Rete

Everyone asks about healthcare plans in the US but few ask about prescription plans. And believe it or not, they are not always part and parcel of your healthcare plan.

For those, who like myself, have an ongoing disease, Type 2 Diabetes and advanced glaucoma in the right eye, your prescription plan can make or break you financially. On Sunday I went to the pharmacy to pick up my 90 day supply of ongoing meds and the out-of-pocket cost was $279.00 My savings: $2,433.85

A 90 day supply of Januvia (1 pill per day) is $1436.89. My cost is $90.00

So when you are looking at possible healthcare plans, please look very closely at the prescription plans offered. Not all drugs can be obtained genetically. Or if they can, they don't always work as well.

tom169

Also check that the drugs can be gotten from a physical pharmacy.

For example, my wife's plan only allows ACA drugs on mail order after the first prescription.

Pulaski

It is always worth checking goodrx.com to compare prices because the difference between the price for the same drug at local pharmacies can be astonishing. A couple of years ago some antibiotics for little Miss P ranged in price from under $20 to over $120.
Yeah, mail order can save a huge amount too. A drug that Mrs P needed over ten years ago was, IIRC, going to cost $2,000 locally, but only $500 from a pharmacy in New England.

Rete

And I have found that using Express Scripts to be more expensive than using Walgreen's for my meds. In addition, I didn't have to deal with incompetent people when I had to call them because they once again shipped the meds to Mississippi instead of New York or that they didn't contact the doctor for new prescriptions as they should have. Thankfully, the Union finally ditched them for CVS. My plan will NOT use Costco or Walmart for prescriptions. Although our prescription plan said we had to use Express Scripts and now CVS, I stopped using them while still under those plans and used Walgreens/Duane Reade without a problem.

petitefrancaise

my son had to take retinoids for his acne. $3k a month. We paid $10 co-pay.

mind you, do ask the doctors for any coupons for medications. They can often pay the co-pay for you on expensive meds (I know, I know, it just forces the insurance companies to fork out the rest).

Englishmum

Our prescription plan is through the CVS, but my local pharmacy - walking distance from our house and 100 yards from the GP's surgery - applies the CVS discounted rate.

The first prescription I had filled there was when I'd just moved back here from Switzerland; I was charged $40 for 90 days supply of Levothyroxine which is a generic tablet taken once a day for an underactive thyroid (I will have to take it for the rest of my life). I thought it was odd as I was paying the equivalent of $15 for 90 days worth of the same drug in (expensive) Switzerland and I remember paying much less a few years ago at the same US pharmacy for the same drug.

It turned out that the US pharmacy was applying the 'discount' for an AAA motoring discount which I used once a few years ago as an experiment (not even a member any more!). I had a nice chat with a rep at CVS and I can send the receipt in and get a partial refund based on the rate I should have been charged.

The most annoying thing though is that although I can request repeat prescriptions at the pharmacy via an App on my phone.....the pharmacist says that on this CVS plan I can now only have 30 days of Levothyroxine each time. That's going to be very inconvenient when I will be going on trips overseas for longer than that during the Summer

bugsybuz

We just discovered how ridiculous this can be here. The same meds we used to purchase in Australia for $50 AUD, which we thought was expensive, are over $400 here??!! And no generic brand available How is this justified? We've been trying to navigate and understand the health plans for the best part of the day

scrubbedexpat099

It is a very expensive system to operate, from paying off Politicians down, lots of noses in the trough.

yellowroom

Most healthcare systems and/or governments in other countries will negotiate with the drug product manufacturers on price to get a balance between allowing companies to recoup R&D costs and make a fair profit versus value for money for the patient/healthcare system.

In the USA, it is pure capitalism and companies will charge what they think the "market" will bear, but the "market" is very murky and can change depending on whether you are the patient, the pharmacy or the prescription plan manager.

Several complications compared to other countries - firstly it is actually against the law for government healthcare systems like Medicare to negotiate drug prices (thank Congress for that, but President Trump has been hinting that may change in round 2 and 3 of "Trumpcare"). Also, Medicaid must cover all drugs approved by the FDA if prescribed, regardless of whether a cheaper, equally or more effective drug is available. In about half of the states, pharmacists have to get patient consent to switch from a brand to a generic alternative drug (regardless of payer).

Finally, insurance companies rarely negotiate prices because of the complicated system with the pharmacies and pharmacy benefits managers. Lots of money sloshing around there and no incentive to reduce prices for the patient.

petitefrancaise

Have you checked with your prescription insurers exactly how much your co-pay will be? You can also ask about alternatives.

When we first moved here, my son had hay fever and the doctor prescribed him a very expensive nasal spray, it was about $250! When I called the insurance company to ask what was going on, they said that they only approved this particular spray if the alternative didn't work or if the dr said that the patient couldn't use the cheaper one for a medical reason. The dr of course hadn't given me any choice so I went back and asked for the alternative, cheaper spray. it worked and we were all happy. Cost was $5 co-pay.

It is always worth checking out with the insurers and the pharmacists for alternatives and that may not mean a generic. Watch out for doctors that always prescribe from the same drug company, handing out coupons as they write the prescription is a sure fire way of knowing the drug company rep has just been in......

Also, look on goodrx.com and the drug company website for money off coupons.

mrken30

Who's responsible for getting the prices down. If CVS charges less, Walgreens makes more money from the insurance companies. If Cigna gets lower prices , Blue Cross makes more money. There is very little competition in this field. ACA helps a bit because some people are paying the full cost for the first few RXs.

petitefrancaise

The EU countries will negotiate the price prior to allowing a drug to be prescribed through the state healthcare. Cost benefit analysis etc.

The NHS is tougher than France to get a drug approval mostly because the cost of the drug has greater weight.

chawkins99

My wife and I are both type 2 diabetic and take insulin.
My wife uses 10ml vials and separate syringe. I prefer the pre-filled pens. Both options cost us $50 per month.
The cost to insurance is around $700 a month for my wife but nearly $2,000 a month for mine but the co-pay is the same $50. I could save the insurance thousands a year by using the vials but they provide no incentive for me to use the cheaper option.
There are no 'generic' insulins so they all cost us $50 a month regardless.

mrken30

Oregon has passed some legislation on RX costs. It may be that other States are passing similar legislation.

Oregon Goes It Alone To Lower Prescription Drug Costs . News | OPB

bugsybuz

We are unfortunately here at the moment on tourist visa so have no prescription insurance

We did have a lovely lady in the doctors recommend the goodrx app. Would definitely recommend that app! One of the meds ranged from $9.32 to $47.36??