Originally Posted by KingB
I don't understand.
Using actual figures: Lipitor 80mg, 90 days supply. I pay $102 and the company pays $238. I split the pills, so now I have 180 days, allowing me to skip the 2nd 90 days order. I save $102 and the company $238. I saved $102 but the company or the insurance was not out of any money. Who got defrauded?
Using your example, if you were taking Lipitor 80mg, at 1/2 tab #45 would last 90 days. Your copay would still be $102 and the insurance would pay roughly half of the amount listed above ~ $119.
90 days later you get your refill, you again pay $102 copay and the company pays $119.
Now over the 6 months you have paid $204 and the insurance has paid $238.
The insurance can now say they provided 6 months of benefits for the $238 (where in your example it only looks like 3 months even if you don't get the 2nd refill for 6 months), but it has cost you double and believe you me - insurance companies have done numerous studies that show the more you (the patient) pays out of pocket, the more you are invested in your health care dollars (now I am going to look for the alternative - simvastatin instead of Lipitor because my 90 day copay drops to $10 and the insurance company pays nothing b/c your $10 copay is the full amount).
We're not even getting into any type of back end deal the insurance or mail order company is getting from the manufacturer.
It is similar to people on Medicaid who have $0 copay for office visits. Not only do they go to the ER for the everyday visits (instead of having a primary care physician, which would be more cost effective), but they go more often. For any scrape, cough, or sniffle. When asked why, "It doesn't cost me anything"