulk. Most health plans have mail-order pharmacies that save you money if you buy in bulk. Buying three months’ worth of medication at one time costs one or two months’ worth of co-pays instead of the usual three for separate prescriptions. If your monthly co-pay is $20, that’s a savings of $80 to $160 a year, depending on the plan.
  
  
• Know your health plan’s formulary. Get a copy of your plan’s formulary – the list of drugs it will cover – from your health insurance company. Share the list with your doctor so he can prescribe the most effective drug that costs the least. Insurance plans charge a hefty fee for nonformulary drugs, if they pay at all.
  
  
• Ask for free samples. Don’t commit to and pay for a 30-day supply of a drug you’ve never taken before. Instead, ask your doctor for at least a week’s worth of samples to see if the medication agrees with you.
  
  
• Know the inside tricks. If you are taking methotrexate pills for RA, you could save money by opting for liquid methotrexate. A four-month supply of pills can cost more than $500; a four-month supply of liquid is around $25. You can either inject the liquid or, if you’re squeamish about syringes, take it orally. (Note: Some experts question whether liquid methotrexate taken orally is absorbed as well as pills or injections. Monitor your symptoms to see if it works for you.)
  
  Another money-saving trick is to split pills. If the medication your doctor prescribes comes in a pill form that can be split, ask if you can get pills in twice the strength you need, then split the pills before taking to get twice the number of doses from a single prescription. Depending on the medication, you could end up getting two months’ worth of medication for the price of one, because many drugs cost the same or about the same regardless of the dose. One caveat: Make sure the pills are ones you can split – they should have a ridge down the middle – and purchase a pill cutter to get an even cut. Never cut coated pills or capsules.
  
  
• Use generic meds. You’ll get the same compound but save substantially. For example, at one Atlanta pharmacy, a 30-day prescription for generic ibuprofen was $4.00, while the same dose of brand-name Motrin was $23.  The cost of other brand-name NSAIDs was significantly higher.