Complexity of Purchasing Prescription Medications

[braumeister]

I long ago gave up trying to understand drug prices.

DW takes one that has an advertised price of about $15,000 for 30 pills (a month). I have no idea how much of that insurance would pay, but she is enrolled in a clinical trial where the manufacturer provides it at no cost.

Apart from that one, everything we take is a generic, so cost is very low.

 

[Car-Guy]

I long ago gave up trying to understand drug prices.

DW takes one that has an advertised price of about $15,000 for 30 pills (a month). I have no idea how much of that insurance would pay, but she is enrolled in a clinical trial where the manufacturer provides it at no cost.

Apart from that one, everything we take is a generic, so cost is very low.

A family member is taking a med that has a "list price" of about 12k a month or 144k a year. When they initially went on this med their drug insurance company was almost begging them to have the doctor send them the prescription and told them their OOP cost would be zero... Ok, that sounded pretty good to me. However, their doctor never sent in a prescription to their drug plan but instead handled getting the meds sent directly to them. No insurance, no co-payment, no paper work.

They aren't asking questions, (I don't blame them) but how does that work?

 

[Act2]

The Senate will be considering this issue as part of their budget process this coming week. Current Medicare law prohibits Medicare from negotiating prices on drugs, if I understand correctly. The legislation could make a big difference in situations like in this thread.

 

[Chuckanut]

I'm sure the doc's don't have any idea what your prescription will cost, nor do they care.

My DW got prescribed an antibiotic a couple of years ago that when we went to fill it, Medicare's (the pharmacy) price was near $500 ($100/pill). I recall calling the Doc's office and requesting a different medication based on cost and they didn't know that the medication was so costly. Next prescribed med was $5.

Or it could have been that pharmacy. My doc recommends trying the Costco pharmacy since they mark up drugs like all other merchandise, about 15%.

The problem is it's hard to know if the high cost is the pharmacy, the manufacturer or some combination of both. FWIW, I am doing to do a serious study come November and it's time to review my medicare Plan D options.

 

[aja8888]

Or it could have been that pharmacy. My doc recommends trying the Costco pharmacy since they mark up drugs like all other merchandise, about 15%.

The problem is it's hard to know if the high cost is the pharmacy, the manufacturer or some combination of both. FWIW, I am doing to do a serious study come November and it's time to review my medicare Plan D options.

We have used Costco before for our Part D plans and they were no better than the Walmart plans. We now use WM because the Costco pharmacy near us is only staffed with two people and there is always a good size wait compared to the WM one nearby.

 

[meleana]

I had no idea! This is probably more of a rant.

Skin doctor puts me on ear drops for itching in my ear and an ointment for a skin rash. Sends it to my local pharmacy. They say that it is going to be $258 for both. I told them to hold and I would look into it.

My insurance company website has a tool that looks around my area to see which pharmacy is cheapest. It says Walgreens.

I ask my doctor's office to switch from local pharmacy to Walgreens. I go there. Before giving them my insurance she says it is $258 for one and $14 for the other as that is the cash price. She runs my insurance and it is $150 and $10.

Next, I ask about Good Rx. She can't do Good Rx but if I can on my cell phone, she can use it. So between Good Rx for the ear drops and insurance for the skin rash ointment, I am done at $47.

Is this the way it is going to be?

It’s such a scam! Same with my husband’s medication. Insurance was like $200 and GoodRX coupon he has to get for every refill runs about $11 - $13!

Yeah- you read that right!

And we shopped the best pharmacy for the Good RX price also!

PS if the doc wants to order a prescription I tell him I will call the office after I shop around and then tell him where to send the script.

 

[Boose]

I thought I understood health insurance, having used it for 30+ years, but being retired on the ACA has been an eye-opener. Three months of my generic prescription is $75 at the pharmacy (using my HMO), $50 by mail-order from Cigna, and $20 from an online pharmacy with no insurance needed (DiRX). I chose the online pharmacy - but I still don't understand why my insurance doesn't negotiate the best rate!

 

[KarenF]

I had no idea! This is probably more of a rant.

Skin doctor puts me on ear drops for itching in my ear and an ointment for a skin rash. Sends it to my local pharmacy. They say that it is going to be $258 for both. I told them to hold and I would look into it.

My insurance company website has a tool that looks around my area to see which pharmacy is cheapest. It says Walgreens.

I ask my doctor's office to switch from local pharmacy to Walgreens. I go there. Before giving them my insurance she says it is $258 for one and $14 for the other as that is the cash price. She runs my insurance and it is $150 and $10.

Next, I ask about Good Rx. She can't do Good Rx but if I can on my cell phone, she can use it. So between Good Rx for the ear drops and insurance for the skin rash ointment, I am done at $47.

Is this the way it is going to be?

Yes, sadly. I really hope Mark Cuban continues to make a run at Big Pharma. I get my thyroid medication from his Cost Plus Pharmacy - $6 for a 90 day supply. My husband gets a medication from there too - $5. These medications would be closer to $100 at a regular pharmacy. Amazon and Costco pharmacies are good too. For any medication you need to take on an ongoing basis, it is worth it to really shop around. It should NOT be like that, but it is.

 

[zippy2020]

Yup, one of the best things about being a Kaiser HMO member is that they run their own hospitals and pharmacies. Depending on the plan (we have the top tier Advantage [Medigap] plan), prescriptions cost us between $5-15 per.

There is a downside - they push generics, so prescriptions for medications still under patent can require some do-si-do'ing between you and your doctor. But still doable, and overall it is so much easier a system.

Kaiser went to e-records sooner than many other chains and that has been a huge increase in efficiency, both for members and for the medical staff.

 

[travelover]

The Senate will be considering this issue as part of their budget process this coming week. Current Medicare law prohibits Medicare from negotiating prices on drugs, if I understand correctly. The legislation could make a big difference in situations like in this thread.

Yes, the drug bill is being blocked. I won't say by whom, but anyone can look it up.

 

[jimbee]

I had no idea! This is probably more of a rant.

Skin doctor puts me on ear drops for itching in my ear and an ointment for a skin rash. Sends it to my local pharmacy. They say that it is going to be $258 for both. I told them to hold and I would look into it.

My insurance company website has a tool that looks around my area to see which pharmacy is cheapest. It says Walgreens.

I ask my doctor's office to switch from local pharmacy to Walgreens. I go there. Before giving them my insurance she says it is $258 for one and $14 for the other as that is the cash price. She runs my insurance and it is $150 and $10.

Next, I ask about Good Rx. She can't do Good Rx but if I can on my cell phone, she can use it. So between Good Rx for the ear drops and insurance for the skin rash ointment, I am done at $47.

Is this the way it is going to be?

Yes, it's been that way for a while. I used GoodRx when I had employee insurance (many years ago), their prices were much better. I'm still using GoodRx with an ACA plan. Don't forget to thank Pharmacy Benefit Managers and pharmaceutical lobbyists. They are making sure you get the best deal.

 

[Bamaman]

My wife is on Xarelto and will be on it as long as she lives. We prescribe to the best Medicare prescription programs available for her long list of meds.

Now the doctor's prescribed Farxiga which I already also take. The retail price for it is something like $560. My cost is something like $140 a month. We're just thankful to be well insured.

My wife's had a very serious back surgery today, and she's having a second even more major back surgery two days from now. Her knee replacement surgery at the same hospital 4 years ago was $92K. I wouldn't be surprised if this surgery (with two surgeons) will exceed $200K. It makes us proud we have Plan F and seldom even receive a bill from a doctor, clinic or hospital.

 

[LeeLee2021]

Everything y’all mentioned has been true for me - I used to think insurance had to be the cheapest price, but now I have a spreadsheet where with every 90 day renewal, I check each at good rx, cost plus, Costco and to my surprise, Amazon’s new pharmacy! At amazon, it’s been super easy to buy/order the prescription, then they send it to the doc for approval. Once they get approval, they text/email you to check out/pay for the order and mail it to you with 2 day shipping. Super easy!

 

[azxracer]

I take a generic version of Bystolic. 90 pills from my part D provider is $168.00 Took a look at Cost Plus (the Mark Cuban company) and 90 pills is $11.10 plus shipping. Other things are a bit more expensive, and Cost Plus does require an e-prescription.

I also keep Nitrostat handy and fill it thru the part D. I got my doc to change the quantity from 100 pills per order (the standard number) to 25 per order. If I have to take 100 of those I'm already dead. Cut the price by a 1/3.

 

[wdwwildbill]

All your problems are minor compared to those of my DH. He takes Humira (by shot) twice a month for psoriatic arthritis. It is a miracle drug for him--without it he probably would be in a wheelchair. With Humira he lives a normal life. The retail cost for 2 shots of Humira is about $6000 per month. Same price in Canada and on GoodRx. Before he was on Medicare he was able to get Humira for $5 per month using the manufacture's card. But Medicare has this dumb rule that says you can't use drug manufacture's cards once you are on Medicare. When he got on Medicare for a few years he was able to get Humira through a Foundation for free but to qualify our income has to be under $86,000. This year and going forward our income will be substantially over $86,000 due to SS, etc. Now he has to use Medicare Part D, he goes immediately into the donut hole. Looks like Humira will cost him around $8000 this year. Our only hope is that Humira will go off patent in 2023 and there may be a cheaper generic.

I'm in the same boat with Humira. Can get on medicare but I'm still working and can stay on employers insurance ( even though it's very pricey ) which will still cost less for Humira. Actually spoke with my dr yesterday about this. When they come out, they will be called bio-similars and will only be apx 15% less them Humira... Other option is to go IV and use part B

 

[Z3Dreamer]

A number of you have mentioned Humira so I thought I would look it up. Here is an article that talks about how expiring patents will hurt big pharma's sales and how they create a product using many, many patents so as to destroy, limit, delay competition. Humira appears to lose some patents in 2023.
https://www.fiercepharma.com/specia..., the mother of,deal between AbbVie and Amgen.

A warning: This article is written from the perspective of maintaining sales, not from the perspective of who can pay $3,000 for a shot of Humira.

 

[harllee]

I'm in the same boat with Humira. Can get on medicare but I'm still working and can stay on employers insurance ( even though it's very pricey ) which will still cost less for Humira. Actually spoke with my dr yesterday about this. When they come out, they will be called bio-similars and will only be apx 15% less them Humira... Other option is to go IV and use part B

Yikes, only a 15% savings on the Humira generic? I was hoping for a lot more savings. DH's doctor has not brought up the IV route for him, maybe because Humira has been so successful for him.

 

[wdwwildbill]

Yikes, only a 15% savings on the Humira generic? I was hoping for a lot more savings. DH's doctor has not brought up the IV route for him, maybe because Humira has been so successful for him.

Yes, has been life saver for me as well !! My R/A doc is on a lot of boards, etc. and is patient advocate.. I believe her when she said ony 15% less .. very depressing as I was hoping for much more discount !! Really don't want to go IV but that would be through part B and covered. At this point, that is the only other option as I to will be over the income limit. Good luck

 

[harllee]

Yes, has been life saver for me as well !! My R/A doc is on a lot of boards, etc. and is patient advocate.. I believe her when she said ony 15% less .. very depressing as I was hoping for much more discount !! Really don't want to go IV but that would be through part B and covered. At this point, that is the only other option as I to will be over the income limit. Good luck

Fortunately we are able to pay the Medicare Part D portion of DH's Humira cost (looks like it will be around $8000 this year). I would hate for DH to get off of Humira and then have a bad flare up of his psoriatic arthritis.

 

[ERD50]

Yes, the drug bill is being blocked. I won't say by whom, but anyone can look it up.

But I'd bet that bill has 147 other provisions tacked on, so who knows what other reservations some Senators may have?

If I were President, I'd let it be known that every bill that isn't a single issue bill gets an automatic veto. No more attaching 'pork' to some other bill.

-ERD50

 

[youbet]

The people without the ability or resources to shop around are getting screwed. I guess that's why there is so much money to be made in generic drugs.

Eliquis is similar to Xarelto in being an expensive anti-coagulant without a generic equivalent. My mother was able to get it for $75 with her Medicare drug plan. Your doctor might be willing to switch you if you could find a deal.

$75 during which coverage stage? For 30 or 90 pills?


Each year I go with the Part D plan which offers the best coverage for Xarelto or Eliquis (they're priced and covered almost identically.) This has usually meant changing insurance companies each year, a pita. Switching from one drug to the other wouldn't help.

I just spent $615 yesterday for 90 Xarelto as I still had to cover my annual deductible. Retail would have been about $1,500. Next fill, it'll be about $200. Then I'll go into the doughnut hole and it heads back up into the $500 range. If I ever hit the catastrophic coverage range, it becomes cheap. For the year, I'm estimating my total cost for Xarelto will in the $mid-teens.

I asked doc about ordering the generic equivalent from an international source (such as manufactured in India). He said he couldn't recommend doing that or warn against it as he has seen no reliable data showing that there is no risk of receiving meds that are lower/higher potency or just placebos. But he also hasn't seen data showing that there were known risks. He didn't say yes. He didn't say no. But he made it clear he wasn't part of the decision and his prescription would continue to be written for brand name Xarelto.

 

[friar1610]

It must be more than a coincidence but many of the (pricey) drugs mentioned in this thread are the very same meds you see advertised on TV during the evening news programs. “Ask your doctor if XXX is right for you….” Those ads are expensive, ‘eh?

 

[travelover]

.......... Those ads are expensive, ‘eh?

Well expensive is relative. Ever try to buy a whole Congress?

 

[friar1610]

Well expensive is relative. Even try to buy a whole Congress?

 

[EastWest Gal]

It must be more than a coincidence but many of the (pricey) drugs mentioned in this thread are the very same meds you see advertised on TV during the evening news programs. “Ask your doctor if XXX is right for you….” Those ads are expensive, ‘eh?

Only two countries allow direct to consumer advertising for prescription drugs. The US and New Zealand. Such a waste of money, IMO.