Complexity of Purchasing Prescription Medications

[Z3Dreamer]

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?

[REWahoo]

Yep!

[VanWinkle]

It pays to check all of the avenues for obtaining prescriptions.

[Z3Dreamer]

Ok, then I go to the Ear, Nose and Throat Doctor. He wants to give me something for allergies. He wants to use a specialty pharmacy that will deliver some mix that I squirt in my nose. Pharmacy says $75 without insurance.

I give pharmacy my insurance and they say $65, but they would have to go back to ENT Doctor and request that the prescription get modified to be the way the insurance company wants. I say "Never mind, here is my credit card."

Again, just a rant.

[JDARNELL]

Keep in mind if you have time you can order medicine from other parts of the world. I just made a order yesterday for some medication that was minimal compared to what I was finding here.

[Z3Dreamer]

Quote:

Originally Posted by JDARNELL Keep in mind if you have time you can order medicine from other parts of the world. I just made a order yesterday for some medication that was minimal compared to what I was finding here.

As a retired old goat, I have time. I have heard of ordering overseas, but have never done so. For recurring expensive items, I have heard that it is a wonderful solution. I suspect that adding to the complexity of ordering prescriptions will save money, but will also drive my blood pressure up. No?

[MRG]

Don't forget Costplus drugs.

[ncbill]

Yep, I think the expats who retired down to Mexico & pay routine stuff out-of-pocket but keep Medicare B just in case have it right.

[youbet]

Quote:

Originally Posted by Z3Dreamer As a retired old goat, I have time. I have heard of ordering overseas, but have never done so. For recurring expensive items, I have heard that it is a wonderful solution. I suspect that adding to the complexity of ordering prescriptions will save money, but will also drive my blood pressure up. No?

For some drugs, there just doesn't seem to be a solution or any relief in sight.

I take Xarelto, an anti-coagulant, because I have AFIB. No generic available. People on Medicare don't qualify for the manufacturer discount program. Good RX and similar don't help in any meaningful way. I'm unaware of anyplace outside of the USA to purchase Xarelto. I purchase the best Part D plan for Xarelto I can find every year but still pay $500+ for 90 pills during the deductible stage and almost that much once I'm in the "doughnut hole." It seems like "grin and bear it" is the only current way to handle it. I'm just glad I can afford it.

[Z3Dreamer]

Quote:

Originally Posted by youbet For some drugs, there just doesn't seem to be a solution or any relief in sight. I take Xarelto, an anti-coagulant, because I have AFIB. No generic available. People on Medicare don't qualify for the manufacturer discount program. Good RX and similar don't help in any meaningful way. I'm unaware of anyplace outside of the USA to purchase Xarelto. I purchase the best Part D plan for Xarelto I can find every year but still pay $500+ for 90 pills during the deductible stage and almost that much once I'm in the "doughnut hole." It seems like "grin and bear it" is the only current way to handle it. I'm just glad I can afford it.

I see their ads on TV all the time. Are you happy and good looking like all of their actors are?

Just kidding. What you are saying is that the cost of Xarelto for a year is about $2,000. Because of donut holes and deductibles you pay about $1,000 even though you have a premiere insurance plan. Correct?

[tfudtuckerpucker]

This might be worth looking into-
https://www.pharmacychecker.com/xare...suggest#prices
I haven't purchased through them, so I don't know anything about safety or risk.

[youbet]

Quote:

Originally Posted by Z3Dreamer I see their ads on TV all the time. Are you happy and good looking like all of their actors are?

I could be happier (geezer curmudgeon here) but I am very good lookin' .

Quote:

Just kidding. What you are saying is that the cost of Xarelto for a year is about $2,000. Because of donut holes and deductibles you pay about $1,000 even though you have a premiere insurance plan. Correct?

The Good Rx price for a year of Xarelto would be about $6k.

Depending on what happens with my other drugs (which determines when I'm past my deductible, when I'm in and out of the doughnut hole, etc.) my cost for Xarelto with insurance will be in the $1.5k range this year. I can't find a way I'm qualified for to do any better than that.

[Z3Dreamer]

Quote:

Originally Posted by MRG Don't forget Costplus drugs.

DW had told me about this but I didn't recognize "Costplus drugs." She described it as "Mark Cuban's drug company."

Looks promising. So, before filling a prescription, I should look at my insurance company's website for cheapest pharmacy in town. Then I should consider overseas pharmacies. Then I should look at CostPlus and Good Rx. Finally, I should ask for the cash price. Is this ALL I have to do?

[Z3Dreamer]

Quote:

Originally Posted by tfudtuckerpucker This might be worth looking into- https://www.pharmacychecker.com/xare...suggest#prices I haven't purchased through them, so I don't know anything about safety or risk.

Looks like a good site. I have bookmarked for my next (hopefully never) mega-expensive prescription.

I still can't believe the amount of work I did for a small bottle of ear drops and some skin rash cream. And I can't believe the amount of work doctors' offices do in helping you get the cheapest prescription. I know it is all computerized, but...

[youbet]

Quote:

Originally Posted by tfudtuckerpucker This might be worth looking into- https://www.pharmacychecker.com/xare...suggest#prices I haven't purchased through them, so I don't know anything about safety or risk.

Yes, that program does look like some investigation would be warranted. ?Thanks.

[RetMD21]

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.

[Sue J]

All of our Rxs are tier 1 on our Part D plans, except for 1 of DHs. That one is tier 3 and over $100 for 90 days. So, for that one we use GoodRx or RxSaver and it’s been $45-$60 at a local drug store.

Last time I searched GoodRx a new coupon came up for Meijer, a grocery store not too far away. Meijer’s price was $16.71! When I picked it up the clerk told me they don’t need the coupon. Their system will automatically find the lowest price.

If you have Meijer in your area, it’s a good pharmacy service.

[harllee]

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.

[Qs Laptop]

Quote:

Originally Posted by youbet For some drugs, there just doesn't seem to be a solution or any relief in sight. I take Xarelto, an anti-coagulant, because I have AFIB. No generic available. People on Medicare don't qualify for the manufacturer discount program. Good RX and similar don't help in any meaningful way. I'm unaware of anyplace outside of the USA to purchase Xarelto. I purchase the best Part D plan for Xarelto I can find every year but still pay $500+ for 90 pills during the deductible stage and almost that much once I'm in the "doughnut hole." It seems like "grin and bear it" is the only current way to handle it. I'm just glad I can afford it.

Another Afibber on Xarelto here. I pay $10 a month for Xarelto. Yes, ten dollars.

You need to check out the Janssen CarePath Savings program. Google it. My wife heard about it several years ago and it has literally saved us thousands of dollars. They have certain criteria for getting on the program, one of them is long term use of Xarelto (that's us.) I don't recall if another criteria is income or not.

They send you a membership card that you present to the pharmacist and that gets you the discount. A couple times over the years the pharmacy has tried to charge me the "normal" price for it whereupon I give them the Janssen CarePath 800#, my membership ID#, and in 5 minutes I'm back to $10 a month.

I don't know if Medicare makes a person ineligible for the discount program. I will start Medicare in 6 months.

[aja8888]

Quote:

Originally Posted by Qs Laptop Another Afibber on Xarelto here. I pay $10 a month for Xarelto. Yes, ten dollars. You need to check out the Janssen CarePath Savings program. Google it. My wife heard about it several years ago and it has literally saved us thousands of dollars. They have certain criteria for getting on the program, one of them is long term use of Xarelto (that's us.) I don't recall if another criteria is income or not. They send you a membership card that you present to the pharmacist and that gets you the discount. A couple times over the years the pharmacy has tried to charge me the "normal" price for it whereupon I give them the Janssen CarePath 800#, my membership ID#, and in 5 minutes I'm back to $10 a month. I don't know if Medicare makes a person ineligible for the discount program. I will start Medicare in 6 months.

My wife was on Forteo for bone density problems....$1000+ per month and that's with Plan D (Medicare). We did not qualify for the manufacturer's discount program as it was income based and even though we live mostly on SS, we couldn't qualify. Some of these manufacturer's "help" programs are challenging.

Maybe youbet will qualify for the Janssen program...He should give it a try.