Prescription Drugs

[JOHNNIE36]

Notice in mail today from our health care provider with a reduction in the cost of a couple of their prescription drugs. This prompted me to start a thread about how we try to control the cost of our drugs and wonder what everyone else does. We have United Health Care's Medicare Advantage Plan which includes coverage at various drug stores with a copay. The copay depends on the drug being purchased. Our plan also provides for a mail in order and we usually order a 90 day supply. This is all helpful, but we lower our costs further by buying certain drugs at WalMart ($6 for ninety day supply), some antibiotic drugs are free at Publix Supermarket, the most expensive drug (Plavix) is purchased through a Canadian pharmacy and they offer the generic that cannot be sold in the States by American pharmacies. As mentioned at the beginning of this thread, our prescription drug plan just reduced two generic drugs to $4 for a 90 day supply. How often does this happen?

The whole intent here is to keep away from the "donut hole", at which point you start paying 100% of the cost. Just wondered if anyone taking a number of prescription drugs has reached the donut hole and if you are doing anything special to reduce your costs?

 

[W2R]

I'm not on Medicare yet. With my federal BCBS health insurance, my three prescriptions cost me about $35/month. Two are generic, so most of that is for the one that is not yet available in generic form.

I guess the only thing I know of to keep my costs down, is to try to live a healthy and stressfree lifestyle, and hope that I don't need more prescription drugs in the future. Will be interested to read others' responses to this thread, though.

 

[JOHNNIE36]

W2R, I guess the problem only surfaces when you hit the majic number for medicare (you lucky dog). Just keep all this in mind for when it happens. Last year we both came within a wisker of hitting the donut hole. I think that number was $2750 each (more on that below). The prescription drug fiasco comes about when you have some life crisis like coronary bypass. The normal procedure then is to automatically prescribe about six prescription drugs, most of which you never get off.

Ref the donut hole: As it stands right now, your cost of the prescription drug PLUS the health care companies cost is totaled and applied toward the donut hole. Lets say your cost is $90 and the companies cost is $320. That's $410 applied toward the donut hole. Once you hit the donut hole, you pay 100% of the cost until it hits $4000(?). Then there is another discount.

 

[W2R]

Yes, I really AM a lucky dog! I'm only 63 (young wisp of a girl that I am, ). So, no medicare for me yet.

That system sounds so aggravating. Just when you NEED the help for your prescription drugs, the financial support for them is withdrawn (at least until you hit the other side of the donut hole).

 

[Ronnieboy]

Ref the donut hole: As it stands right now, your cost of the prescription drug PLUS the health care companies cost is totaled and applied toward the donut hole. Lets say your cost is $90 and the companies cost is $320. That's $410 applied toward the donut hole. Once you hit the donut hole, you pay 100% of the cost until it hits $4000(?). Then there is another discount.

IIRC, as part of Obamacare, this year when you hit the donut hole you will [-]only have[/-] get to pay 50% of the cost of brand name drugs.

Easiest way to lower your costs would be to ask your physician if there is a generic version of a drug in the same family you can use. Worst case you are a 'non responder' and have to go back to the pricey brand only drug, best case your $180/month med is now under $20. Most recent example is ARB's (Diovan/Benicar/Cozaar/Atacand/Avapro/Micardis/Teveten) Cozaar/Hyzaar has gone generic and if you are on one of the 6 others you might be able to switch. (TALK TO YOUR PHYSICIAN!!).

Lipitor is coming out generic at the end of this year and people are getting swiched to the 'replacement' drug Livalo because the manufacturer is offering coupons. Which is fine, but remember to switch back to Lipitor when it drops to $10/month

 

[winger]

We see all our doctors in Nov/Dec each year when we are in the Dallas area. All are aware that we travel, and won't be in except then.

Last fall, I changed to several generics from brand name. Benicar to Lisinipril, Lexapro to Citiilapram, and Lipitor to Simvastin. Had a blood test in March, cholesterol ok still. I take my own BP semi regularly, still good.

Both drs were a-ok with it, just keep them informed of any issues. I wish they had email....Need to call about the recent Simvastin warning. I hate calling
.
We saved a couple hundred a month through Medco Mail Order. Kinda like a COLA...

In the fall, I'll check on the generic Lipitor and generic Benicar.

 

[Sue J]

We're not on Medicare yet, but we are on DH's retiree health care plan. Our prescription deductible is $550 each. DH switched from Avapro to losartan (generic) which is around $30 for 90 days. He's monitoring his BP and his Dr may have to up the dosage or try another drug.

I switched form Atacand to losartan and the results are just fine. I dropped Niaspian ER and take OTC Slo-Niacin instead and the results of that are great. And no flushing Another of my prescriptions is $10 for 90 days and the last one is free from my grocery store.

Neither of us will reach our deductible for prescriptions. Both of our doctors have been very cooperative in helping us with prescription costs.

 

[GregLee]

Last fall, I changed to several generics from brand name. Benicar to Lisinipril, ...

Lisinopril? This interests me, since I've taken Benicar for several years. But so far as I can tell, Lisinopril is not a generic version of Benicar, as you seem to imply here.

 

[Ronnieboy]

Lisinopril? This interests me, since I've taken Benicar for several years. But so far as I can tell, Lisinopril is not a generic version of Benicar, as you seem to imply here.

There is no generic (in the US) for Benicar. Losartan is the generic for Hyzaar, but it is in the same 'family/class' as Benicar. Lisinopril is an even older bp med (ace inhibitor - Prinivil/Zestril). But some people might get as good results from it.
Alway check with your prescriber when thinking about change.

 

[Ronnieboy]

In the fall, I'll check on the generic Lipitor and generic Benicar.

Lipitor is 'supposed' to come out in December. Not sure about Benicar yet, still aways a way. Losartan is the closest to Benicar but if the lisinopril is working with no adverse effects why change? Same with simvastatin, those two are probably some of the least expensive generics around. $10-15 for 90 days.

 

[Goonie]

I'm about 11 years away from Medicare, but was able to keep my BCBS coverage when I retired. With it I have a $4 copay on generics and a $20 copay on brandname. I take Tricor and Micardis HCT...both brandname. We tried various generics, but none performed for me nearly as well as these two have, so I drop $40 each month at my neighborhood pharmacy.

 

[winger]

Lisinopril? This interests me, since I've taken Benicar for several years. But so far as I can tell, Lisinopril is not a generic version of Benicar, as you seem to imply here.

You're right. It's not a generic version of Benicar, it's a different medication.

Appears to work the same or better for me. YMMV...............

 

[winger]

Lipitor is 'supposed' to come out in December. Not sure about Benicar yet, still aways a way. Losartan is the closest to Benicar but if the lisinopril is working with no adverse effects why change? Same with simvastatin, those two are probably some of the least expensive generics around. $10-15 for 90 days.

There was a recent warning about possible issues with taking the larger doses of Simvastin. I'm taking 80mg.

 

[Dimsumkid]

We shop for cheapest drugs for our elderly parents and found best prices at Costco and Target. You don't need to be a member to use the Costco (or Sam's Club) pharmacy either. Recently, we had to buy Xalatan (for eye pressure) and the price was over $110 at Walgreens and got it for $89 @ Costco. It recently went generic and prices dropped to $14 for the 1st generic refill to $2 this past month. I was also told that when a drug is about to go generic, they like to increase the cost right before so they can get some extra cash out of you. Another thing I discovered is some Rx's are combinations of 2 drugs. The combinations have no generics, but the individual Rx's do. I was able to reduce the cost, with Dr's approval going back to 2 generic Rx's, from $180 down to $30. Even though the in laws have Rx coverage, the Costco price is cheaper than what the insurance price is, so there's never a point to even use it.

 

[Ronnieboy]

There was a recent warning about possible issues with taking the larger doses of Simvastin. I'm taking 80mg.

Yes, see

FDA Drug Safety Communication: Ongoing safety review of high-dose Zocor (simvastatin) and increased risk of muscle injury

 

[kaneohe]

Another way to lower costs (if generics don't work) is to consider pill splitting.
Not all medications work well this way so check w/ doctor and pharmacist.
I also understand that not all insurance companies will give you the benefit of a lower cost or allow you to do this openly. Mine does which cuts the cost in half.

 

[JOHNNIE36]

I'm about 11 years away from Medicare, but was able to keep my BCBS coverage when I retired. With it I have a $4 copay on generics and a $20 copay on brandname. I take Tricor and Micardis HCT...both brandname. We tried various generics, but none performed for me nearly as well as these two have, so I drop $40 each month at my neighborhood pharmacy.

I was taking Tricor and my physician switched me to the generic fenofibrate. All the numbers came out OK so I'm staying on it. Taking 160mg.

 

[frank]

I had my wife try to get lipitor prescribed from her doctor at 80 mg. she was prescribed 40mg. I thought split the pills and they will last two months for a supply of 30 instead of one month. the cost is the same for 40 or 80. the drs. nurse said they couldn't do that because it was defrauding the manufacturer. what a crock.

 

[Ronnieboy]

I had my wife try to get lipitor prescribed from her doctor at 80 mg. she was prescribed 40mg. I thought split the pills and they will last two months for a supply of 30 instead of one month. the cost is the same for 40 or 80. the drs. nurse said they couldn't do that because it was defrauding the manufacturer. what a crock.

It would be fraud if your insurance is paying for (and charging you for) 1 month supply but it is knowingly lasting you two months (your insurance would expect you to pay two copays). That would be insurance fraud, not really defrauding the manufacturer. If your paying fully out of pocket then it shouldn't really matter.

 

[SteveL]

Am just about to enter Medicare, and am trying to figure out the right strategy. All the drugs that DW and I take are generics. We need a drug plan 'in case". However, the cost of getting these meds through the drug plan aren't significantly different than getting them from Costco. In fact, Costco is cheaper for Losartan, than the "subsidized" price under the drug plan.

Looks like the cheapest drug plan would be about $35-$40 a month for each of us. We also have an option to continue on a plan from my old employer which would cost more out of pocket for Dr. visits etc., but doesn't have the doughnut hole for meds. With the prevalence of drug treatments for lots of ailments that we don't have but might get, maybe we should take the company plan. Have to make up my mind by the end of the month.

 

[frank]

with my insurance I have a 1600 out of pocket deductible and then the insurance pays 100 percent for everything. I can't see how that would defraud the insurance co. but I used to have the copays and I see what you mean. but the way it is now I don't care what it costs because I will hit the 1600 either way.

 

[KingB]

It would be fraud if your insurance is paying for (and charging you for) 1 month supply but it is knowingly lasting you two months (your insurance would expect you to pay two copays). That would be insurance fraud, not really defrauding the manufacturer. If your paying fully out of pocket then it shouldn't really matter.

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?

 

[frank]

that was my question also. I figured if the drug cost the same for 2 months as it did for one the insurance company wouldn't have to pay for the second prescription either. but with the goblledegoop the insurance companies call billing these days how do you know how much they actually pay? somewhere along the line someone is not making the money they thought they should. but the question is who?

 

[Rustward]

With just a little effort anybody can get Lipitor at generic prices now.

http://www.early-retirement.org/forums/f38/lipitor-4-copay-card-55483.html

 

[JOHNNIE36]

Am just about to enter Medicare, and am trying to figure out the right strategy. All the drugs that DW and I take are generics. We need a drug plan 'in case". However, the cost of getting these meds through the drug plan aren't significantly different than getting them from Costco. In fact, Costco is cheaper for Losartan, than the "subsidized" price under the drug plan.

Looks like the cheapest drug plan would be about $35-$40 a month for each of us. We also have an option to continue on a plan from my old employer which would cost more out of pocket for Dr. visits etc., but doesn't have the doughnut hole for meds. With the prevalence of drug treatments for lots of ailments that we don't have but might get, maybe we should take the company plan. Have to make up my mind by the end of the month.

As I noted in my original post, you have to look at ALL the options. For example: I'm taking a generic prescription that costs $6 for a 90 day supply through my health care provider mail-in pharmacy. I get the same '
deal through WalMart. I opt for the WalMart deal because that $6 does not count toward the donut hole. If I use my health care mail-in provider, it cost the same $6; however, that $6 is added to their cost which is $195, so I accummulate $206 toward the donut hole.