Getting prescribed a medication you can’t afford is more common than you think. In 2024, nearly 3 in 10 Americans skipped doses, cut pills in half, or didn’t fill a prescription because of cost. If you’re one of them, you’re not alone-and there’s a proven way to fix it without sacrificing your health: asking for a therapeutic alternative.

Therapeutic alternatives aren’t generics. They’re different drugs that work just as well for your condition but cost a fraction of the price. For example, switching from brand-name Eliquis (apixaban) to generic warfarin can drop your monthly cost from $450 to under $10. Or trading Nexium (esomeprazole) for omeprazole cuts an annual bill from $365 to $15. These aren’t rare cases-they happen every day in clinics across the country.

What Is a Therapeutic Alternative?

A therapeutic alternative is a different medication that treats the same condition as your current drug, but belongs to a different chemical class or is a different version within the same class. It’s not just a generic version of the same pill-it’s a different drug with similar effectiveness and safety.

For example:

• If you’re on Lyrica (pregabalin) for nerve pain, your doctor might suggest gabapentin, which works similarly and costs 95% less.
• If you’re taking Crestor (rosuvastatin) for cholesterol, atorvastatin (Lipitor) is often just as effective and much cheaper.
• For type 2 diabetes, switching from Jardiance (empagliflozin) to metformin can save hundreds per month.

The key is that these drugs have been tested head-to-head in clinical studies and shown comparable results. The American College of Physicians says they must meet three standards: similar effectiveness, similar side effect profiles, and matching dosing schedules.

Why Don’t Doctors Always Suggest These?

Many doctors know about therapeutic alternatives-but they don’t always bring them up. Why? Three reasons:

1. They’re busy. A 15-minute appointment doesn’t leave room to review every drug’s price tag.
2. They’re used to prescribing what’s familiar. If a drug worked for a patient last year, they assume it’s the best choice.
3. They worry about side effects. Some patients respond better to one drug than another-even within the same class.

But here’s the truth: if you don’t ask, you won’t get the option. A 2023 survey by the American Academy of Family Physicians found that 37% of patients who wanted a cheaper alternative were initially turned down by their doctor. But when patients came prepared with data, 68% succeeded.

How to Ask for a Lower-Cost Alternative

Asking for a therapeutic alternative isn’t about pushing back-it’s about partnering with your doctor. Here’s how to do it right.

Step 1: Know Your Current Drug’s Cost

Check your copay. If it’s over $30 a month for a chronic condition, you’re likely paying more than necessary. Use GoodRx (or similar tools) to compare prices at nearby pharmacies. Prices can vary by over 5,000% between stores for the same drug. A pill that costs $120 at one pharmacy might be $15 at another.

Step 2: Research Alternatives

Look up your drug and search for “therapeutic alternatives.” For common conditions, here are proven swaps:

Use trusted sources like the NeedyMeds database or the RxAssist program to find low-cost options and patient assistance programs.

Step 3: Prepare Your Ask

Don’t just say, “This is too expensive.” Be specific. Say:

• “I’m having trouble affording my medication. Is there a similar drug that costs less?”
• “I saw that gabapentin works for nerve pain like Lyrica. Could we try that instead?”
• “My copay is $450 a month. Is there a generic or alternative that’s covered at a lower tier?”

Bring printed info or show your phone screen. Studies show doctors are more likely to agree when patients come with data.

Step 4: Ask About Formulary Tiers and Exceptions

Your insurance puts drugs into tiers. Tier 1 = cheap. Tier 4 = expensive. If your drug is on Tier 4, ask if there’s a Tier 1 alternative. If not, request a tiering exception. For Medicare Part D, you can file this request-your doctor just needs to write a note saying the current drug isn’t working or is unaffordable.

By law, insurers must respond within 72 hours for urgent cases or 14 days for routine ones. Many people don’t know this-and miss out on savings.

Step 5: Use Patient Assistance Programs

Even if there’s no therapeutic alternative, you might still qualify for help. Many drugmakers offer free or $0 copay cards if your income is under $60,000/year. Programs like:

• NeedyMeds (free database of assistance programs)
• RxAssist (search by drug name)
• HealthWell Foundation (covers 1,200+ drugs)

These aren’t charity-they’re standard industry practice. Over 8,000 people used the HealthWell Foundation’s program in 2024 alone, saving an average of $312 per month.

When It Won’t Work

Therapeutic alternatives aren’t magic. They don’t exist for every drug. About 15% of specialty medications-especially biologics for cancer, autoimmune diseases, or rare conditions-have no close substitutes.

Also, not everyone responds the same way. One patient might switch from Jardiance to metformin and see perfect blood sugar control. Another might need the original drug to avoid complications. That’s why your doctor’s judgment matters.

If a switch doesn’t work, don’t give up. Go back. Try another alternative. Or ask about extended prescriptions. Getting a 90-day supply instead of 30 can cut your copay by 25%.

Real Stories, Real Savings

One patient in Ohio switched from Lyrica to gabapentin after showing her doctor a GoodRx printout. Her monthly bill dropped from $450 to $15. She said, “I didn’t even notice a difference in how I felt.”

A man in Texas was paying $380 a month for Crestor. His doctor agreed to switch him to atorvastatin. He saved $380 a month-and kept his cholesterol under control.

But not all stories end well. One woman with psoriasis switched from Taltz to methotrexate because of cost. Her condition flared. She ended up in the ER with $18,000 in bills. That’s why communication matters-don’t switch without your doctor’s input.

What to Do If Your Doctor Says No

If your doctor refuses, ask why. Is it because:

• They don’t know the alternative?
• They think it’s less effective?
• They’re worried about side effects?

Then give them the facts. Bring a printed copy of a clinical guideline from the Institute for Clinical Systems Improvement or a study from the American Society of Health-System Pharmacists. Many doctors will change their mind when shown evidence.

If they still say no, ask for a referral to a pharmacist who specializes in medication therapy management. Most hospitals and clinics have one. They’re trained to find cost-saving options and can often write a letter to your doctor supporting the switch.

Bottom Line: You Have Power

You don’t have to pay what you’re told. Prescription drug prices in the U.S. are wildly inconsistent-and you can use that to your advantage. Therapeutic alternatives are legal, safe, and widely supported by medical guidelines. They’ve been shown to save patients hundreds per month without harming outcomes.

Start today. Check your next prescription’s price on GoodRx. Write down one alternative you’d like to try. Bring it to your next appointment. Say it clearly. You’ve paid for your healthcare-you deserve to get the most value from it.

And remember: if you can’t afford your medication, it’s not your fault. It’s a broken system. But you’re not powerless. You have the right to ask-and the data to back it up.