One of the first steps to take in lowering your drug expenditures is to sit down with your primary-care physician and to ask for his or her help. Whether it’s asking for samples or substituting generic drugs for expensive brand names, you might be surprised how much you can save before you even get to the
pharmacy counter.

Here are eight ways to work with your doctor to save money on your prescription drug bill:

1. Review your prescriptions with your doctor with an eye to reducing costs. Have a heart-to-heart with your doctor and tell him or her how much you can really afford to pay for your meds. When your doctor is unaware of your financial situation, he or she usually doesn’t think about a drug’s price—and may prescribe an expensive drug that’s no more effective than a cheaper alternative. There may also be drugs you can eliminate from your regimen altogether.

2. Ask for samples at every visit. Whenever you visit the doctor, don’t be shy about asking for free samples of the drugs you’re currently taking. Most doctors don’t mind helping you out—particularly if you’ve been candid with them about your financial situation.

3. Ask for generics whenever possible. Whenever your doctor fills out a prescription for you, ask if the drug is generic. If it’s not, ask if there’s a generic version of the drug, or a generic version of a similar drug, that you can take instead.

4. Try over-the-counter medications first. Because of all the TV advertising for prescription drugs today, many of us immediately ask for a prescription when we have seasonal allergies, minor heartburn or occasional insomnia. Our mentality is that prescription drugs must be stronger than over-the-counter remedies— and of course, we all want the strongest medicine for our condition. The truth is, in many cases over-the-counter medications work just as well—and don’t require paying for a high-priced prescription drug and doctor’s visit.

5. Ask for a 90-day supply. For drugs you’re taking on an ongoing basis, you can often save money and cut down on doctor’s visits by requesting a 90-day supply. Unfortunately, many insurance plans don’t allow doctors to prescribe more than a 30-day supply, so ask your insurer. But if you’re uninsured, 90-day supplies can be a money saver. Wal-Mart, for example, recently began selling 90-day supplies of more than 350 generic drugs for just $10.

6. Take care of your medications. How you store your drugs can make a big difference in how long they last and/or how effective they are. You shouldn’t keep your drugs near heat or moisture, for example. If you take drugs that have lost their potency, you’ll have to end up taking them longer—which will cost you more. This is particularly important if you are buying your drugs in 90-day supplies. Ask your doctor the best way to preserve your meds.

7. Make lifestyle changes where you can. Believe it or not, you don’t need a pill for every ill. A whole range of health conditions, such as high cholesterol and acid reflux, can often be managed through diet and exercise. Be sure to ask your doctor if there are lifestyle changes that might reduce or eliminate the need for drugs you’re taking. And don’t stop there. Because physicians aren’t always the most knowledgeable experts on nutrition and its benefits, you should do you own research, too. Harvard University’s Nutrition Source is one Web site we encourage you to check out.

8. Split your pills. Ask your doctor if he or she can prescribe medications to you in double the dosage you need. Drugs that are double the dose are often less than double the price—so splitting pills can lead to big savings for those taking expensive drugs. Pill splitting doesn’t work with all meds, so ask you doctor first. And always use a pill-splitting device; don’t try to do it by hand.

COBRA is not the best name for a government program, is it? When you get laid off, you’d probably rather be handed information on a program called KOALA or KITTEN than COBRA.

A cobra sounds like it might eat your kitten — not to mention all your savings as you look for a new job.

And sure enough, many Americans are scared by COBRA, or at least downright frustrated. Because the last thing you want to hear when you lose your job is that you’re going to have a big new expense — paying for your own health insurance.

But thanks to the stimulus plan recently passed by Congress and signed by President Obama, COBRA’s benefits are better than ever.

By law, employers must provide laid-off workers information about COBRA, a government mandate that gives workers the right to choose to continue coverage under the employer’s group plan for a limited period. The average monthly premium for COBRA is $300 for an individual and $1,000 for a family.

That may sound expensive — and it is — but it’s generally much cheaper than finding insurance on your own.

And now, thanks to the stimulus legislation, many workers who have been laid off can receive a 65 percent subsidy for up to nine months, meaning that you only have to pay 35 percent of the total cost. For a family, that can reduce the average burden from $1,000 per month to $350 per month — saving the family about $6,000 over a nine-month period.

For many Americans, this will make the difference in whether that can afford COBRA coverage — and whether they can afford to pay for their prescription drugs.

The federal subsidy applies only to people who have lost jobs between Sept. 1, 2008, and Dec. 31, 2009. For information, visit the Department of Labor’s Web site at www.dol.gov/ebsa/cobra.html.

Remember, you are required to sign up for COBRA within 60 days of being laid off or you lose the option.