Medicare part d prescrip. Drug plan users: Your ins. Co. Is profiting on your backs!
 

In 2003 came the passage of the Medicare Part D Prescription Drug Plan to go into effect in 2006—a fantastic piece of legislation, I felt—for the insurance and pharmaceutical industries—and not particularly for seniors. By now those of us covered by it are well familiar with its deductibles, denials, and donut holes. I’m almost embarrassed to realize that after living with this program all these years, I just learned something about it that shocked me but, in the end, didn’t surprise me. Here’s my story in specifics:

My physician changed my cholesterol med from Prevastatin ($0 co-pay) to Rosuvastatin (generic of Crestor) that will be better for my needs. The local pharmacy cannot check what the cost will be of a prescription without having it in their hands ostensibly to fill it. I did not have the scrip yet, so I called the insurance company directly and asked, and they told me $141 for a three-month supply. I double-checked with the local pharmacist, who told me he has a ‘back door’ through which he can get the costs the insurance companies charge us, and he verified that mine would be $141.

Now comes the shocker. The pharmacist asked me if I would consider simply filling it for its cash price, which he explained to me could be (though not necessarily have to be) lower than my insurance co-pay? He checked for me, and the cash price for filling this identical prescription is—ready for this?!—$51—indeed lower! Remember, this is a generic; certainly the pharmaceutical company that developed its original—Crestor—earned back its research and development costs and then some. What does this mean?

Two seriously significant points:

1. My insurance company is charging me nearly TRIPLE the cash price (without using any insurance) for this generic drug Rosuvastatin. And here I thought they were certainly making enough for their shareholders with premiums, deductibles, and fair co-pays without doing this! Yet we are fined if we choose not to elect prescription drug coverage, even though it might cost us less NOT to use insurance. (Is this even conceivable?)

2. By charging such inflated prices, some of us are driven into the coverage gap known as the “donut hole” so much sooner, as the insurance company is the one who sets the prices we pay for our medications if we use our Part D Plan. I now check EVERY prescription I am given to make sure I’m not spending more than I have to.

However, in the end I purchased this medication from a Canadian mail-order pharmacy. Please see thread titled ‘THE LAW AND CANADIAN MAIL-ORDER MEDS.’

I have a similar situation with a generic, Levothyroxin.

When purchasing a 90-day supply with my Part D plan at the preferred pharmacy (and mail order, for that matter), my co-pay is $38.50.

When purchasing a 90-day supply with cash at Walmart, it costs me $10.00.

Technical reason for this: My Part D plan classifies Levothyroxin as a Tier 2 generic. Walmart classifies it as a Tier 1 preferred generic and has it on their $4/month ($10/3 month) list.

So why don't I change Part D plans? Because of the coverage I get for an expensive Tier 3 preferred brand drug.

I have said this many times ... when it comes to healthcare, it's a jungle out there.

I'm not on Medicare yet but I'm now on an ACA subsidized comprehensive PPO. The differences in prescription coverage was profound. Once I'm eligible for Medicare (not for 9 more years unless it changes AGAIN), I'll have to look at the options for prescription riders. I take levothyroxin too. On my current plan, the mail order pharmacy charges me $10/90. On the plan I had when DH was working, their mail order pharmacy was $14/90, so I would just get them at Walmart instead.

The insurance company didn't care where I got my meds, or whether or not it was a participating pharmacy. If I wanted to use THEIR pharmacy, I paid X. If I wanted to go elsewhere I paid whatever the elsewhere charged.

Posted on wrong thread; please see 'The law and Canadian mail-order meds (long read—but important …).'

What, again?!
 

I just had this happen again, this time with a generic controlled substance which cannot be mailed. My doc sent it to a local discount pharmacy (Benzer) and included my Part D Insurance coverage: $282 for three-month supply.

In the past I would have paid it. Now I know to question it, in this case learning that its cash price (no insurance) is $230, a no-brainer quarterly savings of $82. I really thought there would have been greater interest in this subject, but perhaps my fellow seniors had long been more conscious of this than I had been. In any case, here is one med on which I save $328 a year that I can then use for something else altogether.

goodrx.com is an excellent resource for checking into the possibility of saving by paying cash.

I'm confused as to where your insurance company is charging you for prescriptions. I thought you were at a pharmacy? I don't think your insurance company makes any money from what you spend at a pharmacy.

Absolutely! I just had this happen again, leading me to wonder if it happens far more frequently than one would realize. We all remember the 'Epi-Pen Debacle' of a couple of years ago, where the new owner of the patent jacked up the price of it thousands of percent. Well, mine is an old generic anti-fungal cream that up until a couple of years ago was an old tier 1 med.

I just went to fill it now, and my Medicare Part D Prescription Drug Plan co-pay would be $1,072.55 for a three-month supply. Using the GoodRx app, I bought this prescription at Walmart Pharmacy for $74.19! In this instance the difference was so absurd that I would like to think anyone would notice it. But others are more subtle.

I'm just suggesting that as our doctors prescribe medications that are tier 3 or higher, we should check various discount sources for what often seem to be better prices (whether Drug Price Comparisons, Online Pharmacy Safety and Coupon Savings | PharmacyChecker.com for Canadian mail order pharmacies; www.costco.com who has among the lowest mail order cash prices; and the GoodRx app, which might come up with a lower price yet. If any readers have found other economical sources, please share them. I guess we have to 'shop around' for our medical care much as we do for, say, a major appliance! Incredible. . . .