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Old 05-08-2019, 09:49 AM   #1
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Prescription insurance, how much are they actually contributing?


Apparently my pharmacy is a "preferred cost sharing pharmacy?". When I pay for an rx it says preferred solutions and shows what I pay. It does not show the normal cost or what the insurance pays and my monthly summary shows zero contribution from the insurance company.

Bottom line is I have no idea how much my rx insurance coverage is saving me so I can make an informed decision as to, is it worth the monthly cost.

I stopped in and asked and got dizzy from the run around, they clearly didn't have a clue. Apparently Medicare has a contract with selected rx suppliers to charge predetermined prices with no information provided to me on what they are paying and my savings. It all seems a bit shady and given the many reduced prices available from other sources I don't think I'm saving a lot.

Any information on preferred solutions?

Bud
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Old 05-08-2019, 09:58 AM   #2
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Re: Prescription insurance, how much are they actually contributing?


I have insurance too, and I'm marching towards Medicare, or maybe shuffling . . . .

One way to find out how much you're saving is to call pharmacies with your prescriptions and tell them you don't have insurance and see the prices they quote you. If you're at Walgreens in town A, call the one in town B and ask.

That's what I did, and I found out I'm saving a lot, even with my relatively routine medicines.
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Old 05-08-2019, 10:32 AM   #3
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Re: Prescription insurance, how much are they actually contributing?


I have a different take on the pharmacy insurance scam.

My pharmacy will charge me $12.00 for a certain med, if I pay out of pocket.

When my insurance pays for it the pharmacy charges the insurance $37.50, and me $0.65.

Yes you read that right, If I pay for it, I get a discount, and if insurance pays they pay triple, and I still pay 65 cents.

Somebody is seriously over charging for their stuff.


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Last edited by de-nagorg; 05-08-2019 at 10:33 AM. Reason: erer
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Old 05-08-2019, 10:36 AM   #4
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Re: Prescription insurance, how much are they actually contributing?


Thanks Dave. I suspect a walk-in price w/o insurance would not be the lowest available, especially with my pharmacy, not a box store. From some searching it looks like many places offer coupons or one time discounts probably in hopes of getting all of your business. But for those who are willing to shop around on a regular basis I think lower prices can be had every month.

In my searching I was not able to find a list price or typical price for anything. Here are a couple.
Metoprolol Succinate ER 50 mg Preferred Solutions for 90 tabs was $54.70.
Losartan Potassium 100 mg Aurobindo (whatever that means) 90 tabs $26.83.

Bud
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Old 05-08-2019, 11:20 AM   #5
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Re: Prescription insurance, how much are they actually contributing?


Our insurance has RX coverage. In most cases the cash price is cheaper than the copay amount. I know that would not be true for some of the exotic stuff but it is true for most common drugs.


I always laugh, say I'm a tightwad and ask before I pay or pull out the insurance card.
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Old 05-08-2019, 11:40 AM   #6
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Re: Prescription insurance, how much are they actually contributing?


Another variable I've encountered is that for some medicines, pharmacies will charge really rock-bottom low prices if you pay out of pocket for the whole thing and don't use your insurance.

I had a couple meds like that (which I'm off now) which I was able to get for $5.00 instead of the $10.00 "co-pay." I'm incapable of making this up.

(Oops, I see @de-nagorg already mentioned this, but it bears repeating.)

Also, my pharmacy will give a really great price on some medicines if you get a three month supply at a time. If you're on meds you'll have to take for a lifetime, like gout or BP meds, I'd ask the pharmacy if they have deals like that, particularly if they're old reliable meds. And, periodically make a point of asking (nicely) to see if a medicine that used to not have a deal now does.

And watch out for "gag rules" that forbid pharmacies from coming out and telling you about better deals, instead requiring you to ask! Those are in decline, but they're around.

So march (or shuffle) on into your druggists and ask them if they can give you a better deal, and stuff the gag rules.

https://www.cnn.com/2018/05/11/healt...ces/index.html



https://www.nytimes.com/2018/02/24/u...g-clauses.html

https://newpittsburghcourier.com/201...ut-drug-costs/
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Last edited by DoomsDave; 05-08-2019 at 11:45 AM.
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Old 05-08-2019, 11:51 AM   #7
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Re: Prescription insurance, how much are they actually contributing?


And, one more BIG thing:

If you're on regular meds, periodically ask your doc if there's a way that something that's outlandishly expensive can be replaced by something cheaper.

(Be nice. Don't call them [expletive] shills and profiteers. Even if they've got the latest drug tatted on their forearm . . . . )

Most doctors will appreciate patients who are on the ball.

If you sense that your doc doesn't like patients who are on the ball, run (or shuffle) screaming, to another doctor if you can.

This is important as lots of patented drugs go off-patent from time to time. And alternatives pop up too.

And, you don't want medical malpractice, or drugs interacting with other drugs. The best way to avoid it is to be mindfully active your care, and any reasonably sane doctor should agree wholeheartedly.

Ask, and ye shall receive, or if not ask another . . . .

And if you have a friend or relative who thinks they might be getting taken advantage of (mindfully, discreetly) help them and see if that's true. Be careful, but be willing to look.
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Last edited by DoomsDave; 05-08-2019 at 11:54 AM.
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