Are Pain Meds Like Hydrocodone Expensive Now?

Oct 20, 2015

  1. wehotex
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    wehotex Guru

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    I have a few chronic pain disabled Medicare beneficiaries in my Book. They've been kicked around a lot in the last year or so by our burdensome government. Last I checked, Hydrocodone was generally Tier 2 (nonpreferred generic). I'm now noticing that most, if not all of my MA carriers now have them as Tier 3 or 4 (prfd brand or non-prfrd brand). What gives? I'm going to the local discount SAM's to see if it's cheaper to pay cash.
     
    wehotex, Oct 20, 2015
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  2. insuranceconceptscindy
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    insuranceconceptscindy Guru

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    Yep. I'm seeing that too. Add in that some of my clients have to pharmacy shop, since some don't carry controlled substances at all. One guy said that he can only go to a certain pharmacy on a certain day of the week to get his Lortab and another pharmacy to get another pain med. It's crazy!
     
  3. pcbinsurance
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  4. TN_agent
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    TN_agent Guru

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    In TN prescription drug abuse is rampant.

    I am sure the prices are going up to combat that (meaning, the "agreed to" price is such to dissuade people from using much of it unless they really need it or so they won't resell it). Cash prices are going up, too, good luck getting vicodin for $10 cash at a TN pharmacy if you are uninsured (may be different other places). Maybe at Walmart, but even then you have to find one that will fill it. The pharmacies know 75% of uninsured or cash buyers with pain scripts have a habit or are reselling to recreational users.

    As you mentioned, also seeing where the controlled substances are getting harder to fill at local pharmacies. Here there are ratios of controlled to uncontrolled prescriptions that are assigned to pharmacies by authorities, if a pharmacy has a bad ratio, they get in trouble or are closely scrutinized as a "pill mill", suspected of fraud or kickbacks .

    Some pharmacies cant/wont even fill them unless you bring 2-3 non-controlled substance prescriptions with them because of the ratios they are allowed. Plus a lot of the controlled substances aren't allowed to be filled by mail order (and of course mail order is cheaper for part D people usually) . So the local pharmacies are left with 50 people showing up to only fill pain scripts because their other 10 normal scripts each are $3 copay mail order. The pharmacies say no way because that throws off their ratios.
     
    TN_agent, Oct 20, 2015
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  5. JimmyUt
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    We were told by the local UHC office that covering pain meds at the lower costs somehow has had an affect on their star ratings, Most things like hydrocodone are a tier 4 and can be had for much cheaper outside the MAPD
     
    JimmyUt, Oct 20, 2015
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  6. germanwine1
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    germanwine1 Super Genius

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    Yes it is have a client on hydrocodone and oxycodene. Has a great relationship with her pharmacy who ensures her meds are on hand.

    Also on eight other meds worried about her hitting the donut hole with those two drugs alone.
     
  7. wehotex
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    wehotex Guru

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    Wouldn't the mb still get the insurance negotiated price, which would amount only a discount (not a low copay). You make it sound like CMS thinks it OK to rip on the chronic pain folk.. CMS wouldn't do that, would it?
     
    wehotex, Oct 20, 2015
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  8. Fisher
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    Nope. If the med is not purchased through the PDP or MAPD the retail cost of said drug has nothing to do with any 'negotiated' price. The smart strategy is to find a way to buy the high-priced meds OUTSIDE of the PDP/MAPD coverage which also helps to avoid the coverage gap. Or at least delay it.

    That being said, some Tier 3 and 4 meds wind up being cheaper out-of-pocket while IN the coverage gap. I know... clear as mud, right?
     
    Fisher, Oct 21, 2015
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  9. wehotex
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    wehotex Guru

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    I meant to say that the mb would still use their Rx PDP.
    Local Sam's Pharmacy has usually cheap cash price, but not as cheap as Costco.
    SAMs quoted me $86.62 for #120 hydro/APAP 5-325 tab.
     
    Last edited: Oct 22, 2015
    wehotex, Oct 21, 2015
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  10. JimmyUt
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    I am just telling you what they told me. They would still get the negotiated cash price, but avoid using the insurance thus supposedly raising their star ratings. It must have worked here as UHC has 50% market share and went from 3.5 to 4.5 stars.
     
    JimmyUt, Oct 21, 2015
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