Prescription Drugs

[imoldernu]

Thankfully, we have Medicare "D", the prescription drug plan.
See the copy below my latest prescription, picked up yesterday.
As I was picking it up, I asked the clerk if there were many drugs that had costs in this range. She said that there were many (busy pharmacy) and that there were people who were paying over $1,000/mo., and, who were paying out of pocket.
That's $1,000.00 for a single drug, 30 day supply.

I was shocked when my "Colchicine" went from $4.00, to $220.00 for a 30 day supply, and then, when my EpiPen went from $26.00 to $600.00. (current full drug costs for both of these.)

So... a year's supply for my Xarelto would cost $5200.00 (no generic). The $432.00 that I'm paying is bad enough.

While I'd love to say that I don't take drugs, I'm not ready for the alternative.

[/IMG]

Wondering what others think about this.

 

[bingybear]

I have friends who blow by their $6k deductible in the first few months and are in their 50's with employer coverage.
my wife just had $50 after insurance (ACA) for a script... $100 before insurance. One time deal.

My MIL has some for parkenson's that would easily run $2500+ per month without insurance (individual med...not the lot).

My 3 meds are less than $200 for the year (maybe $150 with insurance) They are common generics ... so fairly cheap anyway.

It really depends the specific scripts you have... and hope you have good insurance.

 

[meierlde]

To add on you do have to watch your physician like a hawk and check to see if they are prescribing generic versions when available. (The web helps here and allows one to enter the name and see if a generic is available) This happened to me when the physician started out on a branded version of metformin, I checked and got it changed to the generic version for significant savings. Second insist because generics have been used by a larger population, and therefore the chance of a bad reaction is lower (witness all the lawyer adds on tv), that the physician use generics unless there is no other option.

 

[GrayHare]

How much do I spend on prescriptions? My pharmacy sends me Christmas cards. No, really, they do.

 

[imoldernu]

To add on you do have to watch your physician like a hawk and check to see if they are prescribing generic versions when available. (The web helps here and allows one to enter the name and see if a generic is available) This happened to me when the physician started out on a branded version of metformin, I checked and got it changed to the generic version for significant savings. Second insist because generics have been used by a larger population, and therefore the chance of a bad reaction is lower (witness all the lawyer adds on tv), that the physician use generics unless there is no other option.

I agree about doing personal research, and not to accept your doctor's thinking as final. And yes... for the most part, I would agree that generics are most often a suitable and less expensive option.
However...
Depending on the medical problem, and the drug, the first site that pops up on google is not always the final or even the best choice. In my own case, the normal websites like WebMD or even the NIH gave a broad overview that suggested that there were alternate and generic drugs that were available for the medical issue. Fortunately my doctor is well schooled in the deeper analyses that medical abstracts provide.
In this case, the issue was the level of risk. Current risk with the recommended generic (not equivalent) is less than 4%... That said, preliminary studies of the relatively new drug, indicates that the longer term risk may be less than 2.5%... The question then becomes, is it worth the cost? A personal decision, but at my own age, the money has to be measured against the chances of staying alive.

In any case, my own thinking is "Trust", but "Verify". Particularly in case involving heart specialists, the risk percent is an accepted number to be used in making recommendations. Asking for this "number" should be a part of any visit IMO.

 

[NatureBoy]

Also, one has to be circumspect about "Cash" or "Retail" prices listed on receipt paperwork. I know my 90-day supply of a generic statin (for which I pay $9.50 in a Medicare Part D PDP) has a "Retail" price of $524+ listed on the receipt. However, a quick look online showed the typical cash price of about $20 at multiple sources. I know this may not apply to many brand drugs, but one has to wonder if the "Cash" price listed for generics is sometimes actually the price for equivalent brand drugs. Caveat Emptor!

 

[sengsational]

Generally I find that having your doctor not check the "allow generics" box is the least of most peoples' problems! That is SO easy to resolve: you get home and type the drug name into goodrx.com, it will tell you there's a generic, you call the doctors office and they change it. Done.

The problem is the shameful pricing in the USA. The pricing is insane. Even established generics pricing has gone mad. And it's because "too many people have insurance that's too good". The drug makers just keep raising prices and they see only a tiny bit of elasticity now. "Might as well multiply the price by 10, nobody seems to notice".

That, and also that we're not really supposed to import our own prescription drugs. Let's make criminals out of everyone who can't afford the insane prices of the USA protected prescription drug market.

Why so little elasticity? Well, because the prices are already so high, many people are already not buying. Of those people that are still buying, they're people with "good" insurance. For instance the OP. Or even the guy that burns through the max out of pocket in the first month and everything becomes "free".

If the drug you're prescribed has a generic somewhere else in the world, but no generic in the USA, you can usually buy it online and have it shipped internationally. In this category, you can routinely find drugs that sell overseas for 5% or 10% of the USA price!

Or even if there's no generic anywhere in the world, you can often get a drug made in the same factory for 25% of the USA price.

These are kinds of examples are more common than not.

And those drug makers in other countries? They're making a fair profit.

Why are the consumers in the USA the patsy in the world drug game? It just burns me every time this comes up.

 

[sengsational]

Also, one has to be circumspect about "Cash" or "Retail" prices listed on receipt paperwork.

For the OP, the cash price is accurate. And GoodRx only reduced the price by 15%. It's a newish drug, one manufacturer. But people in Canada, the UK, and elsewhere can walk-in to THEIR pharmacy and pay 25% of what we pay, and walk out with the same medication, made in the same factory as what we are being sold.

 

[John Galt III]

Was given a tube of wound healing cream from the hospital, for the gf. To get another 5 ounce tube of the cream would be $94 WITH insurance. $220 list price. But luckily I was able to get the dr to recommend a different medication that does about the same thing. Not a generic, just a different med, which is way cheaper. (Free, in fact, since I already have a tube of it!)

 

[Bamaman]

I'm Type II diabetic, but on insulin by choice as blood sugar levels are much more stable than when taking pills.

A 3 month supply of insulin vials is $1770 at CVS, and my share would be 20% after my Medicare supplement. That's $255 per tiny vial of the stuff. Needless to say, the price has shot through the roof--getting ready for the many baby boomers are or will be diabetic.

Because I'm on an insulin pump, Medicare Part B covers my insulin--with my co-pay of $82. I'm saving my regular insurance company a bunch, and CVS is getting paid just a pittance--not their regular excessive profit.

If I was poor, insulin would be furnished by someone. The medical companies or government agencies won't allow any insulin dependent diabetic to go without it if they don't have the money to purchase it.

 

[travelover]

Why are the consumers in the USA the patsy in the world drug game? It just burns me every time this comes up.

If you don't like it, buy your own congressman.

 

[meierlde]

Also, one has to be circumspect about "Cash" or "Retail" prices listed on receipt paperwork. I know my 90-day supply of a generic statin (for which I pay $9.50 in a Medicare Part D PDP) has a "Retail" price of $524+ listed on the receipt. However, a quick look online showed the typical cash price of about $20 at multiple sources. I know this may not apply to many brand drugs, but one has to wonder if the "Cash" price listed for generics is sometimes actually the price for equivalent brand drugs. Caveat Emptor!

Was the prescription subsititued for a generic. i.e did the physician use the brand name?

 

[Ally]

I am so blessed to be on my husband's Medicare advantage plan as he is a retired state employee. I take several expensive meds and since we've gone on this plan, I hardly pay anything. Most RXs are under $10 now. I can't imagine paying $1000.

 

[Ronnieboy]

Also, one has to be circumspect about "Cash" or "Retail" prices listed on receipt paperwork. I know my 90-day supply of a generic statin (for which I pay $9.50 in a Medicare Part D PDP) has a "Retail" price of $524+ listed on the receipt. However, a quick look online showed the typical cash price of about $20 at multiple sources. I know this may not apply to many brand drugs, but one has to wonder if the "Cash" price listed for generics is sometimes actually the price for equivalent brand drugs. Caveat Emptor!

+1

The 'cash' price is like you see on your EOB from your health insurance, your physician billed $200 for your office visit, but your member rate is $130. Basically a contracted price between the physician and your health insurance. Same goes for pharmacy.

You could price shop for #360 metformin 500mg at Costco for $15 or at Walgreens for $90 but when it gets run through your insurance and your copay is $20 you get it for $20 at Walgreens and $15 at Costco because (Costco's) their U and C (usual and customary) price is lower than your copay.

Does that mean your insurance paid more at Walgreens?

Yes, but not $70 more, they will have a member contract price of say $50 max for that rx so they paid $30 you paid $20. Guess how much they paid at Costco? $0 and you paid $15. If you want to save yourself money and your insurance go to the least expensive place.

And feel sorry for the poor slob who doesn't shop around or have insurance and gets bilked for the whole $90.

The Xarelto is another story as it is brand only and everywhere would be over the $36 copay, but Costco's cash price is $35 cheaper

 

[Ronnieboy]

Generally I find that having your doctor not check the "allow generics" box is the least of most peoples' problems! That is SO easy to resolve: you get home and type the drug name into goodrx.com, it will tell you there's a generic, you call the doctors office and they change it. Done.

The problem is the shameful pricing in the USA. The pricing is insane. Even established generics pricing has gone mad. And it's because "too many people have insurance that's too good". The drug makers just keep raising prices and they see only a tiny bit of elasticity now. "Might as well multiply the price by 10, nobody seems to notice".

That, and also that we're not really supposed to import our own prescription drugs. Let's make criminals out of everyone who can't afford the insane prices of the USA protected prescription drug market.

Why so little elasticity? Well, because the prices are already so high, many people are already not buying. Of those people that are still buying, they're people with "good" insurance. For instance the OP. Or even the guy that burns through the max out of pocket in the first month and everything becomes "free".

If the drug you're prescribed has a generic somewhere else in the world, but no generic in the USA, you can usually buy it online and have it shipped internationally. In this category, you can routinely find drugs that sell overseas for 5% or 10% of the USA price!

Or even if there's no generic anywhere in the world, you can often get a drug made in the same factory for 25% of the USA price.

These are kinds of examples are more common than not.

And those drug makers in other countries? They're making a fair profit.

Why are the consumers in the USA the patsy in the world drug game? It just burns me every time this comes up.

Welcome to the USA. One of the reasons why prices are so high here in the USA is because we are supplementing everyone else in the world. It is not cheap or easy to come up with new drugs that work and get them to market or for that matter to defend them against every lawsuit that will come up immediately after it goes to market and enters a much higher 'trial group' of patients. The mortality rate of .0001% with 400 patients seems not too bad, but when you get it to 100 million patients and 100 people die, time to get the lawyers involved and those daytime ads going 1-800-bad-drug.

Now that the US has developed the drug, other countries with price controls can sell it for much cheaper to their population, because the good ole peeps of the U S of A get to pay the high prices so the drug manufacturers and make *some* money, you can't expect them to do it for free. They're here to make money not friends....

These other countries also have a shorter patent period so the generic gets to come out sooner than the US another kick in the shorts to the people of 'merica.

As far as generic pricing in the US?? When there is a generic available, due to some nice legislation by our government a successful challenge to a patent by a generic company gives them a 6 month head start of making the generic. What to do when only the brand and once generic is on the market? Charge almost the same as the brand!! Take a look at Zetia and Ezetimibie (the recently approved generic of Zetia) it is only 10-15% cheaper. You'll see a siginificant price drop after 6 months.....

One of the biggest ways to help your drug costs...not only ask for the generic, but ask for an older drug that has a generic that will essentially do the same thing as the newfangled drug that just came out. Last but not least PRICE SHOP!! Just because your copay is $5 doesn't mean you should go to the closest WALGREENS/CVS/RITE AID call and find out what the cash prices are and save you and your insurance company money by going to the lease expensive place.

 

[travelover]

Welcome to the USA. One of the reasons why prices are so high here in the USA is because we are supplementing everyone else in the world............

Except is isn't true. The drug manufacturers, many international, have a very strong US lobby and make sure that laws favor their profitability.

The “most important factor” that drives prescription drug prices higher in the United States than anywhere else in the world is the existence of government-protected “monopoly” rights for drug manufacturers, researchers at Harvard Medical School report today.

Although drug manufacturers often cite research and development costs when defending high prescription prices, the connection isn’t exactly true, Kesselheim and his team found, citing several studies. Most of the time, scientific research that leads to new drugs is funded by the National Institutes of Health via federal grants. If not, it’s often funded by venture capital. For example, sofosbuvir, a drug that treats hepatitis C, was acquired by Gilead after the original research occurred in academic labs.

Why Prescription Drugs Are So Expensive | Money

 

[NatureBoy]

Was the prescription subsititued for a generic. i.e did the physician use the brand name?

No, it was specified as the generic name in the Rx. It crossed my mind that the pharmacy might be trying to impress me with what a great deal I was getting.

 

[AllDone]

In California the doctor doesn't have to specify generic or name brand. The consumer can make the choice ... except the insurance companies all pay the pharmacies a slightly higher filling fee for generics. Getting a name brand, in the very few cases where one is needed, requires a royal battle with the pharmacy. However it does result in a very high rate of generic use with a good savings for the insurance industry and possibly even some savings to the consumer.

I use one drug, an estrogen patch (that's an old, old medicine that pre-dates even me). The current cash price is $195/month although then pharmacy will discount to $165 for the uninsured. I buy a six month supply from Canada for $213.

 

[6miths]

Whatever the market will bear unless there are checks in place. Valeant Pharm got into hot water for dramatically increasing the prices of its drugs as well as buying rights to some niche drugs and then pushing the prices way up. One of their antifungal drugs was selling for 200x more in the US than the same drug in Europe. That drugs like estrogen or colchicine should have such high prices is incredible given how old they are and easy to synthesis or isolate. There was a story on naloxone (narcotic reversing agent) where the cost went from $375 a dose to almost $2000 per. The cost of the actual drug is likely much less than $15.

 

[MRG]

Whatever the market will bear unless there are checks in place. Valeant Pharm got into hot water for dramatically increasing the prices of its drugs as well as buying rights to some niche drugs and then pushing the prices way up. One of their antifungal drugs was selling for 200x more in the US than the same drug in Europe. That drugs like estrogen or colchicine should have such high prices is incredible given how old they are and easy to synthesis or isolate. There was a story on naloxone (narcotic reversing agent) where the cost went from $375 a dose to almost $2000 per. The cost of the actual drug is likely much less than $15.

Valeant did get taken to the woodshed, at least the stock did. I held a managed fund that was wayyyy overweight in it.