RXdrugs - Flying blind

[imoldernu]

Too much to cover in one post...
For starters... Prescription plan covered drugs.
Do you get a Formulary?
How do you check the pricing?
Are plans open ended for price changes?
How sharp is your doctor in selecting generics?

A few starters.
Tricor 30 days approx $430 - Generic fenofibrate -approx $35 but... even there, a little trick from the manufacturer re: dose.
https://www.goodrx.com/blog/why-are-tricor-and-trilipix-so-expensive/

Xarelto... 30 days $432... With my Prescription drug plan it used to be $36/mo., but the company changed payment "tiers", and without warning the price went up to $115 for the same drug.
https://www.goodrx.com/xarelto?drug-name=xARELTO

Another change for 2018... without notice the price of tier 1,2,and 3 drugs
doubled.. and the company stopped sending the Formulary... which used to be a 220 page document. Also many drugs moved from tier one to tier 2. Annual plan cost rose 13%.

Basically, it seems that unless one is willing to spend hours (for people who take multiple prescriptions)... that the only chance to outsmart the vendors, is to have a very smart doctor, who has a handle on the constant changes. Current estimates of the number of US drugs is over 7 thousand.

Old folks (like me) take an average of 4.2 drugs/day. You can check where you fit in here:
https://assets.aarp.org/rgcenter/health/rx_midlife_plus.pdf

As mentioned above... just a few starters. Living in a CCRC , the stories about prescription drug costs is endless. Some paying thousands per month, sadly, because the the information available is so obscure.
...........................................................................................

I used to say "My mama had an ugly child, she didn't have a stupid child!:
Now I'm not so sure....

 

[Chuckanut]

One can check Rx costs here. Sometimes the lowest price will not be the insurance copay.

https://www.goodrx.com/

 

[MRG]

My plan's formulary is shrinking and adding hoops to jump through.

My Flowmax was not in formulary until I took several other meds first. One was an alpha blocker that had me crawling on the floor, bp was 60/30! I should have gone to the ER just to add to the stupidity of the experience!

 

[tfudtuckerpucker]

Have you looked at buying from Canada? Xarelto won't go generic for 3 more years. They are now charging you $3.83ea through your insurance, but if you buy from Canada directly (no insurance involved), I found one place that sells for $2.33 ea here These are manufactured by Bayer in Turkey, and sold through Canada.

 

[imoldernu]

To add a reader comment from the GoodRX site, re: the fenofibrate (generic for the drug Tricor $400+/30day supply)... this not from the manufacturer but from the drug plan.

More freakin' ripoff by Big Pharma! AARP/United Health raised their monthly rates on Part D MedicareRX the last two years by large percentages and this year they elevated Fenofibrate to a Tier 3 drug so the co-pay jumped 350 percent. And the pills are most likely being manufactured in India and cost them only pennies to produce.

And one more... here's a link to the United Healthcare formulary...
https://www.uhccommunityplan.com/co...rmulary/en/2017-TX-Formulary-H7833-001-EN.pdf

My challenge to you, is to find two simple, common drugs...

fenofibrate and Flomax. Betcha a nickel!

 

[Clone]

My challenge to you, is to find two simple, common drugs...

fenofibrate page 53 Tier 1 ($1.20 - $3.30)
Flomax- tamaulosin- page 65 Tier 1 ($1.20 - $3.30

That is easier than Sudoku!

I also found a drug that I take on your formulary- Tier 1 ($1.20 to $3.30)

I just paid for my refill. After a $700 manufacturer rebate, my share was only $2550. After the February refill I will have met my $6000 max out of pocket...

This is also through United Healthcare.

 

[imoldernu]

fenofibrate page 53 Tier 1 ($1.20 - $3.30)
Flomax- tamaulosin- page 65 Tier 1 ($1.20 - $3.30

That is easier than Sudoku!

I also found a drug that I take on your formulary- Tier 1 ($1.20 to $3.30)

I just paid for my refill. After a $700 manufacturer rebate, my share was only $2550. After the February refill I will have met my $6000 max out of pocket...

This is also through United Healthcare.

Unless you found a different United Healthcare formulary, I think I may have won the nickel... I couldn't find "Flomax".
I already take Tamsulosin.

 

[spncity]

SHIP counselor

Each year in November/December - just before you keep or change your prescription plan during open enrollment - have your prescriptions and potential best coverage plans analyzed by your county's SHIP counselor - State Health Insurance Program counselor. Free service.

Prescription plans often change what they will cover from year to year - and you get stuck with the results.

 

[Koolau]

My old Megacorp used to have an incredible policy of supplying pharmaceuticals. Typical was that if a 90 day supply did not cost $10, it cost $20. That was for virtually everything unless there was some very occasional formulary issue - never experienced such. BUT then Megacorp switched to a plan that give us money every year to purchase our own insurance (including drug coverage.) They DID give us access to a middle-man type system to match needs, costs and providers. Using them is as simple as telling them which drugs I take. They tell me which available company offers the best overall monthly fee vs drug cost. Of course, if mid year, a drug changes, you may be up the creek (happened to me this year.)

Overall, our out of pocket drug costs tend to be manageable and the system works for the most part. I don't know if such companies (Towers Watson in my case) are available to folks not dealing with their own Megacorp or former employer, etc.

Good luck as YMMV.

 

[growing_older]

Mid year, my prescription plan changed prices even though the plan itself was the same plan. Some drug prices raised to 4 times their cost the previous month. When I asked about it I was told I was lucky, some more expensive medications went up ten times or more. Even generic drugs with no patent issues were affected. It has all the looks of insurance and drug company making an opportunistic cash grab when they think regulators won't call them on it.

 

[Ronnieboy]

Unless you found a different United Healthcare formulary, I think I may have won the nickel... I couldn't find "Flomax".
I already take Tamsulosin.

tamsulosin is the generic for trade name Flomax, the brand will (almost) always be higher than the generic. I say almost, because newly generic drugs that get a 6 month exclusivity agreement may or may not be cheaper on your insurance plan.

 

[Ronnieboy]

Too much to cover in one post...
For starters... Prescription plan covered drugs.
Do you get a Formulary?
How do you check the pricing?
Are plans open ended for price changes?
How sharp is your doctor in selecting generics?

A few starters.
Tricor 30 days approx $430 - Generic fenofibrate -approx $35 but... even there, a little trick from the manufacturer re: dose.
https://www.goodrx.com/blog/why-are-tricor-and-trilipix-so-expensive/

Xarelto... 30 days $432... With my Prescription drug plan it used to be $36/mo., but the company changed payment "tiers", and without warning the price went up to $115 for the same drug.
https://www.goodrx.com/xarelto?drug-name=xARELTO

Another change for 2018... without notice the price of tier 1,2,and 3 drugs
doubled.. and the company stopped sending the Formulary... which used to be a 220 page document. Also many drugs moved from tier one to tier 2. Annual plan cost rose 13%.

Basically, it seems that unless one is willing to spend hours (for people who take multiple prescriptions)... that the only chance to outsmart the vendors, is to have a very smart doctor, who has a handle on the constant changes. Current estimates of the number of US drugs is over 7 thousand.

Old folks (like me) take an average of 4.2 drugs/day. You can check where you fit in here:
https://assets.aarp.org/rgcenter/health/rx_midlife_plus.pdf

As mentioned above... just a few starters. Living in a CCRC , the stories about prescription drug costs is endless. Some paying thousands per month, sadly, because the the information available is so obscure.
...........................................................................................

I used to say "My mama had an ugly child, she didn't have a stupid child!:
Now I'm not so sure....

Couple of things you can do.

1st, ask your insurer which is their preferred of the blood thinners. There are 4 drugs similar (not exact) to each other. Xarelto, Eliquis, Pradaxa, Savaysa and the oldie but goodie Warfarin. Warfarin is going to be the cheapest but requires blood monitoring, an added inconvenience but you have to decide which is more important to you. If you find out Eliquis is preferred (less expensive copay) over Xarelto say $90 copay, ask your doctor if it is right for you. Then decide what you want to pay the big bucks for Xarelto, the medium for Eliquis or the dirt cheap for warfarin (and added inconvenience).

2nd, see which of the fenofibrates are cheapest for you via insurance or via cash without insurance. There are about 15-20 types of fenofibrate forms and strengths on the market. Maybe the 48mg tabs are $90 and the 54mg tabs are $23 (yes the prices can vary that much) and after talking to your MD, he or she and you decide that 54mg is close enough. Or the 60mg capsules are cheaper and 'close enough' or 1/2 tablet of the 160mg. Who knows but you have to invest some time into a little research and maybe a call to your pharmacy to get an idea too.

Last but not least remember if you have a deductible you'll be paying that first before your copays kick in and using goodrx doesn't go towards your deductible...

 

[growing_older]

There are 4 drugs similar (not exact) to each other. Xarelto, Eliquis, Pradaxa, Savaysa and the oldie but goodie Warfarin.

These kinds of drugs are NOT simple substitutions for each other. Clotting (and blood thinning) is quite complicated and depending on WHY you need blood thinning can make a big difference in which drugs work better and safer for you. Medical reasons are MUCH more important than drug costs for many specific conditions. I want my DOCTOR to be making these kinds of decisions, NOT my insurer.

 

[Buckeye]

I use the tool on Medicare.gov to find the best plan each year for my mom. You load in the meds and it tells you (by your zip code) which plans are available and what they pay for each med.

 

[Ronnieboy]

These kinds of drugs are NOT simple substitutions for each other. Clotting (and blood thinning) is quite complicated and depending on WHY you need blood thinning can make a big difference in which drugs work better and safer for you. Medical reasons are MUCH more important than drug costs for many specific conditions. I want my DOCTOR to be making these kinds of decisions, NOT my insurer.

Never said they were simple substitutions for each other and did say talk to your doctor to decide what they could do. The prescriber is the one who has to make the switch, the patient cannot do it. It could be the one they are on is the best one for them.

We all want our own Doctor making the decisions, but the formulary lists that most insurances use are determined by doctors that work for the insurance company. It not some accountant punching numbers into a spreadsheet.

Its nice that you are able to forgo the insurance and just pay cash whenever your prescibers suggestion doesn't match up with theirs. And I am sure you don't complain about it to the help either