There are a few ways to ensure you're getting prescription drugs at the lowest possible cost. Credit: AP Photo/Elise Amendola, File

I recently got a call from a former patient, indignant that the cost of his arthritis medicine had gone from $31 to $148 per month.

“What’s up?” he sputtered. What could he do?

His was a problem I had encountered all too often in my 45 years of practice: many Mainers can’t afford their medications.

I had learned that it wasn’t enough for me to arrive at a diagnosis and prescribe a pill. To be a good doctor I had to be sure my patients could actually get their medicines. It was a seemingly simple problem — but, as I learned, one with a complex answer that goes to the heart of our complicated, profit-driven, frequently unethical pharmaceutical industry.

For most of my patients, I had a few simple answers:

Ask for generics or store brands. Generics can replace brand-name drugs after 20 years and now comprise 90 percent of medicines sold in the U.S. The FDA requires that they have the same active ingredients and meet the same safety standards as brand-name drugs. The coloring, binders and fillers may be different. Side effects due to these differences are extremely rare, but be aware of the possibility.

This was my former patient’s problem: his current doctor had inadvertently not checked the generic box. He was able to get his pills for $31!

Also, if you are taking a tablet, ask if a higher dose is available. With the pharmacist’s approval, purchase the higher dose and cut it into appropriate pieces. A double dose is never double the price.

For very expensive medicines, inquire about charity or compassionate help.

Use mail order. Many insurers have preferred mail-order pharmacies with which they have negotiated lower prices.

Pay attention to your insurer’s annual updates. Many negotiate new prices each year, and you may want to switch plans. If you are old enough to be on Medicare, there’s Part D coverage for prescription drugs. is also a good source of comparative information.

Ask for the number of pills you will need. Do you need a few for an acute problem (for example, pain pills after an injury) or a 90-day supply of pills to take long-term? The reason: providers and hospitals often write prescriptions for more pills than you need so they won’t be bothered by refill requests.

Look into Maine’s programs for low-income adults. Maine has expanded Medicaid, has a prescription access program for low-income seniors, and has transitioned to a state-based insurance marketplace. Further information is available from Maine’s Department of Health and Human Services.

Then, there is another option: buy your medicines in Canada. We pay two to four times more than Canadians for the same medicine. Unfortunately, importing medicines is generally illegal, although it appears the prohibition is rarely enforced when the medication is for personal use. Many U.S. citizens find importation a viable path.

The FDA is responsible for ensuring the safety of our medicines. It has an excellent track record. Federal law permits the importation of medicines made abroad only from FDA-inspected facilities. And a regulation from last year creates a state-by-state pathway for imports from Canada.

Unfortunately, big pharma and other industry advocates have sued the federal government to block this effort, claiming that foreign medicines may be substandard, unsafe and counterfeit, and that they may not save consumers money.

While this may be true in some instances it is certainly not true in all. Canada cares for its citizens just as well (often better) than we do. Health Canada, Canada’s FDA equivalent, is just as good. Politicians from Donald Trump to Bernie Sanders point to the fact that foreign pharmacies credentialed by independent groups have an excellent safety record.

So, if my prior patient had not been able to get a generic form of his medicine, should he have tried to get them from Canada? There is no right answer.

I spoke with Dr. Ed Schollenberger, the registrar of the New Brunswick College of Physicians. He said that this person would need a prescription from a Canadian doctor or from one of the 50 Maine doctors with a New Brunswick “border area” license. (These are now available to almost any Maine doctor with a valid license.) He said it is best to pick up medicines in person in Canada.

If you need to use mail order, caution is in order. Scams are intermixed with legitimate pharmacies. There are extensive discussions about this topic online.

The federal regulation is on hold due to big pharma lawsuit. Maine’s related initiatives are in limbo.

My friend asked the question that gets to the heart of the matter: is the argument against importation about patient safety, or about a threat to pharma profits?

Geoff Gratwick is a retired rheumatologist who represented Bangor and Hermon in the Maine Senate from 2012 to 2020. He chaired the Health and Human Services Committee while in the Legislature. He is also...