T he high cost of prescription medication creates a heavy financial burden for many Americans. According to a study in American Journal of Medicine, more than one in five Americans over the age of 50 with a chronic health problem has been forced to cut back on essentials -- including food -- to pay for prescription drugs. Nearly one in five has had to skip doses of prescribed medications to save money.

High deductibles and copayments mean that these problems can affect even people who have prescription drug coverage through health insurance.

But there are ways to reduce out-of-pocket prescription drug costs...

Decline free samples. Receiving things for free sounds like a wonderful money-saver -- but accepting free samples to start a new long-term treatment could cost you a bundle. Pharmaceutical companies typically supply doctors with free samples of expensive new drugs with which they are trying to win market share from lower-cost, better proven alternatives. These free sample drugs often require long-term use, so receiving the first dose for free will mean much less to your bottom line than the hefty price you will pay for subsequent doses.

Unless your doctor has reason to believe that this drug is better for you than the alternatives, say, “No, thank you, Doctor. Keep the samples. Just give me a prescription for a trusted medication that’s within my budget.”

Exception: Free samples will save you money if your doctor is willing to give you enough samples for a complete course of treatment. Though uncommon, this might be possible with, say, an antihistamine for a case of hives or an antibiotic for an infection.

Split tablets. You may know that splitting tablets can save you money. But most people, including doctors, don’t realize just how much you can save. Most prescription drugs are sold in a range of dosages. There might be a 20-milligram (mg) pill, a 40-mg pill and an 80-mg pill.

The higher-dose pills usually are a relative bargain, per milligram of medication, compared with lower-dose pills. In other words, an 80-mg pill will almost always cost substantially less than twice the price of a 40-mg pill and less than four times the price of a 20-mg pill. In some cases, pills of different dosages are priced exactly the same.

Example: The 20-mg, 40-mg and 80-mg versions of the cholesterol medication Lipitor cost the same per pill.

Whenever you are prescribed an expensive medication, ask your doctor if it would be possible for him/her to prescribe half-tablet doses of pills twice as strong as you need -- half an 80-mg tablet rather than one 40-mg tablet, for example. Most doctors aren’t very familiar with medication prices, so you might have to explain that this could save you a lot of money. Pill-splitting devices, sold at pharmacies, can help you divide pills accurately. Caution: Certain types of pills, including capsules, gelcaps and extended-release tablets, cannot be split safely. Discuss any plans you have to split pills with your doctor and pharmacist.

Apply to pharmaceutical company patient-assistance programs. Most major pharmaceutical companies will supply their drugs for free to patients who are unable to afford them. These underpublicized, underutilized assistance programs are not necessarily restricted to people who are very poor. Families making as much as $70,000 per year can qualify for the most liberal programs. Other pharmaceutical company programs cap income at $40,000 or less, but exceptions may be made or applicants may be allowed to deduct the cost of medical expenses when determining their annual income. Income, not assets, is used to determine need, so retirees often qualify even if they have considerable savings.

There is no downside to applying. Look for details and an application on the pharmaceutical company’s Web site or call its 800 number.

Attention veterans: Anyone who has been honorably discharged from the military following active service can obtain many prescription drugs for $8 per month per prescription through the US Department of Veterans Affairs’ Health Care System. Contact the VA for more information on health-care eligibility (877-222-8387, www.va.gov).

Ask your doctor to prescribe a cheaper alternative to a name-brand drug. Most people know that generic versions of expensive prescription pharmaceuticals are just as effective at a fraction of the cost.

Examples: The generic equivalents of the popular drugs Ambien, Prozac, Soma, Xanax and Zantac cost less than 10% as much as the name brands.

However, you may not realize that there are less expensive medications within the same class of drugs that might be equally effective for you.

Example: Beta-blockers are a class of drug used to treat high blood pressure. Though all beta-blockers are very similar, a three-month supply of Zebeta costs about $242... a three-month supply of Inderal is closer to $80. Even generic versions of these drugs differ substantially in price -- $90 for a three-month supply of the generic version of Zebeta... only $11 for generic Inderal.

Sometimes it is possible to switch to a different, cheaper class of drugs without any health consequences. New classes of drugs are heavily marketed, but that does not mean they are any better than older, cheaper drugs that treat the same problems. Ask your doctor whether there is evidence that the expensive new class of drug he/she wants to prescribe will be any more effective for you than a drug from an older, less expensive class.

Example: Januvia, a new class of drug used to treat type 2 diabetes, costs more than $500 for a 90-day supply. Studies suggest that for many people it is less effective than far cheaper diabetes drugs previously on the market.

Don’t ask your doctor for advertised drugs. Pharmaceutical companies now market prescription medications directly to consumers. Asking your doctor about an advertised drug could be bad for both your financial and physical health. Not only are heavily advertised prescription drugs usually very expensive, research suggests that mentioning advertised drugs to your doctor could lead to prescriptions that you do not need.

Example: In a 2005 study published in The Journal of the American Medical Association, medical researchers had actors pose as patients suffering from depression-related symptoms. The symptoms that the actors described did not indicate the need for prescription antidepressants, and only 10% of the actors were given prescriptions. But when the actors presented the same set of symptoms and asked the doctor, “Do you think Paxil will help me?” they were prescribed Paxil or a similar antidepressant more than 50% of the time.

Don’t use insurance for very low-cost drugs. Patients who have prescription drug coverage typically use this insurance every time they purchase medication. When these prescriptions are for low-cost generic drugs, however, their copayments can exceed the cost of purchasing the drugs out-of-pocket. Ask your pharmacist the cash cost of a generic drug before producing your insurance card.

Example: I prescribed one-half tablet per day of hydrochlorothiazide, a high blood pressure medication, to a patient. This patient used his prescription drug plan to buy the medication, paying a $10 copayment each month, for a total cost of $120 per year. These pills would have cost him only around a nickel apiece had he paid cash -- approximately $10 per year.

Also, check Walmart and Target for their $4 prescription drug plans.