Why Your Pharmacist Can’t Tell You That $20 Prescription Could Cost Only $8
- Thread starter Northeast Agent
- Start date
- 6,462
If it was advantageous to make a cash purchase, rather than an insurance purchase, when the insurance copay for the drug was $30, it will continue to be advantageous to make the cash purchase when the insurance copay is $300.
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- 6,462
The cost of medications is an issue for all, regardless of age. Comparing cash and insurance costs for those medications is an issue for all who are able to afford and have insurance, regardless of the type of insurance they have.
It has been to my understanding that when the pharmacist inputs your info to get that drug it automatically ties you to Part D. So not much of a way to hide it just by going to another pharmacy.
You lost me on that one.
If you take a prescription from the doc to Kroger (who doesn't have your current info) they are going to fill it as a cash pay.
If you take your prescription to your current pharmacy, with the Part D on file, its going to hit Part D. BUT you can tell them to pull it off the insurance. (I actually did that today. I need the meds before the refill too soon date and its a $10 copay or $12 cash price. I'm paying the $2.)
Unless you are staying within the same pharmacy chain, the computers are not connected.
What IS connected is the PBM. That way you can't get your Tylenol #3 at Walgreens. And CVS. And Rite Aid. All on the same day.
You need a better agent
Its based on the whole year and if you are or are not going to hit the donut hole (and get out of it).
Drug costs $500 under Part D.
Cash Price is $400.
Assuming other drugs, you are going to hit the donut hole May-ish. And be out by October-ish and paying 5%.
Or you can pay $4800 for 12 months and never get to the 5% level.
There are WAY too many factors.
1. Total cost of all meds
2. Donut Hole
3. Time of RX
Which is why everyone needs an annual Part D review
From a consumer perspective I can tell you this.
Wife covered by her group plan (high deductible) + HRA. When a new Rx is called into our pharmacy the store fills the prescription and bills the carrier. By the time she picks it up the money is out of the HRA.
A couple of times they have auto-filled the next refill even though she tells them NOT to fill until she calls them. When that happens the $$ comes out of her HRA and getting it back in there is like fighting city hall.
My doc has called in a refill for an Rx I get about every 18 months or so. When I got to the drug store the refill price is over $100 for a creme that was less than $20 a few years ago. I rejected the refill and got doc to give me a paper Rx so I could fill in Canada for less than $20. Have no idea if they reversed the charge against my Part D or not but nothing came out of my pocket.
I wonder how many drugs are filled and billed to the PDP but never picked up and never had charges reversed with the carrier.
I do show my clients how to save money with an iniital and annual PDP review. Even encourage them to fill some med's outside the PDP which I presume they do. But I also discover new drugs they are taking during the review and they just went on autopilot and filled using their drug card.
One client told me during the review last year that his doc put him on "eyeball medicine" for glaucoma. Seems like he was paying around $60 or so when he could get the same for around $20 with GoodRx.
I do encourage them to call their drug plan and me whenever they get a new Rx but no one ever does that.
Wife covered by her group plan (high deductible) + HRA. When a new Rx is called into our pharmacy the store fills the prescription and bills the carrier. By the time she picks it up the money is out of the HRA.
A couple of times they have auto-filled the next refill even though she tells them NOT to fill until she calls them. When that happens the $$ comes out of her HRA and getting it back in there is like fighting city hall.
My doc has called in a refill for an Rx I get about every 18 months or so. When I got to the drug store the refill price is over $100 for a creme that was less than $20 a few years ago. I rejected the refill and got doc to give me a paper Rx so I could fill in Canada for less than $20. Have no idea if they reversed the charge against my Part D or not but nothing came out of my pocket.
I wonder how many drugs are filled and billed to the PDP but never picked up and never had charges reversed with the carrier.
I do show my clients how to save money with an iniital and annual PDP review. Even encourage them to fill some med's outside the PDP which I presume they do. But I also discover new drugs they are taking during the review and they just went on autopilot and filled using their drug card.
One client told me during the review last year that his doc put him on "eyeball medicine" for glaucoma. Seems like he was paying around $60 or so when he could get the same for around $20 with GoodRx.
I do encourage them to call their drug plan and me whenever they get a new Rx but no one ever does that.
Believe it or not, most of them. Not timely, but they do get reversed eventually, because of inventory.
This years classic call. "This new eye drop is killing me. Its $100 a month. I need to switch from Silver Script"
Told her that didn't sound right. Its a $20 RX at CVS.
Client: "I go to Walgreens"
Daughter (who is on the call):" MOTHER. Jenny told you to take all new prescriptions to CVS, in case they are expensive."
Client: "Its a pain to go across the street"
Daughter:" Then pay the extra $80 because you are lazy, but its not Jenny's fault"
- 15,041
Gotta love it when daughter has your back.
- 6,462
You need a better agent
Its based on the whole year and if you are or are not going to hit the donut hole (and get out of it).
Drug costs $500 under Part D.
Cash Price is $400.
Assuming other drugs, you are going to hit the donut hole May-ish. And be out by October-ish and paying 5%.
Or you can pay $4800 for 12 months and never get to the 5% level.
There are WAY too many factors.
1. Total cost of all meds
2. Donut Hole
3. Time of RX
Which is why everyone needs an annual Part D review
You separated your example from op's post, the other agent did not. I stand by what I said in regard to that post.
And, How is it possible to say when one will be in and out of the donut hole without knowing the retail price of the drug in question?
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