How much can you save? The following strategies can result in deep discounts on your prescription drug bills. Try this:  You save:  Substitute an older but equally effective drug.  75%  Buy generic drugs instead of name brands.  70%  Split higher dosage medication in half.  50%

NEW YORK (MONEY Magazine) - Kendall DePascal was studying for her Ph.D. at the University of California at San Diego when she was struck by a hit-and-run driver, sustaining serious head injuries.

That was 20 years ago. The seizures and random memory loss caused by the accident have continued ever since, robbing DePascal of the ability to find a long-term job.

"It's hard to hold on to a position," she says wryly, "when you keep forgetting your boss' name."

Without steady employment and the health insurance that typically comes with it, DePascal, 43, has struggled to pay for the prescription drugs she needs to control the seizures, as well as anxiety and high blood pressure -- all of which costs nearly $1,000 a month.

So she has learned to be creative: She asks her doctors for free samples, orders 90-day supplies from discount mail-order pharmacies and, most important, uses a new online service that enables her to locate free and discounted prescription drug programs that she qualifies for. Her total costs now for medicine? Less than $90 a month.

DePascal is just one of the millions of Americans searching for ways to cope with the high costs of prescription drugs. Even people who have employer-provided insurance coverage aren't immune.

As retail prescription prices have risen at nearly triple the inflation rate for most of the past decade, companies have been passing along more of those costs. Since 2000, for instance, employee co-payments for drugs on a health plan's nonpreferred list (usually expensive brand names) soared 94 percent.

Alarmingly, many consumers are responding to these increases in ways that endanger their health, according to a new survey released exclusively to MONEY by Medco Health Solutions, a leading national pharmacy benefits manager.

Some 22 percent of the respondents admitted that they've avoided going to the doctor during the past year, 17 percent didn't get prescriptions filled, and 14 percent took less than the recommended dosage.

What's more, those surveyed reported that they'd sharply increase these risky behaviors if their out-of-pocket drug costs continue to go up.

You, of course, would never sacrifice your health to afford drugs -- and the fact is, you probably have to sacrifice far less income than you thought. With a few smart moves, you can cut your prescription drug bill, often by 50 percent or more. Here's how.

If your doctor prescribes a brand-name drug, always ask if there's a generic equivalent -- that is, a drug usually known by its chemical name that is virtually identical to the better-known drug. Generics retail for 70 percent less on average than brand names and carry average co-pays of only $9 vs. $20 for brand names (and nearly $100 for some top-tier brand names) -- yet you give up nothing in quality.

Generics must meet the same Food and Drug Administration effectiveness and safety standards as their brand-name counterparts. Half are actually made by the same company that puts out the brand-name version.

A new crop of generic drugs comes to market every year as the patent protection on the brand-name version expires. Among the drugs expected to go off patent in the U.S. either this year or next are commonly prescribed brand names such as Zocor (cholesterol-lowering) and Zoloft (an antidepressant).

New does not always mean improved. If you're taking a brand-name drug for which no generic is available, ask your doctor or pharmacist if you can switch to an older drug in the same category -- a technique called therapeutic substitution.

When a drug's patent protection expires (typically after 14 to 20 years), pharmaceutical companies often heavily advertise a new successor drug that is likely to be more expensive but is not necessarily better.

The ads work: About a quarter of American adults who've seen or heard prescription drug ads have subsequently talked to their doctor about that drug, according to the Kaiser Family Foundation, a health-policy research group. Some 75 percent of them end up getting a prescription for it or another drug.

"Most people don't realize that federal regulatory standards don't require a new drug to be more effective than existing alternatives," says Larry Sasich, a pharmacist at Public Citizen, a Washington, D.C. consumer-advocacy group. "The fact that more than a dozen new medications that have come on the market since 1992 have been withdrawn for safety reasons clearly demonstrates that new drugs can be riskier too."

Shifting to therapeutic equivalents has been a big cost saver for John Palmer, 63, of Middleport, N.Y. Palmer has enjoyed prescription drug coverage under his retiree health plan with Kodak, his former employer. But he still had to make hefty co-pays of $80 each for Glucophage, a drug to treat diabetes, and for cholesterol-lowering Lipitor.

Steve Giroux, a knowledgeable local pharmacist, suggested that Palmer could save money by asking his doctor to switch him to similar, older prescription drugs in the same class that carried co-pays of only $8 each. As a result, he slashed his monthly medicine costs from $160 to $16.

In some cases, a therapeutic substitute may even be available over the counter. Case in point: Nexium, a heartburn remedy advertised as "the new purple pill," retailing at $120 to $140 for a month's supply. Chemically, Nexium is almost identical to the drug Prilosec, which lost its patent protection in 2001 and is now marketed OTC for about a quarter of the cost. You can get advice about other money-saving therapeutic substitutes at Public Citizen's Web site, Worstpills.org.

Shopping around for the best price is especially important for people without insurance, which includes 20 million working adults in the U.S.

"Prices for the same drug vary dramatically from local pharmacies to chains to online pharmacies, so you have to do homework to know what's a good deal," says Michael Cecil, an Atlanta cardiologist and author of "Drugs for Less."

Start by checking prices at online pharmacies such as Costco.com, Familymeds.com or Drugstore.com. Costco uses a pricing formula that often makes it the low-cost supplier, so it provides a good baseline. But also consult your local pharmacist, who may be able to suggest an even more cost-effective combination of therapeutic equivalents and generics.

If you take certain drugs regularly, buying a 90-day supply can also reduce costs by eliminating some of the dispensing fees that pharmacies impose each time they fill a prescription.

Savings are proportionally greatest for generics and lower-priced brand names, says Holly Henry, president of Rxtra Care, a group of Seattle pharmacies. For a generic that costs $1.50 for a 30-day supply and is filled by a pharmacy with a dispensing fee of $9 per prescription, you'd pay $31.50 to refill that 30-day supply three times vs. $13.50 for a 90-day supply. Your savings: 57 percent vs. only 5.5 percent for a $100 name-brand drug.

If you do have employer-provided insurance coverage, make the most of it. Many pharmacy benefit plans offer discounts for 90-day supplies from their own mail-order services but impose a co-pay for every 30 days' worth of medication you buy elsewhere. And don't forget to take advantage of flexible spending accounts, which allow you to use pretax money to cover drug co-pays as well as other out-of-pocket health expenses.

You may be able to halve your costs for any brand-name medications you take on a regular basis by asking your doctor for a higher-dosage version. If you cut each tablet in two with a pill splitter, you'll need 50 percent fewer refills.

There are some pills that shouldn't be split, such as those with time-release coatings, so be sure to ask your doctor or pharmacist whether the strategy will work for you.

Always ask your doctor for free samples as well -- pharmaceutical company sales reps distributed $16.4 billion worth of samples at physicians' offices in 2003. You may also find samples or discount coupons on drug company Web sites, in TV and magazine ads or through coupons you get in the mail.

Several patient-assistance programs have been launched this year that offer free or discounted medicines to those who need them most -- primarily people without insurance coverage and lower-income consumers.

For instance, Partnership for Prescription Assistance (pparx.org; 888-477-2669) now provides a centralized data bank that makes it easier to learn about 275 public and private programs, typically (but not always) aimed at lower-income households.

Merck recently introduced a program for uninsured consumers, regardless of income, that offers discounts of 10 to 40 percent on its drugs.

The biggest shift in government prescription programs will start up for seniors next year when Medicare's new prescription drug benefit plan goes into effect.

If you elect to participate, you'll initially pay monthly premiums of about $35, plus a $250 deductible, with the plan paying 75 percent of prescription costs until your total drug expenses hit $2,250. Then you'll pay in full for the next $2,850 worth of drugs; coverage will begin again when medication costs reach $5,100.

A recent Kaiser Foundation study projects that the majority of participants will pay less next year as a result of the plan. But one in four would pay, on average, nearly $500 more. (To estimate whether you'd lose or gain, check out the Medicare drug calculator at familiesusa.org.)

One final tip from cardiologist Cecil can save you money while also improving your quality of life: "I've seen many patients who are able to go off some of their meds when they start eating right, exercising and losing weight," he says. "After all, the cheapest prescription drug is the one you no longer need to buy."

Over the past several years, Sandra Zuckerman, 74, a retired journalist in Northbrook, Ill., had tried many ways to cut the drug costs that were running her several hundred dollars a month.

Nothing made much of a dent until she joined the more than 1 million Americans who get their prescriptions filled by mail from Canada. Now Zuckerman gets a month's supply of Asacol, a colitis medicine, for $230 vs. $554. She has also halved her costs for the cholesterol drug Lipitor and for Toprol-XL, a high-blood-pressure treatment.

The only glitch with this strategy: It's not exactly legal. Drug costs in Canada and other industrialized countries are generally 35 to 55 percent less than in the U.S. But anyone who buys medications abroad is breaking a 1987 law forbidding the importation of prescription drugs.

In practice, however, the Food and Drug Administration doesn't bring charges against consumers who order a supply of 90 days or less for their personal consumption.

Asked whether Americans who do so should worry about being slapped in handcuffs, Tom McGinnis, the FDA's director of pharmacy affairs, says, "That's not going to happen."

The more pressing concern, he contends, ought to be safety, "There's just no assurance by this agency that drugs from outside the U.S. are the same as what you'd get at a state-licensed pharmacy."

There haven't been any reported cases, however, of unsafe drugs being shipped from any licensed Canadian pharmacies. And several bills are pending in Congress that, in addition to removing the legal barriers, would ensure that prescription drugs bought abroad meet U.S. safety standards.

"Our goal is not for everyone to buy medicine in Canada or Europe but to force prices in the United States down," says U.S. Rep. Bernie Sanders, co-sponsor of two of the bills.

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