Price-compare Your Medications if You Pay Cash

[Binxie]

Over the last few months, I've discovered that pharmaceutical pricing is as wildly varied in price as any other medical service. Let me give you two crazy examples from one of my medications, of which I take 225 mg a day ...

Case 1: This medication was prescribed by a specialist, who was no longer on my insurance this year. So my primary care physician agreed to represcribe the medication until I could get in with a new specialist. When I went to pick up my new prescription, the total was 12 times higher than what I usually pay, over $700! After going back and forth with Walmart and CVS, I finally figured out why. The old specialist had prescribed 3 capsules per day at 75 mg, totaling 225 mg, of course. My primary care physician just prescribed one 225 mg capsule. In other words, the drug company charges, for this medication 12 times the price per milligram for the privilege of having it all in one pill. Thankfully, I did figure out what was going on, and my primary care physician was cool about represcribing it at 3 x 75 mg.

Case 2: My insurance is Blue Cross/Blue Shield of Texas. I was traveling in Kentucky when it was time to refill the same prescription. I went to CVS, and it was nearly $400 instead of the usual $60 I pay for a 90 day supply. I thought this was really weird since I pay cash because my Bronze policy has a $6,000 deductible. In other words, I'm paying out of pocket for just about everything until I hit $6,000. What I didn't realize is that in Texas I was still getting a Blue Cross/Blue Shield negotiated price with CVS, which doesn't apply out of state. My policy only covers me in Texas, except for emergency care. I didn't know what else to do, so I paid. But I have since learned that this medication's retail price varies wildly from pharmacy to pharmacy. I've also learned that there are websites, like Goodrx.com, where you can price compare and get coupons. (Reviews online say the coupons aren't always honored at the pharmacies). I've seen retail prices for my prescription of 3 x 75 mg per day for 90 days from about $80 to more than $600 at major pharmacies.

It pays to shop around. And I must say: Mexico is looking better and better. This is bullshit.

PS: For my annual panel of blood tests, I've been using DirectLabs.com's "Comprehensive Wellness Profile," which covers everything my doctor was ordering from his office. It's $97, and I can usually find a $10 off coupon code online. You can get the blood drawn almost anywhere in the USA as you travel and emailed to your doc. And it's a huge savings. When I had employer-provided insurance, also under Blue Cross/Blue Shield, the same panel of tests was $400 according to my statements, though I didn't pay more than my small office visit deductible at that time. I'm quit smug in paying 20-25% of that. But then, Mexico is still looking better than playing this game. This is a lot of work to keep from getting screwed over.

 

[wayneL]

I have BC/BS in Al and have several expensive medications. I have wondered about the out of service area costs may be.
If I have the same problem you have I will ask one of my children pick up locally and forward them to me via us mail to local general delivery address

 

[compassrose]

Kinda went thru this with David's heart doc. One of the pills he was prescribing was triple digits (and the first number was NOT a 1) for a 30 day supply. We simply told the doctor that #1 we did not have an income like his. #2 please prescribe generics when ever possible. #3 when not possible, please find a cheaper medication that does the same thing. Then we spoke to the Pharmacists at Sam's Club. Told them that we needed to meds changed to generics when ever possible. Got a $4/$12 (or is it $4/$10) list from them. This is a list of medications that the sell in 30 day supplies at a much lower price. The doctors know about them but are too lazy to be bothered. They are grouped into categories (allergy, heart, blood pressure, etc). David would simply take the sheet with him (always got an updated sheet before his next dr visit) and hand it to the doctor when he would start changing meds. The walk-in clinic already had the list. We got an extra discount because of the type of membership we had at Sam's Club but you can refill prescriptions there even without a membership. Don't know how the prices are. I do know that we had to get refills at the local Wal-Mart due to weather twice (I-25 was closed). The first time, we got the Wal-Mart to honour the Sam's price. The second time we paid $170 for a refill that we had been getting for under $60. We had no insurance and only paid cash. Now that David is gone, I am on some insurance that I don't pay for nor do I use. When we needed it, we couldn't get it. Now that it is not needed, I can get it. Sounds stupid to me. Doesn't matter, I pay cash for everything anyway.

 

[SoulRaven]

With the coming of the affordable care act and Medicaid expansion (depends on what state you reside) there should only be a need to pay just a small copay for prescriptions.

In the Commonwealth of Pennsylvania with Medicaid AKA medical assistance my life sustaining prescription have a zero copay, $1 copay on generics, and $5 copay on all others. All my doctor and specialist appointments have zero copay, and I have vision and dental care with no annual deduction.

In October of 2016 I am eligible for medicare with no deduction from my SSDI monthly allowance and Medicaid with pick up the rest and any copays.

 

[GotSmart]

I just was put on Januvia.  My copay was to be $130, but was cut to $45. a month.  

I managed to get all get a few of my regular meds onto OTC items.

 

[TMG51]

This is true of more than just prescriptions. I read an article about a guy who needed surgery, and his out of pocket cost after insurance was through the roof. By paying in cash and cutting out insurance entirely he was able to pay less than the portion he would have otherwise owed! The problem is that when dealing with insurance the cost is always estimated as high as possible. Many people think you can't negotiate for medical costs, but when paying cash, you can.

 

[Goshawk]

Find it amazing that patients who are literally dieing for medicine, need to shop for treatment just to stay alive in USA.

 

[Binxie]

Find it amazing that patients who are literally dieing for medicine, need to shop for treatment just to stay alive in USA.

I'm grateful that I can shop around for these items. Were I seriously ill and/or in an emergency, I'd pay whatever the first vendor told me, pretty much. It's like buying a pig in a poke. I think it's part of the reason we have all these crazy price differences.

I read an economists analysis of health care, and his conclusion is that there are two reasons we have crazy and at times inflated pricing. First, there's the fact that with healthcare you can't always shop around because you're too sick or you're tied to a particular insurance carrier or hospital. But the second reason he said is that there is a serious imbalance between the number of hospitals, pharmaceutical companies, and insurance companies. Basically, there are just a handful of hospital systems (I think 6 major ones) and pharmaceutical companies, but there are tons of insurance companies. We either need a single payer system or a few near-monopoly insurance companies (think Baby Bells) to have negotiating leverage against the hospital systems and pharmaceutical manufacturers. OR we need some way to break up or price manage the hospital systems and Big Pharma.

I agree, too, with what Compassrose's experience shows. Sometimes for patients a good enough, older generic is good enough. We don't always need the latest drug, just like we don't always need the latest phone. If a new drug has 14% better results than the old drug, is it worth paying top dollar? Depends on the situation. But in most situations, I bet the answer is no.

 

[amparo]

Just stumbled on this and great trips all around.

For lab testing, I've ordered online through Accesa Labs (www.accesalabs.com) and have had a good experience overall and did not have to use my insurance. I've run into issues with trying to use insurance when out of my home region to see doctors and find it's just easier to pay cash for a visit in most instances. In fact, I've had instances where cash is even cheaper than a co-pay, particularly for things like an MRI.

Also, a lot of pharmacies have a cash pricing menu if you need medications. Just make sure to ask them what the cash price is before you give them your insurance card.