WWYD (re: finding best prescription price)

[lanejudy]

My doctor wanted to know if I'd be willing to try Ozempic.
Me: "What's the ball park cost"
Doc: "I don't know, we'll call it in and they'll tell you."
Me: "Ok, let's try the mail order." (because again, the insurance 'pushes' mail order)

A week later, the 30 day prescription gets filled, for $150! The mail order never confirmed I actually wanted to prescription filled. AND it's an injection and needs to be refrigerated. Two things, that because of my travel, I really don't want to deal with if I don't have to.

Ball park -- Ozempic could run you ~$1000 per month without insurance. With insurance will depend on many factors.

Ozempic only needs to be refrigerated until first used. Once you do the first dose, the pen can remain out of the refrigerator for up to 56 days (which should be plenty long enough to use up the doses).

My Rx insurance has a "price a medication" feature on the website that I've found to be quite accurate for checking prices. The "push" for mail order may save you money if your insurance is set for a lower copay through mail order (often a 3-month supply with a 2-month copay). Discount cards often cannot be used with insurance.

 

[Christine]

Really? OK. I'll give them a call. Thanks!

Yes anyone can use the Costco pharmacy but members do get a better rate on drugs, especially if they are paying for them without prescription.

 

[SC Minnie]

RIght before Thanksgiving DH went to the Dr for an issue, they ran tests and found he had blood clots in his lungs! In the hospital he goes and they start him on blood thinners. Once he does well the Dr is going to release him and give him a script for Xarelto. He goes to pick it up -- $900 WITH insurance . It was Thanksgiving day and of course the Dr office wasn't open nor were they open on Friday. He had to have it. Thank goodness for our HSA. He goes back next week for a follow up and is asking if there is another brand he can take that will be cheaper.

 

[Christine]

RIght before Thanksgiving DH went to the Dr for an issue, they ran tests and found he had blood clots in his lungs! In the hospital he goes and they start him on blood thinners. Once he does well the Dr is going to release him and give him a script for Xarelto. He goes to pick it up -- $900 WITH insurance . It was Thanksgiving day and of course the Dr office wasn't open nor were they open on Friday. He had to have it. Thank goodness for our HSA. He goes back next week for a follow up and is asking if there is another brand he can take that will be cheaper.

FYI, I had to take Xarelto for 8 weeks after I had reconstructive surgery on my foot. The manufacturer had a coupon that got my montly copay down to around $10 I think. I have insurance but Xarelto was third level tier drug on my insurance so my copay was going to be something like $60. The discount worked like a charm at CVS and it was good for a year's supply.

ETA: Xarelto and Eliquis are essentially the same class of blood thinners. There are cheaper/older ones but these two drugs seem to have the best side effect profile. I'm SUPER sensitive to most medications and I had zero issues with Xarelto.

 

[sam_gordon]

Yes anyone can use the Costco pharmacy but members do get a better rate on drugs, especially if they are paying for them without prescription.

I called them. Over $400 for a 30 day supply for members. Of course, that doesn't include insurance, which they can't tell me that cost without knowing the insurance/having the prescription. Which takes us back to the beginning. CVS was over $100 for 30 day supply WITH insurance.

Going to my insurance page, they can only tell me what the mail order cost would be ($150/3 months), not what anyone else would charge. The mail order won't use the discount card. I guess I'm going to have to suck it up and pay it.

 

[jimmymc]

This isn't a great answer, but it really depends on your insurance. See if they offer a specific mail order program or if they have partner pharmacies, that will be the cheapest option.

 

[sam_gordon]

This isn't a great answer, but it really depends on your insurance. See if they offer a specific mail order program or if they have partner pharmacies, that will be the cheapest option.

They have a mail order program, but the program doesn't recognize the drug manufacturer discount card.

 

[lanejudy]

They have a mail order program, but the program doesn't recognize the drug manufacturer discount card.

And most insurances won't. That's the "deal" made between the pharmacy (retail or mail) and the manufacturers who typically subsidize such discount programs intended for patients without insurance.

 

[sam_gordon]

And most insurances won't. That's the "deal" made between the pharmacy (retail or mail) and the manufacturers who typically subsidize such discount programs intended for patients without insurance.

What sucks is the first 2-3 times I used the discount card (as 2nd to my insurance) with no problems with the local pharmacy. Then the local pharmacy changed their policy I guess?

I don't understand because the pharmacy still gets their money, it's just they get part from insurance, part from me, and part from the manufacturer.

 

[Christine]

What sucks is the first 2-3 times I used the discount card (as 2nd to my insurance) with no problems with the local pharmacy. Then the local pharmacy changed their policy I guess?

I don't understand because the pharmacy still gets their money, it's just they get part from insurance, part from me, and part from the manufacturer.

I've never had an issue using the manufacturer's discount with my insurance in order to lower or eliminate my copay. Most of them say right on the card that they can be used with all insurance with the exception of government sponsored insured such as Medicare, Tricare. I will say that I've definitely had certain pharmacies absolutely STRUGGLE with running the manufacturer's discount card correctly.

When I had to do this with Xarelto, I got a written script from my doctor and I walked it to every pharmacy with my discount card until I found one to get it to work. Barring all that, check with the manufacturer because I also was able to get a check/rebate from one of them after I sent in (online) my proof that I bought the prescription when the pharmacy just couldn't handle it.

I just looked at the Jardiance website and you should have no issues with this if you have commercial insurance. I think these pharmacies are being stupid. I tried to go further into the site to learn more about the savings card but I can't without enrolling.

 

[lanejudy]

I don't understand because the pharmacy still gets their money, it's just they get part from insurance, part from me, and part from the manufacturer.

Likely the manufacturer refused to reimburse their portion because insurance was involved. That's typically the agreement between the manufacturer and the pharmacy. So the pharmacy would be out that difference.


ETA: I just looked up the Boehringer Ingelheim Jardiance savings card. It's only valid for the 1st 3 months of the prescription. The website does say you can be re-enrolled after 12 months, so you'll get another 3 months of savings after a year. But in the meantime you've got 9 months of "full" copay (because it sounds like you have insurance that provides good coverage or has negotiated a considerable savings off the typical ~$500 price tag without insurance).

 

[sam_gordon]

Likely the manufacturer refused to reimburse their portion because insurance was involved. That's typically the agreement between the manufacturer and the pharmacy. So the pharmacy would be out that difference.


ETA: I just looked up the Boehringer Ingelheim Jardiance savings card. It's only valid for the 1st 3 months of the prescription. The website does say you can be re-enrolled after 12 months, so you'll get another 3 months of savings after a year. But in the meantime you've got 9 months of "full" copay (because it sounds like you have insurance that provides good coverage or has negotiated a considerable savings off the typical ~$500 price tag without insurance).

Thank you. I tried to read the fine print, but must have missed the "1st 3 month" part.

 

[Christine]

Likely the manufacturer refused to reimburse their portion because insurance was involved. That's typically the agreement between the manufacturer and the pharmacy. So the pharmacy would be out that difference.


ETA: I just looked up the Boehringer Ingelheim Jardiance savings card. It's only valid for the 1st 3 months of the prescription. The website does say you can be re-enrolled after 12 months, so you'll get another 3 months of savings after a year. But in the meantime you've got 9 months of "full" copay (because it sounds like you have insurance that provides good coverage or has negotiated a considerable savings off the typical ~$500 price tag without insurance).

Where are you reading that? I'm seeing that it's "as little as $10 a month for a "1- to 3-month" prescription and then you're automatically re-enrolled the next year.

 

[Christine]

Thank you. I tried to read the fine print, but must have missed the "1st 3 month" part.

I'm not finding it either.

 

[SC Minnie]

FYI, I had to take Xarelto for 8 weeks after I had reconstructive surgery on my foot. The manufacturer had a coupon that got my montly copay down to around $10 I think. I have insurance but Xarelto was third level tier drug on my insurance so my copay was going to be something like $60. The discount worked like a charm at CVS and it was good for a year's supply.

ETA: Xarelto and Eliquis are essentially the same class of blood thinners. There are cheaper/older ones but these two drugs seem to have the best side effect profile. I'm SUPER sensitive to most medications and I had zero issues with Xarelto.

Thank you!!! when this happened on Thanksgiving day it was a bit of a whirlwind and we had to do what we had to do. Will look in to the manufacturers savings card and see what we can do.

 

[Christine]

Thank you!!! when this happened on Thanksgiving day it was a bit of a whirlwind and we had to do what we had to do. Will look in to the manufacturers savings card and see what we can do.

I'm pretty sure Xarelto also does the mail in rebate too so once you enroll, you can just send your receipts in and they will send you the rebate check.

 

[Cadiewampus]

Just 10mg.

now that you say 10mg thats what mine was originally and then went to 25 (I knew 50 sounded high) Anyway my pharmacist said the 25mg was the more standard size so maybe thats why it was covered?

 

[AppleDumpling]

My insurance plan also pushes mail order for prescription drugs. If I’m sick or have a temporary condition and need meds, no problem. However, it is different with long-term maintenance meds (that you may be on for years or indefinitely). For those, I found out that I was able to fill it at a reasonable price, from my local drug store, for the first 3-4 months, as what they call a “courtesy fill”. They consider it a trial period when starting a new medication, to allow your doctor to determine whether it is working and/or adjust the dosage. After that, price for a 30-day prescription, increases significantly. But you can get a 90-day supply through the mail-order pharmacy at a much lower cost. In my case, it gave me no choice but to switch to mail order. YMMV.

 

[greeneyedchick]

Order from Canada. I think the site that I used to get insulin was canshipmeds.com It was a lot cheaper than the US.

 

[mrsstats79]

Really? OK. I'll give them a call. Thanks!

You don't need to be a member but you don't get the Costco membership price.