Silliness of our Healthcare System

[Toocold]

Recently, we went on a trip to MX, so DW decided that we all had to get some typhoid vaccines. We all went to the same provider, same location, and they ordered same prescription, but we picked it up at two different pharmacies.

Here is what the exact same pills cost us according to the EOB by my insurance company:

Pharmacy 1
Description Charges Allowed Amount Paid Amount Amount You Owe

VIVOTIF $220.07 $195.34 $97.67 $97.67

Pharmacy 2
Description Charges Allowed Amount Paid Amount Amount You Owe

VIVOTIF $119.08 $96.14 $96.14 $0.00

Had I known that pharmacy 2 cost 0, we would have obviously chosen it for both. This is so wrong.

 

[HI Bill]

That's nothing. In the past year, I've seen the 'tag' price of outpatient hospital charges of $17K, of which my insurance agency paid $4K, and charges for a medevac flight for $170K, of which my insurance agency paid $16K. If you're uninsured and something like this hits, you're on the hook for the tag price, and are likely bankrupt. Good thing for the "No Surprises" medical act!

 

[folivier]

My DW calls around for prices and frequently Costco is cheaper without using our insurance. IOW using our drug plan insurance we pay more! Figure that one out.

 

[jazz4cash]

Apps like GoodRx are pretty good for finding better pricing. The variation is unbelievable sometimes. That’s an example of how expensive things get when pricing is obscure. I’m still surprised that MDs send Rx directly to pharmacy making it more difficult to compare.

 

[retire to nature]

Apps like GoodRx are pretty good for finding better pricing. The variation is unbelievable sometimes. That’s an example of how expensive things get when pricing is obscure. I’m still surprised that MDs send Rx directly to pharmacy making it more difficult to compare.

I already knew the audit or coding can make difference.

But recently, I learned about goodrx for my pet med. so sometimes goodrx is cheaper than online pet med. So I research each time and find out goodrx is cheaper which is exact brand and place since the zipcode was entered. So I asked my vet to contact the pharmacy. but when I pick it up the price is different from what online showed. And like you said, when the prescription is there, it is hard to bother the vet again. What a stupid healthcare world.

 

[JBTX]

https://www.kff.org/other/report/follow-the-pill-understanding-the-u-s/

While this is 18 years old, it still largely reflects the convoluted process of pharma distribution and pricing.

 

[Sunset]

I already knew the audit or coding can make difference.

But recently, I learned about goodrx for my pet med. so sometimes goodrx is cheaper than online pet med. So I research each time and find out goodrx is cheaper which is exact brand and place since the zipcode was entered. So I asked my vet to contact the pharmacy. but when I pick it up the price is different from what online showed. And like you said, when the prescription is there, it is hard to bother the vet again. What a stupid healthcare world.

This is why I like paper prescription.
Then I take it to various pharmacies to get an acceptable price if the first one is crazy expensive.

 

[Sunset]

Recently, we went on a trip to MX, so DW decided that we all had to get some typhoid vaccines. We all went to the same provider, same location, and they ordered same prescription, but we picked it up at two different pharmacies.

Here is what the exact same pills cost us according to the EOB by my insurance company:

Pharmacy 1
Description Charges Allowed Amount Paid Amount Amount You Owe

VIVOTIF $220.07 $195.34 $97.67 $97.67

Pharmacy 2
Description Charges Allowed Amount Paid Amount Amount You Owe

VIVOTIF $119.08 $96.14 $96.14 $0.00

Had I known that pharmacy 2 cost 0, we would have obviously chosen it for both. This is so wrong.

Yes, so tricky, I think it has to do with which pharmacy is "preferred" by my drug plan.
Go to the wrong one and I pay extra

 

[Toocold]

This is why I like paper prescription.
Then I take it to various pharmacies to get an acceptable price if the first one is crazy expensive.

This is a perfect situation where comparison shopping would have been helpful, especially if you have a paper prescription. When the doc asked where we should pick it up, I didn't think much of it until we picked up the pills.

I've always thought that drug prices would be comparable, and the charges and negotiated discounts would be somewhat comparable. It was the first time I've seen it this blatant.

At first, I was shocked that this vaccine cost $97, but it was too late. Plus it was at Sam's club pharmacy, which has a tendency to be lower than normal pharmacies.

When DW picked up the pills for the kids and she had to pick it up at the clinic pharmacy, because she didn't have time to go to Sam's. I thought it was going to be more expensive. But she said it cost $0.

While this is 18 years old, it still largely reflects the convoluted process of pharma distribution and pricing.

I know the industry very well, and agree that it's convoluted. The sad thing is that the first pharmacy contract would be considered better because it's a 50% discount vs a 20% discount for the second.

The system is actually worse, if you think about it, because pharmaceutical benefits are delegated by the health insurance company, and then even the PBM sub-delegated specialty pharmacy to another company. Every single part want to make a profit.

 

[racy]

An actionable step would be to let your Representatives know your displeasure with the system. https://www.govtrack.us/

 

[mrfeh]

Apps like GoodRx are pretty good for finding better pricing. The variation is unbelievable sometimes.

+1

We haven't used our insurance for generic meds for years now.

 

[audreyh1]

First step is to make sure you are using a preferred pharmacy.

 

[Midpack]

That’s typical. I just filled a Rx:

• CVS was $41.86 for 18.
• GoodRX was $9.51 for 18.
• Harris Teeter was. $12.58 for 36 (bought that)
• It’s a drug that cost $1500 for 90 when it came out about 20 years ago.

Exact same drug and manufacturer. And it’s not very effective…

 

[MichaelB]

Thread moved to healthcare forum

First step is to make sure you are using a preferred pharmacy.

+1

 

[Venturer]

I am using an inhaler daily now and it is crazy how exspensive it is. A 30 day 1 puff a day is in the range of $500-$650 monthly, my price according to which pharmacy. But there is a catch. In doing some research I found a program that gets it for free the rest of the year. I went to my respitory Dr. and get a 90 day prescription which I had found out was $625.00,which is the required spend amount, then sent in a 90 day prescription along with the required forms and I got 3 inhalers in the mail at no charge along with instructions on how to get another 3 in July &October which will get me through December. Then in Janurary I'll have to start all over. The 1st. thing is having to pay over $500.00 for 30 day but then to get a 90 day for $125.00 more is crazy and usually those pharma "help" programs have a little ** that they don't work with Medicare ins. I am thankful I was able to find this one because I actually do breath better using the inhaler.

 

[ShokWaveRider]

I have found that my Part D Plan is basically all but useless, BUT I AM FORCED TO GET IT! Often, they do not cover my prescriptions, in most cases it is the same or cheaper if I shop around. Why are we FORECED to get a Drug Plan on Medicare or suffer penalties.?

 

[Midpack]

I have found that my Part D Plan is basically all but useless, BUT I AM FORCED TO GET IT! Often, they do not cover my prescriptions, in most cases it is the same or cheaper if I shop around. Why are we FORECED to get a Drug Plan on Medicare or suffer penalties.?

We don't have any ongoing Rx needs, but I continue to be amazed at how good my very basic Part D coverage has been. They cover more than I ever would have guessed. My WellCare Part D costs $133.20/yr.

OTOH, DW has her Part D with Aetna. It's only $50.40/yr, and it doesn't seem to cover anything. She plans to change providers next enrollment.

We also find it pays to shop around, starting with CVS, using our local grocers pharmacy, GoodRX and others (e.g. post #13 above). We usually find big discrepancies in prices, which improves what Part D covers?

 

[ShokWaveRider]

We don't have any ongoing Rx needs, but I continue to be amazed at how good my very basic Part D coverage has been. They cover more than I ever would have guessed. My WellCare Part D costs $133.20/yr.

OTOH, DW has her Part D with Aetna. It's only $50.40/yr, and it doesn't seem to cover anything. She plans to change providers next enrollment.

We also find it pays to shop around, starting with CVS, using our local grocers pharmacy, GoodRX and others (e.g. post #13 above). We usually find big discrepancies in prices, which improves what Part D covers?

I am with Aetna, that is most likely the issue. I am lucky also as all my prescriptions are generic Tier 1, with the exception of a few random items like creams etc. that occasionally are required.

 

[Dash man]

We don't have any ongoing Rx needs, but I continue to be amazed at how good my very basic Part D coverage has been. They cover more than I ever would have guessed. My WellCare Part D costs $133.20/yr.

OTOH, DW has her Part D with Aetna. It's only $50.40/yr, and it doesn't seem to cover anything. She plans to change providers next enrollment.

We also find it pays to shop around, starting with CVS, using our local grocers pharmacy, GoodRX and others (e.g. post #13 above). We usually find big discrepancies in prices, which improves what Part D covers?

I use Aetna for my Part D plan and love it. Now, I have a number of health problems that require prescriptions, so I pay the higher monthly amount for the no deductible plan. I pay zero when I pick up most of my prescriptions, except for my asthma medications and pain medications. The pain meds are only a few dollars and the Asthma meds are much less that with other plans.

 

[Toocold]

Yes, so tricky, I think it has to do with which pharmacy is "preferred" by my drug plan.
Go to the wrong one and I pay extra

I often find that the preferred pharmacy is more expensive. For my normal meds, I get it cheaper at sam's club than their preferred pharmacy.

I am not sure if the PBMs even know where the least expensive place is.

I am very certain they know which pharmacy gives them the most profit, which is why many are pushing for their own home deliveries.

 

[fh2000]

Recently, we went on a trip to MX, so DW decided that we all had to get some typhoid vaccines. We all went to the same provider, same location, and they ordered same prescription, but we picked it up at two different pharmacies.

Here is what the exact same pills cost us according to the EOB by my insurance company:

Pharmacy 1
Description Charges Allowed Amount Paid Amount Amount You Owe

VIVOTIF $220.07 $195.34 $97.67 $97.67

Pharmacy 2
Description Charges Allowed Amount Paid Amount Amount You Owe

VIVOTIF $119.08 $96.14 $96.14 $0.00

Had I known that pharmacy 2 cost 0, we would have obviously chosen it for both. This is so wrong.

Can you return and get refund, like you can with merchandise?

 

[CardsFan]

We have found that it pays to shop Part D plans every year. We both take 2 maintenance drugs, but they are for different things.

I have been on Wellcare since the beginning (2020), as it provides the best overall value for my drugs.

DW started with Wellcare the same year, but has switched every year since to get the best value. She currently is on an Aetna plan.

You do need to search on the Medicare sight, as DW's plan was not offered through VIA benefits (which we need to use to get Retiree HRA reimbursement). Since our Medigap costs more than use up the HRA funds, there was no penalty for her to enroll on the Medicare site versus VIA.

There can also be a BIG difference using preferred pharmacies and using mail order.

 

[audreyh1]

Can you return and get refund, like you can with merchandise?

No, not for prescriptions.

 

[Venturer]

^^^^^^ this but you can refuse to pick up and transfer to another pharmacy.

 

[CRLLS]

That’s typical. I just filled a Rx:

• CVS was $41.86 for 18.
• GoodRX was $9.51 for 18.
• Harris Teeter was. $12.58 for 36 (bought that)
• It’s a drug that cost $1500 for 90 when it came out about 20 years ago.

Exact same drug and manufacturer. And it’s not very effective…

I use CVS (inside a Target retail store) for my pharmacy as it is a preferred pharmacy of my Part D plan. I recently had the need for a prescription. Before I went to pick it up, I checked online for both my plan's price and the GoodRX price. Not surprisingly the GoodRX was considerably lower than my plan's negotiated price. When I told the pharmacist that I wanted the GoodRx price and not to go thru my insurance, she voluntarily looked on her computer and found an even lower price for me. She said that they have all of the various discount drug companies and their pricing in their computer at a couple of keystrokes. That's service IMO.