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GoodRX and Part D
Old 08-09-2018, 05:52 PM   #1
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GoodRX and Part D

After seeing all the great values from GoodRX folks here mentioning, I thought I would give it a try.
DW has an allergy eye drop prescription that cost $38 at Costco the first time she gets it. Doc had said $10 but certainly not with our Aetna plan.

I found a GoodRX Costco coupon for $26 and when we refilled the prescription today was told by Costco, they could not accept the GoodRx because we already had insurance. I said I did not want to use the insurance but was told since we had insurance on file, it was not permitted.
I am not sure if this policy is unique to Aetna and Costco or not. But if not, it is seems you have to price your drugs before choosing a supplier and then picking one who does not know if you have insurance. The pharmacy tech implied that might not be possible as if there a central database that pharmacies used.
Anyone else have this experience?
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Old 08-09-2018, 05:56 PM   #2
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Nope, I told my pharmacy to ignore my insurance and have used ScriptSave WellRx without any problem.
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Old 08-09-2018, 06:07 PM   #3
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Remember if you use GoodRX or any similar program it will not count against your deductible. I decided that even though Good RX saved me some money on the front end it using it cost me much more in the long run because the prescriptions purchased with Good RX did not count against my deductible.
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Old 08-09-2018, 06:35 PM   #4
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While I love Costco, I don't love their pharmacy. Due to the ignorance of one of the staff, I ended up paying well north of $100 for a cataract script that should have cost only $25. Due to immediate need of the med, I didn't have time to do the research and had no choice but to pay the higher amount.

I have also opted to pay retail, bypassing insurance. What they are telling you makes no sense.
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Old 08-09-2018, 10:43 PM   #5
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Could you take the Good Rx coupon to another pharmacy that accepts the coupon and have them transfer the prescription from Costco?
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Old 08-10-2018, 07:29 AM   #6
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Quote:
Originally Posted by nwsteve View Post
After seeing all the great values from GoodRX folks here mentioning, I thought I would give it a try.
DW has an allergy eye drop prescription that cost $38 at Costco the first time she gets it. Doc had said $10 but certainly not with our Aetna plan.

I found a GoodRX Costco coupon for $26 and when we refilled the prescription today was told by Costco, they could not accept the GoodRx because we already had insurance. I said I did not want to use the insurance but was told since we had insurance on file, it was not permitted.
I am not sure if this policy is unique to Aetna and Costco or not. But if not, it is seems you have to price your drugs before choosing a supplier and then picking one who does not know if you have insurance. The pharmacy tech implied that might not be possible as if there a central database that pharmacies used.
Anyone else have this experience?
I think maybe the tech was not understanding what you wanted to do. It's true that you can't use the GoodRX in conjunction with the insurance but as a standalone discount prescription card I use it for one of my prescriptions. If you can't get them to budge then you have to decide if it's worth it to you to go elsewhere for this particular med.

If I had significant medical expenses and wanted to have the expense count towards my deductible then I would go through my insurance even if it cost more.
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Old 08-10-2018, 10:38 AM   #7
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I think maybe the tech was not understanding what you wanted to do. It's true that you can't use the GoodRX in conjunction with the insurance but as a standalone discount prescription card I use it for one of my prescriptions. If you can't get them to budge then you have to decide if it's worth it to you to go elsewhere for this particular med.
.
No, she completely understood as she cancelled the original transaction and went to a "higher authority" who apparently told her if customer has any insurance do not accept the GoodRX coupon.
I am going to ping Costco corp in a bit to see if this is really a corporate policy.
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Old 08-10-2018, 11:25 AM   #8
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Originally Posted by nwsteve View Post
No, she completely understood as she cancelled the original transaction and went to a "higher authority" who apparently told her if customer has any insurance do not accept the GoodRX coupon.
I am going to ping Costco corp in a bit to see if this is really a corporate policy.
Must be. According to GoodRx you can use one or the other. But not combined as mentioned.

If you have insurance or Medicare and would like to use GoodRx Gold for a prescription, you will need to ask your pharmacist to process your prescription using your GoodRx Gold card instead of your insurance.

https://support.goodrx.com/hc/en-us/...e-or-Medicare-
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Old 08-10-2018, 11:54 AM   #9
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Must be. According to GoodRx you can use one or the other. But not combined as mentioned.

If you have insurance or Medicare and would like to use GoodRx Gold for a prescription, you will need to ask your pharmacist to process your prescription using your GoodRx Gold card instead of your insurance.

https://support.goodrx.com/hc/en-us/...e-or-Medicare-
Problem is that apparently Costco's policy is that once you use insurance for a prescription, you must ALWAYS use your insurance. I did advise the clerk, from get-go we were not using the insurance. That is when she went to "higher authority" and was told if customer has insurance they must use for the transaction.
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Old 08-10-2018, 12:07 PM   #10
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Interesting- I didn't know there is now a "Goodrx gold" option, for $72/year. It's supposed to save money over the free Goodrx, but I checked a couple of meds and found the prices were actually higher for the "gold" option.

I found a competitor to Goodrx, that might be worth checking also-
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GoodRX and Plan D
Old 08-10-2018, 08:10 PM   #11
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GoodRX and Plan D

Iíve been using GoodRx for a long time and itís been very good. Also tried a few drug searches on this one and for at least one of DHs drugs they had a better price.

Retail Me Not RX Saver https://www.lowestmed.com/

Retail Me Not bought LowestMed. Hereís the faq about how it works and how to use it https://www.lowestmed.com/faq/
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Old 08-10-2018, 08:25 PM   #12
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My wife uses GoodRx and it works well for her but she's never used it at Costco as best I can recall. She does use it at another large discount store with pharmacy and they are willing to use whatever method gets her the best price (insurance or no insurance/coupon).

I think that Costco's stance is technically 'correct' for most if not all insurers. We've run into it at other pharmacies. We find that finagling a little and/or asking nicely usually gets us what we want. The downside to using the coupon for a person who has insurance is that the purchase isn't applied toward their deductible. But the chances of that happening for my wife (because her health is good) is extremely unlikely due to her large (ACA) deductible.
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GoodRX and Plan D
Old 08-10-2018, 08:30 PM   #13
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GoodRX and Plan D

Quote:
Originally Posted by harllee View Post
Remember if you use GoodRX or any similar program it will not count against your deductible. I decided that even though Good RX saved me some money on the front end it using it cost me much more in the long run because the prescriptions purchased with Good RX did not count against my deductible.


In 2014 I used GoodRx for most of our prescriptions and because I didnít use the insurance they didnít count toward the deductible. Then in July I had a major surgery that I knew would use up our deductible and max out of pocket.

Before the surgery I submitted the receipts for all of those rxs, that we already paid for, to our insurance company. They processed them and applied the amounts to our deductible. Their amounts on a few were smaller than I had paid but it was very close. It was worth it to download the form, fill it out and make some copies in order to have those costs applied to the deductible.
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Old 08-11-2018, 01:35 AM   #14
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Originally Posted by nwsteve View Post
No, she completely understood as she cancelled the original transaction and went to a "higher authority" who apparently told her if customer has any insurance do not accept the GoodRX coupon.
I am going to ping Costco corp in a bit to see if this is really a corporate policy.
I can tell you on good authority that it is not a corporate policy at Costco to say you cannot run your scripts through good rx vs your medicare part D.

Having said that, I can tell you that Pharmacies in general are getting the crap beat out of them by the insurers especially with medicare part D and the DIR fees that are taken back from said pharmacies and whether or not they are a preferred 'network' for the medicare members. If you are Walgreens/CVS/Walmart you are untouchable because you have thousands of stores all over the nation and you cannot help but be in the network due to size and convienence. But everyone else is on the outside looking in.

Costco is really small potatoes in the pharmacy game because they 'only' have 500 or less pharmacies and they don't have a presence in every state. Hard to be a preferred pharmacy for Aetna, AARP, United Health Care, etc when you can't service a % of their clientele.

The pharmacy gets to be charged more in DIR fees when a they get a black mark because the patient is not being compliant on the big 3 chronic illness medications. That is diabetes, blood pressure and cholesterol. The way they track this is through your insurance, when you get a prescription for your lipitor and it is a 30 day supply and you get it every 28-34 days then it looks like your in compliance and that is good.

If you get your rx filled in Janurary and run it through your insurance then come February you say, it looks like I can get 3 months of my lipitor on Good Rx for $3 less than if I were to buy my lipitor every month, I am going to do that. Since you didn't run it on insurance, your insurer thinks that you are not compliant with your cholesterol med because you got 30 days in January and you haven't gotten it again (according to their records). Black mark for the pharmacy and more DIR fees paid by them. This is one reason you are seeing more 'auto fill' options from pharmacies and maybe more calls from them to remind you to fill and/or pickup your rx's.

Costco is jumping through hoops and therefore making their pharmacists jump through hoops to encourage you to get your drugs through your Medicare part D plan to save $$ in fees, well over $10m for the 2018 year.

2nd thing is that goodrx and other discount cards charge the pharmacy $8 to 'process' the card. Which they (pharmacies) don't get any payment in turn - they just get to charge less.

It is always good to see what the insurance price is before pulling out the GoodRx card as sometimes it is the same, less expensive or a few bucks higher. IMHO it isn't worth the 'not being applied to deductible' issue keeping track of which rx's to process on good rx like script a, c and g but run b, d, and e on my insurance because it is a better price - for a few bucks.
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Old 08-11-2018, 07:17 AM   #15
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The pharmacy gets to be charged more in DIR fees when a they get a black mark because the patient is not being compliant on the big 3 chronic illness medications. <snip>

If you get your rx filled in Janurary and run it through your insurance then come February you say, it looks like I can get 3 months of my lipitor on Good Rx for $3 less than if I were to buy my lipitor every month, I am going to do that. Since you didn't run it on insurance, your insurer thinks that you are not compliant with your cholesterol med because you got 30 days in January and you haven't gotten it again (according to their records). Black mark for the pharmacy and more DIR fees paid by them. This is one reason you are seeing more 'auto fill' options from pharmacies and maybe more calls from them to remind you to fill and/or pickup your rx's.

Costco is jumping through hoops and therefore making their pharmacists jump through hoops to encourage you to get your drugs through your Medicare part D plan to save $$ in fees, well over $10m for the 2018 year.

<snip>
Complicated stuff but very useful to know. Thanks!
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Old 08-11-2018, 09:26 AM   #16
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I can tell you on good authority that it is not a corporate policy at Costco to say you cannot run your scripts through good rx vs your medicare part D.

Having said that, I can tell you that Pharmacies in general are getting the crap beat out of them by the insurers especially with medicare part D and the DIR fees that are taken back from said pharmacies and whether or not they are a preferred 'network' for the medicare members. If you are Walgreens/CVS/Walmart you are untouchable because you have thousands of stores all over the nation and you cannot help but be in the network due to size and convienence. But everyone else is on the outside looking in.

Costco is really small potatoes in the pharmacy game because they 'only' have 500 or less pharmacies and they don't have a presence in every state. Hard to be a preferred pharmacy for Aetna, AARP, United Health Care, etc when you can't service a % of their clientele.

The pharmacy gets to be charged more in DIR fees when a they get a black mark because the patient is not being compliant on the big 3 chronic illness medications. That is diabetes, blood pressure and cholesterol. The way they track this is through your insurance, when you get a prescription for your lipitor and it is a 30 day supply and you get it every 28-34 days then it looks like your in compliance and that is good.

If you get your rx filled in Janurary and run it through your insurance then come February you say, it looks like I can get 3 months of my lipitor on Good Rx for $3 less than if I were to buy my lipitor every month, I am going to do that. Since you didn't run it on insurance, your insurer thinks that you are not compliant with your cholesterol med because you got 30 days in January and you haven't gotten it again (according to their records). Black mark for the pharmacy and more DIR fees paid by them. This is one reason you are seeing more 'auto fill' options from pharmacies and maybe more calls from them to remind you to fill and/or pickup your rx's.

Costco is jumping through hoops and therefore making their pharmacists jump through hoops to encourage you to get your drugs through your Medicare part D plan to save $$ in fees, well over $10m for the 2018 year.

2nd thing is that goodrx and other discount cards charge the pharmacy $8 to 'process' the card. Which they (pharmacies) don't get any payment in turn - they just get to charge less.
Thank you for the very interesting explanation. I had no idea that compliance was being tracked like that. Even though DH and I are very compliant on our prescriptions, I bet it doesn't look that way based on our insurance refill records.

Quote:
It is always good to see what the insurance price is before pulling out the GoodRx card as sometimes it is the same, less expensive or a few bucks higher. IMHO it isn't worth the 'not being applied to deductible' issue keeping track of which rx's to process on good rx like script a, c and g but run b, d, and e on my insurance because it is a better price - for a few bucks.
We have an ACA Bronze HDHP plan. DH takes nadolol 20mg. Through our insurance's mail order pharmacy, Caremark, it's $151.35 for 90 days. Instead we have been using GoodRX at Walmart for $85.06. Now on RetailMeNot Rx Saver it's $29.78 at Rite Aid. That's a substantial difference and I will jump through hoops to save $120 every 90 days.

I try to know ahead of time what our prescriptions will cost through our insurance mail order vs local pharmacy using GoodRx or RX Saver. If I'm going to use the insurance mail order service the Dr. sends it in electronically right away. If I'm not using our insurance I ask for a printed prescription that I'll use locally with the discount coupon.

At my last appt I asked for a printed one and my Dr. said that was fine but that she is limited to how many printed ones she is allowed to issue. I thought that was odd. I assume it's just her offices policy. Maybe it has to do with tracking compliance like you described.

Thinking back to last year we had an ACA Silver plan. All of our generic prescriptions were paid at 100%, so "free" to us, although our monthly premium cost was higher, it was worth it. That plan changed for 2018 to having an RX copay and just wasn't worth it for the cost.
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Old 08-11-2018, 10:14 AM   #17
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Iíve been using GoodRx for a long time and itís been very good. Also tried a few drug searches on this one and for at least one of DHs drugs they had a better price.

Retail Me Not RX Saver https://www.lowestmed.com/

Retail Me Not bought LowestMed. Hereís the faq about how it works and how to use it https://www.lowestmed.com/faq/
Wow! I have to check at the pharmacy but for one script my insurance won't cover this thing is $175 cheaper($110 vs $285) than the goodrx price!

Thank you for sharing!
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Old 08-11-2018, 10:33 AM   #18
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I can tell you on good authority that it is not a corporate policy at Costco to say you cannot run your scripts through good rx vs your medicare part D.

Having said that, I can tell you that Pharmacies in general are getting the crap beat out of them by the insurers especially with medicare part D and the DIR fees that are taken back from said pharmacies and whether or not they are a preferred 'network' for the medicare members. If you are Walgreens/CVS/Walmart you are untouchable because you have thousands of stores all over the nation and you cannot help but be in the network due to size and convienence. But everyone else is on the outside looking in.

Costco is really small potatoes in the pharmacy game because they 'only' have 500 or less pharmacies and they don't have a presence in every state. Hard to be a preferred pharmacy for Aetna, AARP, United Health Care, etc when you can't service a % of their clientele.

The pharmacy gets to be charged more in DIR fees when a they get a black mark because the patient is not being compliant on the big 3 chronic illness medications. That is diabetes, blood pressure and cholesterol. The way they track this is through your insurance, when you get a prescription for your lipitor and it is a 30 day supply and you get it every 28-34 days then it looks like your in compliance and that is good.

If you get your rx filled in Janurary and run it through your insurance then come February you say, it looks like I can get 3 months of my lipitor on Good Rx for $3 less than if I were to buy my lipitor every month, I am going to do that. Since you didn't run it on insurance, your insurer thinks that you are not compliant with your cholesterol med because you got 30 days in January and you haven't gotten it again (according to their records). Black mark for the pharmacy and more DIR fees paid by them. This is one reason you are seeing more 'auto fill' options from pharmacies and maybe more calls from them to remind you to fill and/or pickup your rx's.

Costco is jumping through hoops and therefore making their pharmacists jump through hoops to encourage you to get your drugs through your Medicare part D plan to save $$ in fees, well over $10m for the 2018 year.

2nd thing is that goodrx and other discount cards charge the pharmacy $8 to 'process' the card. Which they (pharmacies) don't get any payment in turn - they just get to charge less.

It is always good to see what the insurance price is before pulling out the GoodRx card as sometimes it is the same, less expensive or a few bucks higher. IMHO it isn't worth the 'not being applied to deductible' issue keeping track of which rx's to process on good rx like script a, c and g but run b, d, and e on my insurance because it is a better price - for a few bucks.
Ronnieboy thanks for the overview of back office action for the phamarcy business.
I did contact Costco Corp (actually it was their central mail order function) but that is where CS sent me. I had nice chat with a senior tech who told me that it has been a long standing policy by Medicare to disallow discount/coupons for anyone who has Plan D. Her explanation was not nearly as complete as yours but she did say Costco had just began enforcing it in their system.
We are fortunate to not need much in the way of prescriptions so covering the deductible is always problematic. I think we may just go for the paper script from the get go.
Thanks again
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Old 08-11-2018, 11:11 AM   #19
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Thank you for the very interesting explanation. I had no idea that compliance was being tracked like that.
+1
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Old 08-11-2018, 02:53 PM   #20
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Ronnieboy--forgot to ask you what are "DIR fees"?
thx
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