GoodRX and Part D

[txtig]

I just refilled three prescriptions using GoodRX coupons, rather than using my Part D drug plan. Cost for a 90 day supply for these three drugs was $117. Cost under my Part D Plan would have been around $320. A nice $200 savings in my pocket. It’s hard for me to understand why my Part D plan has such crappy coverage.

[Another Reader]

Quote:

Originally Posted by txtig I just refilled three prescriptions using GoodRX coupons, rather than using my Part D drug plan. Cost for a 90 day supply for these three drugs was $117. Cost under my Part D Plan would have been around $320. A nice $200 savings in my pocket. It’s hard for me to understand why my Part D plan has such crappy coverage.

Which state and which company, if you don't mind sharing?

I assume you went to a different pharmacy and told them you did not have coverage. To the insurance company, you will look like an uncooperative patient, not taking your prescribed drugs. That could have repercussions.

[Gotadimple]

Quote:

Originally Posted by txtig I just refilled three prescriptions using GoodRX coupons, rather than using my Part D drug plan. Cost for a 90 day supply for these three drugs was $117. Cost under my Part D Plan would have been around $320. A nice $200 savings in my pocket. It’s hard for me to understand why my Part D plan has such crappy coverage.

It's the payment schedule your plan negotiated with the pharmacy benefit manager. Generally when drug prices are that high, you have a low $ premium, OR, the drug store is not on the preferred list for the Part D plan, and you're paying for the convenience of using that particular store.

All the druggist gets is a dispensing fee (about $2), the PBM contracts with a smaller number of chains. The PBM orders the drug and supplies it to the chains. By restricting the number of chains they supply, they get volume discounts from the wholesaler who delivers to the chain for dispensing.

I hope that's clear.

The cost of drugs at GoodRx.com are what the local drug chains choose to charge those without insurance. It's cheaper (no electronic connection to the plan to check coverage, no contracting, etc.) because they fill more prescriptions and keep their admin costs low. Higher volume leads to lower wholesale cost of the drugs they buy from the manufacturers because of the volume.

So it is good to compare GoodRx to Part D plans. They are both doing the same thing, trying to get the lowest price on common drugs by increasing the volumes in order to negotiate prices.

[ivinsfan]

Quote:

Originally Posted by Another Reader Which state and which company, if you don't mind sharing? I assume you went to a different pharmacy and told them you did not have coverage. To the insurance company, you will look like an uncooperative patient, not taking your prescribed drugs. That could have repercussions.

Repercussions like what...obviously you don't have to use your insurance to pay for meds

[Another Reader]

Someone recently posted here about how the "system" works. I can't find it right now unfortunately. There are multiple players, pharmacies, PBM's and insurance companies. Pharmacies are penalized if you don't purchase the prescribed medicine at the refill time. The assumption is that patient is not taking the medicine. The PBM and the insurance company don't know you used Good RX somewhere else for a better price. Have you noticed recently that your doctor asks which pharmacy you use and sends the prescription directly to them? Try to get a written scrip from a doctor. A lot are not allowed by their employer to give it to you. If the pharmacy has your prescription and your insurance information, often they won't sell you the prescription except through insurance. They lose money if you don't buy it through the insurance/PBM.

[travelover]

Quote:

Originally Posted by Another Reader ......... Try to get a written scrip from a doctor. A lot are not allowed by their employer to give it to you. If the pharmacy has your prescription and your insurance information, often they won't sell you the prescription except through insurance. They lose money if you don't buy it through the insurance/PBM.

This is true, but I'm fairly certain that you can have the prescription transferred to another pharmacy. It is an inconvenience, though.

[ivinsfan]

Quote:

Originally Posted by Another Reader Someone recently posted here about how the "system" works. I can't find it right now unfortunately. There are multiple players, pharmacies, PBM's and insurance companies. Pharmacies are penalized if you don't purchase the prescribed medicine at the refill time. The assumption is that patient is not taking the medicine. The PBM and the insurance company don't know you used Good RX somewhere else for a better price. Have you noticed recently that your doctor asks which pharmacy you use and sends the prescription directly to them? Try to get a written scrip from a doctor. A lot are not allowed by their employer to give it to you. If the pharmacy has your prescription and your insurance information, often they won't sell you the prescription except through insurance. They lose money if you don't buy it through the insurance/PBM.

that makes no sense,what control does the pharmacy have over you taking your meds.my national pharmacy chain has no problems with using either good R X
or insurance whichever is cheapest.

[txtig]

Quote:

Originally Posted by Another Reader Which state and which company, if you don't mind sharing? I assume you went to a different pharmacy and told them you did not have coverage. To the insurance company, you will look like an uncooperative patient, not taking your prescribed drugs. That could have repercussions.

I’m in Texas and my Part D provider is Aetna. I have been ordering 90 day supplies of my meds directly from Aetna using their mail-order plan. I thought that would be most cost effective. But, the cost of my meds through Aetna is about triple of what I was paying through my former private insurance plan (I just went on Medicare this year).

I checked the price of my meds on the GoodRX site and noticed the big difference. I asked my doctor’s office to send a new prescription to the drug store I wanted to use. I had never used this store before, so they did not have any insurance info on me. When I picked up the meds, the pharmacist asked me for my insurance info. I simply handed her the GoodRX coupons. She them processed the payments to with no further questions.

I don’t think that my Part D plan is a low premium, bare bones plan. I used an online tool to select them based on the meds I’m currently taking. I still have a hard time understanding why a plan that I have to pay for is much more expensive than using free coupons available on the internet. It almost seems like the insurance company is making a profit by selling me these meds rather than defraying my costs.

[audreyh1]

Quote:

Originally Posted by txtig I don’t think that my Part D plan is a low premium, bare bones plan. I used an online tool to select them based on the meds I’m currently taking. I still have a hard time understanding why a plan that I have to pay for is much more expensive than using free coupons available on the internet. It almost seems like the insurance company is making a profit by selling me these meds rather than defraying my costs.

There is definitely some funny business going on.

It may have something to do with pharmacy benefit managers and rebates.
https://www.pbs.org/newshour/health/...-for-a-40-drug

[audreyh1]

Quote:

Originally Posted by ivinsfan that makes no sense,what control does the pharmacy have over you taking your meds.my national pharmacy chain has no problems with using either good R X or insurance whichever is cheapest.

I agree it makes no sense, but apparently it is true. Read post #14 in this thread.

[audreyh1]

In terms of pharmacist gag-rules about cash prices and claw-backs. Apparently that has been outlawed in a few states. Well - looks like one or the other in most cases.

Quote:

In September[2017], Texas became one of 11 states to outlaw clawbacks or gag clauses for pharmacists. The new Texas law says that health insurance plans can't require members to pay more for a drug than they would if they paid without insurance.

https://www.nbcnews.com/health/healt...armacy-n811171

Quote:

Some of the pharmacists NBC News spoke to say their contracts with pharmacy benefit managers prevent them from volunteering information about drug prices, but if a customer specifically asks for a lower price option, most say they can provide it. "When a patient comes into a pharmacy to get a prescription filled," Hoffart advised, "ask the pharmacist, 'Is that the best price for that medication? Is this the least expensive medication that's out there? What other options do I have other than my insurance that may reduce my costs?'"

[Another Reader]

Quote:

Originally Posted by audreyh1 I agree it makes no sense, but apparently it is true. Read post #14 in this thread.

Yes, that's the post I was thinking of.

I filled a prescription for the capsule form of Clindamycin yesterday for my cat for $10.91 using a GoodRX coupon. The computer would not take the prescription at first because it came up "invalid provider." Took a phone call to the central office to resolve that. Cash price was $85.00. My vet's office has a display with GoodRX cards now.

[ivinsfan]

Quote:

Originally Posted by audreyh1 I agree it makes no sense, but apparently it is true. Read post #14 in this thread.

I did go read it and it sounds like the independent pharmacy dispensaries are impacted by this..We use Walgreens and they dont bat an eye when switching between insurance and Good R X...what a screwed up system..my DH doesn't have a Part D supplement since he has VA coverage so the insurance is run thru his regular Medicare supplement..it cost less then the VA and when we travel we have more options for getting refills .When he turned 65 we were just going to use the VA until Walgreens said we could get a reduced price with Medicare supplement insurance

[Another Reader]

Quote:

Originally Posted by ivinsfan I did go read it and it sounds like the independent pharmacy dispensaries are impacted by this..We use Walgreens and they dont bat an eye when switching between insurance and Good R X...what a screwed up system..my DH doesn't have a Part D supplement since he has VA coverage so the insurance is run thru his regular Medicare supplement..it cost less then the VA and when we travel we have more options for getting refills .When he turned 65 we were just going to use the VA until Walgreens said we could get a reduced price with Medicare supplement insurance

Based on CVS' behavior when you don't pick up a refill timely, I think they are impacted. I finally had to block the number as I was getting 5 to 10 robo-calls a day reminding me to pick up refills we did not order. I went to the website to get off the calling list several times with no effect. You cannot get through the pick up process at the pharmacy without agreeing to being called. I put in all zeros as the phone number and agreed. CVS is probably calling invalid numbers all over the country thousands of times every day because of this nonsense.

[tuckeverlasting]

I did not buy any Part D insurance and fill most of my prescriptions through Costco mail order pharmacy. At my last refill I got a call from Costco asking me to provide my Medicare or SS number so they could "verify that I did not have Part D". I was considerably taken aback (and slightly offended) by this, and refused to provide the information, stating I found it intrusive and unnecessary. That seemed to settle the matter and everything proceeded as usual with my prescriptions being filled.

The pharmacy rep went on to say they "encourage" people to use their Part D if they have it, which I took to mean they possibly "force" you to use it. How is it any of their business if I choose to use any insurance coverage or not? I tried to do a Google search on the topic but could not find anything. I don't like the whole tightening, Big Brother aspect of this, and the evident pressuring by the insurers.

I also use a couple of other pharmacies if the price is better and sometimes use discount programs like GoodRX, or the chain's own discounts. And I buy one very expensive med from Canada.

Also, the Costco rep said they would take GoodRX, but first I would have to let them verify I do not have Part D.

[ivinsfan]

So much secrecy in the RX world and it seems to be getting pervasive....I just turned 65 and bought the cheapest Plan D possible just to avoid the penalty if I ever go on an expensive drug..hope I didn't make a mistake..

[Another Reader]

I'm beginning to think it might be cheaper not to buy Part D and just pay the penalty when my prescriptions become more costly. I'm pretty good at comparison shopping and GoodRX plus cash might be the better option for now.

[audreyh1]

The penalty increases for each month you do not have it: https://www.medicare.gov/drug-covera...llment-penalty

And it’s permanent.

[Dawg52]

Quote:

Originally Posted by Another Reader I'm beginning to think it might be cheaper not to buy Part D and just pay the penalty when my prescriptions become more costly. I'm pretty good at comparison shopping and GoodRX plus cash might be the better option for now.

My mother didn't have it. Lived to be 95 and her meds were not expensive paying by cash. In my case, the only drug I take (for now) is a generic statin. One company I'm looking at EnvisionRxPlus. Cost is only $12.60/mo with a $300 annual ded for higher tier drugs. For mail order delivery of my particular drug the cost is -0- and just $8 annually using a local CVS. Anyone use this company and know of any reason not to go with them?

[Another Reader]

Quote:

Originally Posted by audreyh1 The penalty increases for each month you do not have it: https://www.medicare.gov/drug-covera...llment-penalty And it’s permanent.

If I go a number of years with minimal prescriptions, the 1% per month penalty might be a good trade. I'm trying to get information on the plans from calling around. Don't trust OneExchange from the conversations so far, and they will only have a serious conversation during your "enrollment call." Ummm...no.