Why Your Pharmacist Can’t Tell You That $20 Prescription Could Cost Only $8

For every example of unnecessary government regulation, there is another for needed regulation. Too many contracts are negotiated by unequal parties and inevitably the stronger party will use their leverage to force an inequitable contract.
 
I was trying to figure out why this is news.

Its been this way FOREVER. I remember the blue and white PCS cards in the 80's. I got my *** chewed for telling an EDS employee it would be cheaper to pay cash while working at a pharmacy in high school.

Also, this is another state specific issue. TX does not allow the copay to be charged if the cash price is less. However, the pharmacy staff is under no obligation to tell people about coupons, goodrx, etc.
 
I have told medicare customers before to use a different pharmacy and just say they don't have any insurance if there was a problem with co-pays. Sometimes they were able to get the medicine cheaper without insurance.
 
I have told medicare customers before to use a different pharmacy and just say they don't have any insurance if there was a problem with co-pays.

Do you tell them to carry a copy of their prescriptions with them as well?
 
I’ll play devils advocate here...isn’t this going to create a new problem with people forever stuck in the coverage gap? If their copay goes from 30 bucks to 300 during the coverage gap and the pharmacist tells them not to use insurance because it’s only $250, then they never register the costs and never hit the out of pocket threshold .
 
I’ll play devils advocate here...isn’t this going to create a new problem with people forever stuck in the coverage gap? If their copay goes from 30 bucks to 300 during the coverage gap and the pharmacist tells them not to use insurance because it’s only $250, then they never register the costs and never hit the out of pocket threshold .

Good point. I'm not sure if the client could then file a paper claim to the carrier to have the purchase applied. Might be worth looking into.
 
I’ll play devils advocate here...isn’t this going to create a new problem with people forever stuck in the coverage gap? If their copay goes from 30 bucks to 300 during the coverage gap and the pharmacist tells them not to use insurance because it’s only $250, then they never register the costs and never hit the out of pocket threshold .

The same could be said for the deductible stage, Unfortunately there are some seniors who cant or wont take the time to comprehend this

When I say some I do mean a minority not the majority
 
I’ll play devils advocate here...isn’t this going to create a new problem with people forever stuck in the coverage gap? If their copay goes from 30 bucks to 300 during the coverage gap and the pharmacist tells them not to use insurance because it’s only $250, then they never register the costs and never hit the out of pocket threshold .

If one of my clients did this, I would feel like I failed to properly explain the coverage gap.

If they bought from someone else, tough. Should have picked a better agent.

However, most techs and pharmacists understand the system way better than you are giving them credit for. I cannot imagine them telling a senior to pay cash while they are in the coverage gap, unless its December. And even then they are going to explain why they are doing it.

The issue is more for U65, either Indy or Group, not Part D enrollees.
 
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