GoodRX and Part D

[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.

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/heal...surance-be-costing-you-money-pharmacy-n811171

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]

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]

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]

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-cover...-drug-coverage/part-d-late-enrollment-penalty

And it’s permanent.

 

[Dawg52]

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]

The penalty increases for each month you do not have it: https://www.medicare.gov/drug-cover...-drug-coverage/part-d-late-enrollment-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.

 

[travelover]

Just because a prescription is sent to Costco does not mean it is trapped there - another pharmacy can transfer it to their store. I do try to get paper prescriptions when I can, though I know it is resisted. Ditto with my vet, who overcharges for simple generic meds.

 

[ivinsfan]

Just because a prescription is sent to Costco does not mean it is trapped there - another pharmacy can transfer it to their store. I do try to get paper prescriptions when I can, though I know it is resisted. Ditto with my vet, who overcharges for simple generic meds.

Yes its a hand glove between doctor drug company and pharmacy....My husband needed a med post surgery and I was secure messaging his doctor> While the doctors office was informing me they had written a script in real time I got a message from Walgreens saying it was filled and ready for pickup.. it's a cluster and shouldn't be so hard...he needed a med before discharge and the first thing I knew the hospital pharmacy offloaded me to a branch pharmacy where they had it waiting for me at a mere 100 bucks more then GoodRx….we had a 75 mile drive home after an 8 day hospital stay and I just threw up my hands and paid the robber barons....I needed that med in my hand before we headed for home..

 

[travelover]

Yes its a hand glove between doctor drug company and pharmacy....My husband needed a med post surgery and I was secure messaging his doctor> While the doctors office was informing me they had written a script in real time I got a message from Walgreens saying it was filled and ready for pickup.. it's a cluster and shouldn't be so hard...he needed a med before discharge and the first thing I knew the hospital pharmacy offloaded me to a branch pharmacy where they had it waiting for me at a mere 100 bucks more then GoodRx….we had a 75 mile drive home after an 8 day hospital stay and I just threw up my hands and paid the robber barons....I needed that med in my hand before we headed for home..

Yes, sometimes they've got you, but my point is that when you have flexibility, you can move your prescription to the lowest price pharmacy.

 

[ivinsfan]

Yes, sometimes they've got you, but my point is that when you have flexibility, you can move your prescription to the lowest price pharmacy.

Exactly what I did for subsequent refills but they sure don't make it easy...

 

[GrandmaHoo]

Doctors are audited for compliance with many standards set by Medicare. Much more regulation since Obama care. One of their standards include electronic prescriptions as preferred method of prescribing. If the doctors don’t meet the standards, they literally get docked in reimbursement. Good information in this thread on a very complex and trying topic.

 

[ivinsfan]

Doctors are audited for compliance with many standards set by Medicare. Much more regulation since Obama care. One of their standards include electronic prescriptions as preferred method of prescribing. If the doctors don’t meet the standards, they literally get docked in reimbursement. Good information in this thread on a very complex and trying topic.

And part of this is fighting prescription abuse with doctor shopping and drug seeking behavior. Obviously much easier to track them electronically.

 

[aja8888]

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.

One of my DW's drugs last year was $4,000/month. Pard D covered $3,000 of it. GoodRX probably would have not even listed it for coverage. Taking chances without Part D coverage may be a real problem when you get real sick.

 

[MRG]

One of my DW's drugs last year was $4,000/month. Pard D covered $3,000 of it. GoodRX probably would have not even listed it for coverage. Taking chances without Part D coverage may be a real problem when you get real sick.

.+1

That happened to my sister's ex. No need for meds till a brain tumor changes everything. Sad.

 

[omni550]

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?

I had Envision RX Plus for 2018, as they were the low-cost provider and I am not on any maintenance prescriptions. I don't think I had any Rxs filled so far in 2018, so I can't give you any feedback, positive or negative.

They do not cover Shingrx to any great degree, so I am planning on switching my Part D provider for 2019 to minimize my costs (after the monthly premium and my out-of-pocket portion of the two Shingrx shots).

omni

 

[wmc1000]

I had Envision RX Plus for 2018, as they were the low-cost provider and I am not on any maintenance prescriptions. I don't think I had any Rxs filled so far in 2018, so I can't give you any feedback, positive or negative.

They do not cover Shingrx to any great degree, so I am planning on switching my Part D provider for 2019 to minimize my costs (after the monthly premium and my out-of-pocket portion of the two Shingrx shots).

omni

I checked all the 2019 Part D plans available for us in Central Indiana and NONE of them covered Shingrix at a low cost that made it worth paying any more than the least expensive Part D plan which is Aetna at 17,10 monthly.

 

[omni550]

I checked all the 2019 Part D plans available for us in Central Indiana and NONE of them covered Shingrix at a low cost that made it worth paying any more than the least expensive Part D plan which is Aetna at 17,10 monthly.

I'm in SE Michigan. Here's my post from a few weeks ago http://www.early-retirement.org/forums/f38/medicare-part-d-2019-planning-93900.html

I've been traveling and haven't had time to do any more research to see if 2019 premiums have been posted yet.

omni

 

[wmc1000]

I'm in SE Michigan. Here's my post from a few weeks ago http://www.early-retirement.org/forums/f38/medicare-part-d-2019-planning-93900.html

I've been traveling and haven't had time to do any more research to see if 2019 premiums have been posted yet.

omni

2019 Part D plans and premiums were posted on October 1st

 

[travelover]

I had an infuriating experience at Costco today. Took my Good Rx coupon in and they refused it because I have Medicare Part D insurance. The person taking the prescriptions said it was a federal law that the insurance must be billed first. This was clearly untrue, as I printed a second coupon and took it to a local grocery pharmacy and they didn't blink an eye, even though I have my insurance registered there as well.

I've been a loyal Costco fan for years, but this policy sucks.

Rant over.

 

[audreyh1]

Hmmmm.......

 

[njhowie]

The person taking the prescriptions said it was a federal law that the insurance must be billed first.

Complete nonsense. Others have likewise indicated that Costco has given them a hassle with GoodRx and other discount cards. There is no such law that insurance must be billed first and Costco certainly does not have a monopoly on the pharmacy business - so get it filled somewhere else. You could walk in to any pharmacy and say that you have no insurance and use GoodRx. We took WellRx to our local supermarket seeing on the website how the price was significantly less than our insurance drug plan. The pharmacist simply replaced the insurance drug plan number in the computer with the WellRx and now we get the WellRx price automatically. No hassle, no problem.

https://www.goodrx.com/insurance

Can I use GoodRx instead of insurance?
You can and should use a GoodRx discount instead of your health insurance or Medicare if the price is lower. Keep in mind that you cannot use GoodRx and insurance at the same time. However, you can use GoodRx instead of insurance or government-funded programs, such as Medicare or Medicaid, to pay for your prescription medications. GoodRx is not insurance.

If you find a better price on GoodRx than what your coverage offers, ask the pharmacist to use the coupon and process the transaction as a “cash” payment instead. They will use the codes on the GoodRx coupon to find your new price.

If the pharmacist has any trouble, please give us a call at 1-855-268-2822 (M-F 9am-6pm CST). Our advocates are there to help you, and can often resolve your issue while you’re still in the pharmacy.