$160 Prescription for $11!!!

[AlbertZeroK]

So I goto the Doctor and get new prescription, then goto CVS where I'm a member of their health plan that gives me 9.99 90 day prescriptions. Come to find out one of my meds, $160 for a 90 day supply!!! OUCH!

So I informed them, I'll have to shop it around. I found the same medicine at HealthWarehouse.com for $11 for 90 day supply with free shipping!!! I have ordered from them before and they have a good name online, so I ordered again!

How can CVS justify $160 for an $11 prescription? I mean $160!!! Ouch. Just thought I'd share.

 

[rynosmom]

I had 2 prescriptions filled at CVS in July, 1 antibiotic and 1 pain killer. I was charged $10.00 each with my ins copay. Just got the exact 2 filled out again but this time at Shoprite and I only paid $8.72 for both. At Shoprite the antibiotic was free and I only paid the actual cost of the pain killer which was $8.72 not $10.00.

 

[maggiew]

I know there are some places that charge more for prescriptions than others. As mentioned in the second post. However your price difference is just HUGE!

I would check to make sure you are getting first quality prescription at that price. Make sure it is not expired or a bad batch (a batch that didn't meet QA guidelines).

You don't mention the prescription name, but that price is even cheaper than the prices I saw in Mexico and Belize for different medicines!!!

Maggie

 

[3boymthr]

I had 2 prescriptions filled at CVS in July, 1 antibiotic and 1 pain killer. I was charged $10.00 each with my ins copay. Just got the exact 2 filled out again but this time at Shoprite and I only paid $8.72 for both. At Shoprite the antibiotic was free and I only paid the actual cost of the pain killer which was $8.72 not $10.00.

Food for thought....

CVS is defnitely a more expensive pharmacy than many others but it may be cheaper for your insurance company if you go to CVS because they get higher pharmaceutical discounts and rebates when you use CVS which plays into the cost of your insurance premium going forward.

Plus the price difference on the pain med may be your insurance plan not CVS (free is free on the anti-biotics - can't beat that). If you have a minimum co-pay on your plan you are going to pay the cost of the co-pay even if the cost of the med is below $10. Shop-rite may have not put the meds thru your insurance. Some pharmacy techs will automatically check to see the price differnce between insurance and not others won't. (In my experience most CVS techs won't unless you ask them to unfortunately.) Your OOP cost may have been similar or even less at CVS if they hadn't put it thru your insurance. When I have a med I know is inexpensive I always ask the price difference between insurance and uninsured.

 

[DisneyAndRedSox]

Another thing, print out a list of the $4 generic prescriptions at Target and Walmart and bring it to your doctor. There is a skin cream I use and it is $4 a tube (small or large size) or $10 for 90 days (3 tubes) at both retailers. Target was also running a coupon for a $10 gift card if you bought in a new prescription. Ended up getting 3 tubes for free! Otherwise if I got it at CVS my FSA would have been hit for about $12 a tube.

Also, last year Stop and Shop was advertising free antibiotics in the late fall/winter with your S & S card. DD got her first ever ear infection and I called my local S&S and her Rx was on the list! I told my doctor about it a week later at her well visit and he had no clue they were offering it! According to their website it looks like they are still running the program.

http://www.stopandshop.com/antibiotics

Walmart $4 list:
http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf

Target $4 list (some are $9-mostly smoking and women's health):
http://sites.target.com/site/en/health/page.jsp?contentId=WCMP04-040590

 

[AlbertZeroK]

The prescription was for Norvasc, which is very standard medication. Wal-Mart is like $60 for the same script the first time I had it filled.

I wish we lived in a larger town, we only have Rite Aid, CVS and Wal-Mart, none of our grocery stores have pharmacies. So I guess they think they can charge more?

I just found the price difference do typical of today's buisness ideals...

 

[Mom2micayla]

It really pays to shop around. I had a prescription filled at Walgreens a few months ago and it cost me $40. (Not covered by insurance). I got a new script for it and since I was at Costco already I went ahead and filled it there. It was $11. Made me sick to think about how much money I had been throwing away until that point. It never occured to me that there would be that big of a difference from one pharmacy to the other.

 

[Ariel224]

Food for thought....

If you have a minimum co-pay on your plan you are going to pay the cost of the co-pay even if the cost of the med is below $10. Shop-rite may have not put the meds thru your insurance. Some pharmacy techs will automatically check to see the price differnce between insurance and not others won't. (In my experience most CVS techs won't unless you ask them to unfortunately.) Your OOP cost may have been similar or even less at CVS if they hadn't put it thru your insurance. When I have a med I know is inexpensive I always ask the price difference between insurance and uninsured.

In most, if not all states, billing a higher amount to an insurance company than what a regular cash paying customer would be charged is a fraudulent practice. If the retail price is less than the copay, the retail price should be billed, and that will be the cost of the drug to the patient. Even if legal, it still isn't, in my book, ethical.

Pharmaceutical pricing at the wholesale level (and therefore the retail level) fluctuates widely and constantly. For example, Chain A might get a great contract price for a fast moving med for 6 months, and then when the contract changes, the price may be multiple times higher. Chain B might then have a great price for the same drug for a specific amount of time, and then it might suddenly change.

Drug shortages and backorder situations occur, which sometimes necessitate the ordering of a different manufacturer for a generic, resulting in a jump in cost.

Most of the $4 and $10 lists contain loss leaders. The pharmacy may or may not be covering their cost to obtain the medication, but I can guarantee you that the overhead to fill that prescription is not being covered. The same can be said for many brand name drugs, as their markup can be quite small at the retail level.

I am a pharmacist at Costco. I love that I can quote people amazing prices on most generics. But I always have to throw in a disclaimer that rx prices are like gas prices, in that they are subject to change on a daily basis.

As for OP being quote $160 for Norvasc.....were they pricing the brand name drug or was that for the generic? Just wondering.....

What frustrates me so much with the huge variance in pricing is that people no longer stay with just one pharmacy. The $4/$10 lists, gift card transfer incentives, and other promos, make it so that people have their med profile scattered all over town. And I don't blame the patient at all for shopping around; we do it in many aspects of life, and for some it is a financial necessity. It just makes my job sooooo difficult, because I don't see the whole picture of a med history. It's like when people don't have a primary doctor and randomly go to different emergency rooms and urgent care centers whenever they need a doctor. I recently uncovered a situation where a lady was on 2 blood pressure meds in the same class and 2 cholesterol meds in the same class. She was filling one of each at my pharmacy and one of each at another. It wasn't until she decided to transfer all of her rxs into my pharmacy that the duplication was discovered. This had been going on for months, as her doctor was not aware that she hadn't stopped the older meds when he prescribed the new ones.

 

[AlbertZeroK]

This is very interesting! Thanks for the insight.

In most, if not all states, billing a higher amount to an insurance company than what a regular cash paying customer would be charged is a fraudulent practice. If the retail price is less than the copay, the retail price should be billed, and that will be the cost of the drug to the patient. Even if legal, it still isn't, in my book, ethical.

Pharmaceutical pricing at the wholesale level (and therefore the retail level) fluctuates widely and constantly. For example, Chain A might get a great contract price for a fast moving med for 6 months, and then when the contract changes, the price may be multiple times higher. Chain B might then have a great price for the same drug for a specific amount of time, and then it might suddenly change.

Drug shortages and backorder situations occur, which sometimes necessitate the ordering of a different manufacturer for a generic, resulting in a jump in cost.

Most of the $4 and $10 lists contain loss leaders. The pharmacy may or may not be covering their cost to obtain the medication, but I can guarantee you that the overhead to fill that prescription is not being covered. The same can be said for many brand name drugs, as their markup can be quite small at the retail level.

I saw Wal-Mart's move to $10 90 day scripts as a SMART move, less overhead cost for filling scripts than $4 / 30 day. And we all knew they had to make up the money somewhere.

I am a pharmacist at Costco. I love that I can quote people amazing prices on most generics. But I always have to throw in a disclaimer that rx prices are like gas prices, in that they are subject to change on a daily basis.

As for OP being quote $160 for Norvasc.....were they pricing the brand name drug or was that for the generic? Just wondering.....

The script was written for the generic form and I don't expect a pharmacy to give me a name brand drug unless I ask specifically for it - especially when the first thing I tell a pharmacist is, how much is it going to cost. On the other hand, we had an issue once getting my daughter's synthroid filled as name brand vs generic - her doctor wants her on the name brand because the dosing is more reliable than a generic - but we still fight once and a while with medicaid on that.

What frustrates me so much with the huge variance in pricing is that people no longer stay with just one pharmacy. The $4/$10 lists, gift card transfer incentives, and other promos, make it so that people have their med profile scattered all over town. And I don't blame the patient at all for shopping around; we do it in many aspects of life, and for some it is a financial necessity. It just makes my job sooooo difficult, because I don't see the whole picture of a med history. It's like when people don't have a primary doctor and randomly go to different emergency rooms and urgent care centers whenever they need a doctor. I recently uncovered a situation where a lady was on 2 blood pressure meds in the same class and 2 cholesterol meds in the same class. She was filling one of each at my pharmacy and one of each at another. It wasn't until she decided to transfer all of her rxs into my pharmacy that the duplication was discovered. This had been going on for months, as her doctor was not aware that she hadn't stopped the older meds when he prescribed the new ones.

I wish I could goto just one place.

Also, I learned long ago, not to count on your doctor knwoing what meds you are on, even if they perscribed them. I always have a list of my meds with me.

 

[happily single]

Don't forget AAA offers a pharmacy discount. I was filling my script at CVS and with the AAA discount it was $30.xx. I stopped into Target one day and inquired; it was $4,92 with the AAA discount!

 

[Psychodisney]

AAA discount? Do you just show your card?

 

[Ariel224]

I wish I could goto just one place.

Also, I learned long ago, not to count on your doctor knwoing what meds you are on, even if they perscribed them. I always have a list of my meds with me.

Like I said, I can't fault someone for using multiple pharmacies due to cost considerations. It just makes my job (which essentially is to monitor your med regimen to keep you safe) much more difficult. It is then up to you the patient to know the names of your meds AND what they are for, keep a CURRENT list with you at all times, and to ask the pharmacist(s) to review your entire list each and every time there is a change in your regimen. It sounds like you do that, which I commend! Unfortunately, you are not the typical person I see in a day. Not only do many people not know what they take or why, they don't even know where they last had it filled after 3 or 4 pharmacy transfers. This sends me on a wild goose chase on the phone to locate the valid prescription record for the drug I "think* they're looking for that day.

 

[horseshowmom]

I know there are some places that charge more for prescriptions than others. As mentioned in the second post. However your price difference is just HUGE

My daughter works at an independent pharmacy as a tech while she's in pharmacy school. They have MUCH lower cash prices than anybody in the area. In fact, when she did one of her rotations with a chain pharmacy in a town 15 miles away and told them where she was working part-time, they said, "Oh, that's the pharmacy with the great cash prices!" By all means, call around and check with several pharmacies.

When my hairdresser heard where DD was working (a few years ago when she first started there), she told me that she used to get her daughter's medicine at Walmart and paid about $150. She had no insurance and started looking elsewhere. She got her prescription at the one where DD works for $25 (same medication). My sister-in-law had something similar with her husband's prescription. Walmart was about 3 times as high as where she had normally been filling it (she made them give the prescription back to her although they weren't too happy about it - she also had no insurance, and it mattered a lot to her).

I do think it's a shame that there's that much difference. It looks a little bit like the ones with the $10/3 month things are making it up on the other stuff where people don't know any better.

 

[windycitymom]

My daughter works at an independent pharmacy as a tech while she's in pharmacy school. They have MUCH lower cash prices than anybody in the area. In fact, when she did one of her rotations with a chain pharmacy in a town 15 miles away and told them where she was working part-time, they said, "Oh, that's the pharmacy with the great cash prices!" By all means, call around and check with several pharmacies.

When my hairdresser heard where DD was working (a few years ago when she first started there), she told me that she used to get her daughter's medicine at Walmart and paid about $150. She had no insurance and started looking elsewhere. She got her prescription at the one where DD works for $25 (same medication). My sister-in-law had something similar with her husband's prescription. Walmart was about 3 times as high as where she had normally been filling it (she made them give the prescription back to her although they weren't too happy about it - she also had no insurance, and it mattered a lot to her).

I do think it's a shame that there's that much difference. It looks a little bit like the ones with the $10/3 month things are making it up on the other stuff where people don't know any better.

Where does your daughter work? Or where could I find a similiar place in the Chicagoland area? Is the pharmacy connected to a pharmacy school? There's a huge difference between $150 and $25 for a prescription!!

 

[honeydiane1953]

IF I could find NEXIUM at a good price I would faint.

 

[phred52]

My DH works at a grocery chain with a pharmacy. We HAVE to fill our scripts with them unless we are on vacation and need an emergency med. Never occurred to me to check cash prices elsewhere then compare that to our co-pay prices. I like to think outside the box!

 

[3boymthr]

In most, if not all states, billing a higher amount to an insurance company than what a regular cash paying customer would be charged is a fraudulent practice. If the retail price is less than the copay, the retail price should be billed, and that will be the cost of the drug to the patient. Even if legal, it still isn't, in my book, ethical.

As to the co-pay they're not charging the insurance because there is no amount over the co-pay they're charging you - and if it's in the PD they can do it. I work underwriting insurance on a national basis and it happens all the time. For example, I underwrote a self-funded contract for a national company with 5,000 employees in 25 states - they had a copay of 20% with a minimum co-pay of $15 so no matter what you paid $15 - even if the cost of the drug was less than $15. I can also give you a real life personal example where this happens, my mother takes hydrochlorathiazide, thru her insurance she gets 30 pills for her $10 co-pay, without her insurance she gets 100 pills for less than $10 - at the same pharmacy (the one at her local grocery store).

As to charging the insurance companies more than retail - well, insurance companies negotiate the contracts at a certain point every year or every couple of years or sometimes even in perpetuity (it's rare but it does happen), if the cost of the drug or service drops in between the beginning of the contract the provider still gets the contracted rate until such time as the contract runs out. Sounds crazy, I know but it happens all the time. We once paid a hospital $30,000 for a $15,000 bill because that was the contracted rate.

 

[horseshowmom]

Where does your daughter work? Or where could I find a similiar place in the Chicagoland area? Is the pharmacy connected to a pharmacy school? There's a huge difference between $150 and $25 for a prescription!!

The pharmacy is independently owned (not a chain pharmacy and not connected to a pharmacy school). For many years, that was the only kind in my area (rural), but now there are more chains popping up - Walmart and Fred's are nearby (with a CVS coming soon) with RiteAid and Walgreen's in towns within 25 miles.

Often the smaller local pharmacy gets overlooked because people just assume there's no way their prices could compete with the chains, but that's not always correct. Check your phone book and call around to check - can't hurt!

As to the co-pay they're not charging the insurance because there is no amount over the co-pay they're charging you - and if it's in the PD they can do it. I work underwriting insurance on a national basis and it happens all the time. For example, I underwrote a self-funded contract for a national company with 5,000 employees in 25 states - they had a copay of 20% with a minimum co-pay of $15 so no matter what you paid $15 - even if the cost of the drug was less than $15. I can also give you a real life personal example where this happens, my mother takes hydrochlorathiazide, thru her insurance she gets 30 pills for her $10 co-pay, without her insurance she gets 100 pills for less than $10 - at the same pharmacy (the one at her local grocery store).

We've had the same thing happen with us. Fortunately, our daughter can check it both ways for us and get us the better price. I do keep some of our routine prescriptions at Walmart because it is cheaper ($10/90 days), and I can get them online with free delivery. That saves me a 25 mile roundtrip to Walmart and is worth paying a little extra for.