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 you don’t have to accept it. There’s a proven way to get the same health results for a fraction of the price: asking for a therapeutic alternative.

What Is a Therapeutic Alternative?

A therapeutic alternative isn’t just a cheaper version of your current drug. It’s a different medication that works just as well for your condition, even if it’s chemically different. For example, if you’re on brand-name esomeprazole (Nexium) for acid reflux, your doctor could switch you to generic omeprazole. Same effect. Same safety profile. But instead of $365 a month, you pay $15.

This isn’t guesswork. It’s based on clinical studies showing these alternatives work just as well. The American College of Physicians says a therapeutic alternative must have:

• Proven equal effectiveness in head-to-head trials
• Similar side effect risks
• Matching dosing schedules

It’s not the same as generic substitution, where you get the exact same chemical compound at a lower price. Therapeutic interchange lets you swap between different drugs in the same class-like switching from Eliquis to warfarin for blood thinning, or from Jardiance to metformin for diabetes. And when done right, it saves patients an average of $47 a month.

Why Doctors Don’t Always Suggest It

You might be surprised to hear that many doctors don’t bring this up first. Why? Three reasons:

1. They’re not trained to ask. Most medical schools focus on prescribing, not cost-saving swaps. Only 43% of patients report their doctor ever asked if they could afford their meds.
2. They worry about safety. Some doctors fear switching drugs might cause side effects or reduce effectiveness-even though studies show most therapeutic alternatives are just as safe.
3. They’re used to the brand. If a drug was marketed heavily to them, they may default to it without checking cheaper options.

But here’s the truth: a 2017 study from Vanderbilt University found that when doctors were given a simple one-click alert in their electronic records suggesting a cheaper alternative, they used it 10% more often. That means the system can help-but you often have to start the conversation.

How to Ask for a Lower-Cost Option

You don’t need to be a medical expert. Just follow these steps:

1. Know your current medication. Write down the brand and generic name. For example: "I’m on Lyrica (pregabalin)." You can find this on your prescription label or pharmacy receipt.
2. Check the price. Go to GoodRx.com and type in your drug. Compare prices at pharmacies near you. You might be shocked-some drugs cost $450 at one pharmacy and $15 at another. If your copay is higher than the cash price, you’re overpaying.
3. Find a cheaper alternative. Use GoodRx’s "Therapeutic Alternatives" tab. It shows drugs in the same class that treat the same condition. For example, if you’re on Crestor (rosuvastatin), it might suggest atorvastatin (Lipitor generic)-which costs 80% less and works just as well for most people.
4. Ask your doctor directly. Say: "I’ve found a cheaper option that treats the same condition. Could we consider switching?" Name the drug: "Could I try omeprazole instead of esomeprazole?" Or: "Is gabapentin an option instead of pregabalin?"

Don’t be afraid to push back if they say no. Ask: "Is there clinical evidence that this specific drug works better for me than the alternative?" Most of the time, there isn’t.

What to Do If Your Doctor Says No

If your doctor refuses, don’t give up. Try this:

• Ask for a reason. Is it because of your condition? Your age? Your other meds? Write it down.
• Check if it’s a formulary issue. Your insurance might not cover the cheaper drug-but you can request a tiering exception. Medicare Part D and most private plans must respond within 72 hours for urgent cases.
• Get a second opinion. Visit a different doctor, especially if you’re on long-term meds. Primary care doctors are more likely to consider cost-saving swaps than specialists.
• Use patient assistance programs. If the alternative still costs too much, check NeedyMeds.org or RxAssist.org. Many drugmakers offer free or $0 copay cards. For example, some GLP-1 drugs (like Ozempic) have programs that cut the cost to $25 a month.

One patient switched from Jardiance (a $600/month diabetes drug) to generic metformin after her doctor refused. She went to a different clinic, brought printouts from GoodRx, and got the switch approved within two weeks. Her monthly cost dropped from $580 to $12.

When Therapeutic Alternatives Don’t Work

Not every drug has a cheaper alternative. This is especially true for:

• Biologics (like Humira or Enbrel for autoimmune diseases)
• Specialty cancer drugs
• Newer medications with no generics or similar drugs

About 15% of drug classes have no proven therapeutic alternatives. In those cases, you’ll need to explore other options:

• 90-day prescriptions (cuts copays by 25%)
• Manufacturer coupons (often available on drug company websites)
• Medicaid or state assistance programs (if your income is under $60,000/year)
• Pharmacy discount cards (GoodRx, SingleCare, RxSaver)

And if you’re on Medicare, you can request a formulary exception. Just fill out a form from your plan and have your doctor write a letter explaining why the cheaper drug won’t work for you. It’s not guaranteed-but it’s worth trying.

Real Success Stories

People are saving hundreds a month by asking for alternatives:

• Warfarin instead of Eliquis: A 72-year-old man saved $450/month after switching from the brand-name blood thinner to generic warfarin. His doctor was skeptical until he showed him the 2021 study proving equal effectiveness.
• Gabapentin instead of Lyrica: A woman with nerve pain went from $450/month to $15/month. Her neurologist agreed after reviewing the same clinical data.
• Atorvastatin instead of Crestor: A 58-year-old with high cholesterol cut his monthly cost from $380 to $12. He’s been on it for two years with no issues.

These aren’t outliers. GoodRx’s 2024 survey of 12,500 patients found that 68% successfully got a cheaper alternative after asking.

What to Avoid

Don’t do these things:

• Don’t stop your medication. Even if you can’t afford it, never skip doses without talking to your doctor. That can lead to hospitalization.
• Don’t assume generics are always cheaper. Sometimes the brand-name drug is on a $4 list at Walmart, and the generic isn’t.
• Don’t rely on pharmacy discounts alone. A 2023 JAMA study found that 24% of prescriptions had copays higher than what pharmacies get paid from insurance. That means the discount card doesn’t help you.

Also, avoid switching on your own. Therapeutic alternatives need to be monitored. Some drugs, like those for epilepsy or heart failure, require careful titration. Your doctor needs to adjust the dose properly.

Next Steps: What to Do Today

If you’re paying too much for your meds, here’s your action plan:

1. Go to GoodRx.com and search your current drug.
2. Click "Therapeutic Alternatives" and write down 1-2 cheaper options.
3. Call your pharmacy and ask: "What’s the cash price for this alternative?"
4. Write down your doctor’s name and appointment date.
5. At your next visit, say: "I found a cheaper option that works the same way. Can we try it?"

If you’re on Medicare, ask your plan for a formulary exception form. If you’re under 65, check your employer’s pharmacy benefits. Many now offer free or low-cost therapeutic alternatives as part of value-based care programs.

Final Thought

You’re not asking for a favor. You’re asking for the standard of care that every patient deserves: effective treatment at a price you can afford. Therapeutic interchange isn’t a loophole-it’s a tool built into the system. And you have the right to use it.