Actual price for rx meds

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  #1  
Old 07-30-15, 06:18 AM
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Actual price for rx meds

I have AARP for my rx prescriptions, but to estimate whether that insurance is worth what I pay I need to know the real price one without insurance would pay.

Yesterday I refilled my 90 day supply of Januvia and when the girl looked at the price she said "oh my". Apparently they had forgot to apply my insurance so it showed the list price $1,200.37. We got it corrected to my deductible of $135 (still too high IMO) but the question is, how much is my insurance saving me? Certainly no one without insurance would be paying $1,200 for 90 days.

Where do I find a real number to compare to what I actually pay?

Bud
 
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  #2  
Old 07-30-15, 06:41 AM
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The same pharmacist should be able to tell you the price. It has to be in their system. Not all of their customers have insurance.
 
  #3  
Old 07-30-15, 06:55 AM
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My wife is a caregiver and used to care for our pharmacist's father. Before she became old enough for medicare, he would sell her prescriptions at his cost. While I doubt he gave anyone else that big of a break I'm sure he gives those without insurance a break. In fact I believe that the retail price isn't always the same as this insurance or that insurance's set price.

With my medicare insurance I get a monthly [?] statement that tells what the provider [doctor or pharmacy] charged, what they were actually paid and what my co pay was. Not sure I'd trust the pharmacist to honestly tell what he pays for the meds.
 
  #4  
Old 07-30-15, 07:00 AM
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Did I misread the post? I thought that you were looking for the cost to the end user without insurance not the wholesale cost, to the drug store.
 
  #5  
Old 07-30-15, 07:05 AM
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maybe I mis read it

Also there is probably a big difference in how much a small pharmacy charges those with out insurance versus a chain store.
 
  #6  
Old 07-30-15, 08:08 AM
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Many medications are just ridiculously expensive - I know someone who pays (well, whose insurance pays) $1400 per month for one drug for him.
 
  #7  
Old 07-30-15, 11:02 AM
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My question is, if I did not have insurance, what would that (and other) med cost. I don't believe their list price of 1,200 dollars, that's a scare tactic. If people without insurance can buy Januvia for the same or less than my co-pay, then I'm saving nothing.

An example from the past is Nasonex. I don't remember the numbers, but my $10 co-pay turned out to be the same price I could buy the stuff for on-line. Bottom line was my insurance saved me nothing.

I'm hoping to soon be able to eliminate the need for the Januvia and since it is currently the big ticket item on my rx list I should be able to dump my rx plan. That of course will take some more planning, but determining how much I'm REALLY saving now is part of the planning.

Bud
 
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Old 07-30-15, 11:06 AM
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  #9  
Old 07-30-15, 02:25 PM
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Even with your insurance, watch out for the "donut hole". That is where you jump to paying 80% of the drug until your schedule resets itself. I, luckily, don't have to use medications, but wifey just fell into the donut hole on her pain meds. Instead of $7.50 the same number cost $110 yesterday, and will until her anniversary date.

Before my mom passed away, she had rheumatoid arthritis for which she was given medication. $1200 per pill She had good insurance, but I still question drug manufacturers and their R&D cost.
 
  #10  
Old 07-30-15, 02:39 PM
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Ah yes Larry, I forgot about the doughnut hole. Funny how they name such a miserable feature after something so sweet. I'll have to check to see if and when I enter that zone.

Thanks ss, that is at least moving in the right direction, $600 vs $1,200 for a 90 day supply. That would make my insurance savings about $155 per month. ($600 - $135)/3 = $155
I don't have my insurance costs at hand, but that is about what my rx coverage costs me and currently I'm not taking much more than the Januvia. At least I'm breaking even and have the coverage. But sure not saving a bundle.

Bud
 
  #11  
Old 07-30-15, 04:32 PM
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Threads like this really make people like me and the_tow_guy (John? Sorry I suck at remembering names) appreciate our medical. $0 for generic, $16 for brand-name for a 90 day supply if you use the mail order pharmacy. Even off formulary (and there aren't too many) stuff is only something like $26 IIRC.

I read an article a while ago about a new drug for Hep-C that is not just a treatment, but a cure. 1 pill a week for 12 weeks...but it's $1100 a pill! That's after insurance from what I saw. Better than dying I guess, but OMG, I was gobsmacked.

To the original question, I really don't know if you can find the actual price, because as someone said, big chains often get discounts and the manufacturers and stores often have programs where you can pay less even with no insurance. Heck, even some eyedrops I was just prescribed, the doc asked about my insurance because some people reportedly paid $1000 for 90 days and if it's chronic you stay on them forever. No generic and no programs because it's not life threatening.
 

Last edited by Gunguy45; 07-30-15 at 06:37 PM.
  #12  
Old 07-30-15, 05:00 PM
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I think it's one pill a day, Vic, which puts the entire treatment around $100,000!
 
  #13  
Old 07-30-15, 05:37 PM
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I hope that you didn't mean Interferon as the cure.
 
  #14  
Old 07-30-15, 06:37 PM
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I can't say I know the prices of medications myself but my cousin who lives in Texas does he is a salesman for the drug companies and brings around samples to doctors. My aunt loves her son but not what he does for a living and I can tell you most of these drugs are not that expensive for the drug companies to make. Once the medication gets to the patient there is a tremendous mark up for both the patient and insurance. It is just criminal what some of these companies charge for medication and criminal with the mark ups, things definitely need to change.
 
  #15  
Old 07-30-15, 06:40 PM
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You're right Becky...1 a day! And no, Pulpo, it's one without Interferon. Still in trials I think.
 
  #16  
Old 07-31-15, 04:59 AM
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Richard, in defense of that huge markup, it is more than the production cost that they are trying to recover. It includes the R&D which we have no way of knowing. They could have been in the red for many years developing that produce and others that never resulted in something to sell.

Once they have a product though, I'm afraid they also adjust the price on what the need is, people dying will pay more. But the bottom line is still like any other business, they need to pay their overhead and show a profit for their investors. And the less the insurance companies pay for one product means the more they have to charge for other products.

Bud
 
  #17  
Old 07-31-15, 08:05 AM
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There's one more factor in the price of these drugs - they have to build in the cost of the lawsuits they will have down the road. I know you've seen the commercials on TV about 'did you or a loved one take XXXXX and now YYYYYYY happened?...". There is a lot of money spent on the back end in the legal system on many of these drugs.
 
  #18  
Old 07-31-15, 06:26 PM
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I agree the price of the medication does relate a great deal to R&D and then their is marketing which my cousin does in part and as stickshift said possible lawsuits. I think everyone can agree though that the price of medication needs to be lower and maybe in this case a bit more government oversight to make absolutely certain that a drug doesn't do more harm than good. Cholesterol lowering statins are one case in point sure they lower cholesterol but have many scary bad side effects some of which I experienced myself. So a medicine may look like a sheep but be a wolf in disguise.
 
  #19  
Old 07-31-15, 07:33 PM
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It certainly is a complicated process. We want to hang the carrot out there so companies will want to develop these medications, but then we want to buy them at cost. An example is the recent Ebola vaccine. I doubt that the R&D and production costs are being passed along to the people receiving this new rx, but it had to be done. I think I saw Merck was involved.

Bud
 
  #20  
Old 08-01-15, 01:11 PM
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Part of the problem is that you're only going to find all of side/negative effects with widespread use; trials just won't show you everything. Oversight is crucial but it's not a silver bullet.
 
  #21  
Old 08-02-15, 05:51 PM
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Larry, you mentioned the doughnut hole so I did some searching. Now, I'm not sure exactly what coverage I have, wife handles all of that, but below is a link that explains the doughnut hole. Here is a quote:
"The coverage gap starts when your total drug costs—including what you and your plan have paid for drugs—reaches a certain amount since the start of the calendar year. In 2015, this amount is generally $2,960."
So, at a combined total drug cost of (rounding it up) $3,000 I would fall onto the gap. To get out of the gap it says my total out of pocket expense has to exceed $4700, but it seems to omit the initial insurance contribution.
A little math. If I assume my part of the initial rx cost that got me into the hole was $1,000 and the insurance co paid $2,000 how much more out of pocket money would I have to contribute before I hit the $4,700?
$4,700 - $3,000 for an additional $1,700,
OR $4,700 - $1,000 meaning I would have to spend an additional $3,700.

The obvious assumption would be the $1,700, but the link below does not seem to include the insurance company's first contribution. I will admit that it is much more complicated than it should be but was wondering if any here have a better handle on it.

Bud
Medicare Interactive - The doughnut hole
 
  #22  
Old 08-03-15, 04:11 AM
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According to the monthly statement I get from blue cross, my medicare drug gap begins when my total drug costs [including prescriptions not covered] reaches $2,960.00. The gap ends when the total costs [including the $2,960] reaches $4,700.00. That includes total costs of the drugs; - what you paid and the insurance paid. It also says after the $4,700 that they pay most of the cost. Not sure what that means, maybe a smaller co pay ??

My monthly statement includes how much I paid and how much the insurance paid with totals both for the month and the year.
 
  #23  
Old 08-03-15, 04:58 AM
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Thanks mark, that is exactly how I would expect it to be calculated, BUT.
In this quote it only mentions MY out of pocket expenses.
"How do I get out of the doughnut hole? You get out of the coverage gap in 2015 when you have paid $4,700 out-of-pocket for covered drugs since the start of the year."

Then further down:
"You continue to pay your drug plan’s monthly premium during the gap, but the premium does not count toward the $4,700 out-of-pocket limit. The amount your drug plan paid for your drugs in your initial coverage period also does not count."

It's that last line "The amount your drug plan paid for your drugs in your initial coverage period also does not count."

If that is correct, then my second calculation above applies "OR $4,700 - $1,000 meaning I would have to spend an additional $3,700."

I'm not sure if this medicare interactive.org is an offician web site or not, but sure has me thinking. If they do as you stated I probably won't fall into the gap this year, but we all face an increasing rx expense as we age.

I'll keep digging. I hope it is just a wording issue.

Bud
 
  #24  
Old 08-03-15, 01:00 PM
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I don't understand how the Medicare Part D prescription drug plans work; in fact the entire Medicare supplemental or Advantage plans are as clear to me as Sanskrit, which is why I STILL haven't made any selection.

However, I have found out that a huge number of medications, both generic and patent, are priced pretty much according to what the market will bear. Within the last couple of weeks I have had to refill three prescriptions (all generic) and two of them qualified under the "$4.00/month-$10.00/three month" common prescription drugs plan at my local pharmacy while a third was going to be something in excess of $260.00 However, by a simple Google search I found a "coupon" that lowered the price to less than $20.00 for a three month supply. That's better than a 90% saving! Upon further searching I find that ALL of my prescriptions have similar savings although not all are quite so remarkable. There are even programs sponsored by the drug companies themselves that offer substantial savings.

As for the "cost of research and development" argument...in many cases the R&D is already paid for by GOVERNMENT grants to either drug companies themselves OR to research colleges working in conjunction with the drug companies. Also, several years ago Frontline did a program where they investigated the costs to the drug companies and it turned out that the companies spent MORE on advertising (around 19%) than they did on R&D (between 12% and 15% as I recall). Why do drug companies even have to advertise via mass marketing when the drugs cannot be purchased EXCEPT with a doctor's prescription? Maybe if the drug companies were a little more honest and also spent less on advertising the drugs wouldn't be so expensive.
 
  #25  
Old 08-03-15, 01:39 PM
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Joel I think the big reason the drug companies want to advertise so much is to get people to buy their medication whether they really need it or not. Many of the advertisements try to get you into thinking you might have this or that problem way before you hear anything about side effects. Then they run through those fast hoping I assume that you don't hear about the side effects. Afterwards everyone is smiling like they are having a great time with no problems in the ad.

Of course there is a way to reduce your costs even further with medication and that is to go into a medicare sponsored HMO. However they may not pay for all of your medications and all of those HMO companies are usually not forthcoming about what medications they will pay for until you sign up. Unfortunately that happened with my mom she didn't find out about what they would pay for until she signed up. It took a call to our senator's office to get the problem resolved as they didn't want to allow her to change back even though she was in the plan for only a few days.
 
  #26  
Old 08-04-15, 02:39 AM
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I think the big reason the drug companies want to advertise so much is to get people to buy their medication...
Of course that is the reason, companies are in business to make money and they can't make money unless they have a product (or service) to sell. My point is that unlike most things where anyone with enough money can buy whatever they desire the products of the drug companies are most often restricted from general sales because the government has decided that a person needs a doctor's approval (prescription) before buying. Since that is the case, all the mass marketing does is try to persuade the individual to pester their doctor for permission. In my opinion any ethical doctor will not be swayed by a patient's request but will only prescribe if there is an actual medical need. So, again, in my opinion, mass marketing is a very poor method to use in selling the drugs.

I trust my doctors to know about new and/or improved drugs and also to be able to determine if I should use the new or improved drugs. I would never presume to tell my doctor what drugs I should be using, after all, that is why I pay the doctor, for his/her expertise in a field that I am not an expert. It is no different than my telling the auto shop how much a certain part costs or the best way to repair my car. If I can't trust my doctor then I need a different doctor...and trust me, I HAVE changed doctors because I thought they were not giving me the best advice or treatment.

Of course there is a way to reduce your costs even further with medication and that is to go into a medicare sponsored HMO. However they may not pay for all of your medications and all of those HMO companies are usually not forthcoming about what medications they will pay for until you sign up.
And THAT is the problem! I prefer to be an informed consumer. Sometimes I have a tendency to over research things but in the case of ANY Medicare supplemental plan (be it Part D, straight supplemental insurance or Medicare Advantage plans the information is NOT readily available and what info IS available is not in a format that induces easy comparison.

For example, there are 13 or 14 different Medicare supplement plans available. Each category (A, B, C,...N) is identical within the plan designation but the various insurance companies that offer the plans can charge whatever they desire. That means that "Plan A" from one company might have a monthly premium of $50. while Plan A from a second company may charge $100. and a third company may offer it for no monthly premium. Since the benefits are the same regardless of the company (and cost) how does a person make an informed decision as to how or why one company may be better even though the cost could be higher or lower than a different company?

Further, these various companies are quite reticent in disclosing why their plan is "better" than that offered by some other company. They ALL want to either come to your home or call you and have a fast talking sales person try to intimidate you into buying THEIR plan regardless of what may be best for you. I am capable of reading and comparing things in print but I have poor sales resistance when confronted by a fast talking agent who more likely as not gets a commission for every deal he or she closes.

As another example my Medicare booklet lists several pages of Advantage plans supposedly available to me based upon the geographical area where I live. The vast majority are HMOs and I prefer a PPO for several reasons. The THREE PPO plans that I found did NOT state for certain that the plans applied to my area and when I went to the websites all they wanted was my address AND telephone number so they could contact me.
 
  #27  
Old 08-04-15, 08:26 AM
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"And THAT is the problem! I prefer to be an informed consumer. Sometimes I have a tendency to over research things but in the case of ANY Medicare supplemental plan (be it Part D, straight supplemental insurance or Medicare Advantage plans the information is NOT readily available and what info IS available is not in a format that induces easy comparison."
Exactly! Very well stated too!...

Healthcare for seniors is exactly as intended. Excessively complex......and overly confusing!... Nor does any aspect or part of it have our best interests at heart.

If you're not already on a sedative, you'll need one before your choices and the selection process is completed.... Or very soon afterward. Good Grief! Tomorrow you'll wake up (Hopefully) and be wondering why you selected that plan and not another......GI2

For seniors the selection should be as easy as buying a postage stamp. One letter sent anywhere in the country for one price. We all pay the same. (Single Payer???) Simple-Simple! Steve Jobs style.

>>>Keep it simple stupid!<<<

 
  #28  
Old 08-04-15, 09:15 AM
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I would never presume to tell my doctor what drugs I should be using, after all, that is why I pay the doctor, for his/her expertise in a field that I am not an expert
I agree! except for the practice of the drug companies of providing perks to the doctors to get them to prescribe their drug instead of a competitor's. My previous doctor told me the main reason he let the drug reps in the door was to get samples so he could provide them to his poorer patients.
 
  #29  
Old 08-04-15, 02:14 PM
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I wouldn't presume to tell my doctor what to prescribe either and quite honestly some of those ads scare me especially with all of the side effects. The most troubling thing is when you get your prescription say for a statin as in my earlier post not all of the side effects are on the information sheet you get from your pharmacist. Luckily I have the internet available to me and I as we all do here navigate it fairly well. For those who don't have a computer and don't navigate the web the consequences could be deadly without the missing information.

The bad thing too besides all of the samples being given are some of the perks the drug companies give that you don't hear about often including paid vacations here is a small article about the perks Most Doctors Take Drug Co. Perks. Don't get me wrong I do trust my doctor but I also go by the old saying trust but verify especially before taking a new drug. Something though definitely needs to change for seniors and everyone else too so that we have safer medication and less influence from drug companies over doctors.
 
  #30  
Old 08-04-15, 02:54 PM
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Backing up to post #21 (this thread may become as confusing as the explanations are for our rx.
Just opened my monthly summary from my ex coverage through AARP. Where I had been assuming my out of pocket is combined with what the insurance pays to total to the initial threshold for falling into the doughnut hole, the $2,960, there is no mention of what the insurance portion was. I've filled three prescriptions and the total towards my threshold is exactly what I paid. Conflicting information, but actually simpler if they keep that definition throughout.

Another note I will need to check out is, when in the hospital, those meds may not be covered. How do you tell the emergency room doctor to only prescribe meds approved by your insurance while you are flat on your back getting put back together?

Another insurance note on a different topic, but when you enter a hospital your/my insurance coverage is different if you are admitted as an inpatient vs outpatient. Big difference as to what is covered. Again, how do you argue the point when YOU ARE the patient.

It's raining so I think I need a lawn chair and a beer to enjoy the cool rain.

Bud
 
  #31  
Old 08-18-15, 10:27 AM
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When it comes to medical care, if you don't have insurance, the sky is the limit. I wouldn't be surprised at all that the $1,200 is what someone without insurance would have to pay. Depending on the drug, the pharmaceutical companies will offer it for a discount if you don't have insurance. You have to go to their website for a coupon or something for it.

Bud, as far as that stuff about coverage in the hospital. You can schedule a surgery with your covered doctor. But the covered doctor has an additional surgeon come in to assist who is not covered by your plan. And they will charge tens of thousands of dollars more than your covered doctor and you have no choice about it and are stuck paying that bill.
 
  #32  
Old 08-18-15, 10:45 AM
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And how's this for crazy. I discovered a popular name-brand medication is exactly the same price for 50 mg AND 100 mg! The insider scoop is if you take it in 50mg doses, get your doctor to write prescription for 100 mg and split the pills, effectively cutting your cost in half. Wonder how many other meds are like that?
 
  #33  
Old 08-18-15, 11:33 AM
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I believe many are like that TG. They've been selling pill cutters for years I know that. Maybe because under insurance it was the same cost no matter what. Get the double dose and cut it.

I swear, you and I are probably in the best position for medical. I had to get some eye drops for this ongoing problem I have. Doc asked how my insurance was because a 3 month supply could be $1000. Relatively new thing, no generic available. Had them send it to the online pharmacy, $16 for 3 months.
 
  #34  
Old 08-19-15, 05:44 AM
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No complaints here, although when we were pushed from Prime to Standard/Extra last year it bites into the wallet a little more.
 
  #35  
Old 08-19-15, 08:48 AM
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Hmmm, I kinda found it the opposite. No every visit co-pay and if your overall health is good, after the deductible is met, a doc visit is pretty cheap. And there's no $500 sign up fee. I must admit though when I was on prime I knew that after the initial payment, the most anything would cost was $12 (that was a few years ago).

Have the eye doc bill in front of me. If no insurance I'd have been billed $375, the contract amount is $75, but I only payed $11.50. That's less than the current Prime co-pay I think.

Prob be a lot different if there were more than the 2 of us. Plus we were both retired military, so that made it more complicated in Prime, not that that matters anymore.

Still the best deal going I think, esp the pharmacy benefit.

Going to have to start exploring how Medicare is going to affect it in a few years.
 
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