Health insurance: supplemental coverage for prescription/pharmacy benefits?

[destrekor]

So I finally called today and discovered that my previous understanding has been mostly correct.

I pay the quoted prices for meds until I hit my deductible, and then the tiers come into play.

And weirdly, both of my meds will cost more to go through the mail order program than going to specific local pharmacies. Rite Aid clearly sucks as a pharmacy on my plan, but Meijer is really low as Kroger is better than most the others. There's actually a local pharmacy that has the best prices somehow, with one of two locations right down the street from me! In the online tool only the one that's a little further from me comes up, but if I got to stick to 30 day in-person fills I need this to be super close or perfectly on the way home from work. The closest location I can literally make on the way home, not even having to backtrack at all and still keep normal commute distance. I normally go a different way but hell, it might add a mile, if that, to my trip. Really hope I can fill to that one, and also really hope that perhaps that pharmacy will be cool with 90 day fills. As they are antidepressants I don't know how that all works and I think it may even vary state to state. I do know the price tool says I can get 90 day in person specifically at CVS and never shows any other retail option but it's the same ridiculous price as the OptumRX mail order option. On the phone they did say it wasn't something up to insurance but up to the local pharmacies and rules set by the prescriber, and presumably laws for that matter.

I did discover that I really need get on Xiidra though (for dry eye). I tried Restasis for a few years during college, I felt it may have helped a little but it wasn't significant. I feel my eyes are getting worse now and have been wondering about giving that one a try. Obviously it would have the worst coverage benefit from my insurance and require specific approval, but I know at least currently the manufacturer offers coupons. But this is the fine print:
"Eligible patients will pay as little as $5 for each 30-day prescription with up to $250 savings on their out-of-pocket costs for Xiidra. Eligible patients with a 90-day prescription will pay as little as $15 with up to $750 savings on their out-of-pocket costs for Xiidra. The actual savings on out-of-pocket costs for Xiidra will vary according to personal healthcare insurance coverage. Program subject to change. Not available under federal or state programs. Program expires 12/31/2019."

Is that basically a $250 discount, or saying that there is some metric that determines how much discount you can get?
I also see the notation that says the discount program will end at the end of this year. Is that typical? (Xiidra is from Shire) Do manufacturers tend to actually discontinue these discount programs when the product is still so new (been out for about a 12-18 months I think) or is it typical to advertise it'll end and then renew the program for another year, rinse and repeat?

 

[highland145]

So the wife was supposed to get a referral to a kidney Dr. "We sent it electronically on Tuesday. You should give it 7 to 10 business days." Possible small cell sarcoma, no biggie.

 

[BarkingGhostar]

GoodRx has proven to be worthless in the one name brand drug and one generic of the name brand drug. I plugged in the name brand drug, then my zip code and got pricing. I noted Walmart having the lowest price and went to that Walmart, who said Goodrx was mistaken and they wouldn't honor the false advertisement. In fact, they said their price was twice what GoodRx had advertised. Feeling let down, I tried CVS, across the street, and Costco and the exact same thing. GoodRx was advertising a price less than half the actual price.

I then stumbled upon something when the CVS pharmacist said the Good Rx price was their price of the generic drug, but when I looked up the generic on GoodRx is was still considerably lower. So, I repeated this with Walmart and Costco and in each case GoodRx was advertising prices that were no where near correct. And considering I checked three sources for both the name brand and generic equivalent I would say GoodRx was a total bust.

 

[highland145]

I used them just today at CVS for doxycycline. $17 instead of $50.

We have had problems with walgreens not honoring the price but we just don't use them anymore.

 

[Dulanic]

Thanks, Bush.


The high deductibles suck until you blow past them. The wife picked up an autoimmune problem. Just the hospital stays in 2017 were $70K. We met our deductible in the 1st quarter of 2019.

I'm with you. I hit my OOP max in 1 month. I'm on a med that I taut every 6 months, 35k per so I got cap. Thankfully the manufacturer covers that. But our whole health care system is so fucked up.

 

[destrekor]

So I just wanted to add that I presently have the lowest cost sourcing method available, which is a local pharmacy business which operates two stores, one of which is about a mile down the road from my house, literally the same road. I can swing by, and they have a drive through, adding but a mile on an otherwise direct route on my way home from work. This is amazing, and I absolutely love supporting the local businesses in this area of town.

But when I went shopping on Amazon I was reminded of the PillPack company/service, and also that it was bought by Amazon.
I was able to find their National Provider Identifier number and used that in the OptumRx price lookup page, and discovered that their 30 day prices are for all intents and purposes the same - it's a difference of loose change. Pennies/dimes/nickels, I didn't feel like hunting down the receipt and OptumRx only lists one of the retail prices I paid, the other it isn't listing instead saying unknown. Whatever, the rough total I knew was barely any cheaper, less than a quarter total between the two is my rough guess. And PillPack packages each medication by time of day, per day, along with any OTC products you desire.

Yes there's the argument that perhaps we shouldn't be letting an Amazon company learn all about our medications and lives in general, but the more I think about it, the more I realize that all of the various PII streams add up to far more data concentration. I mean hell, video providers like DirecTV have either started, or have been planning, to collect credit card information on subscribers with the plan to correlate ad views with purchase habits, and this kind of data use is only going to grow my exponential across multiple industries. Even inadvertently that same information may still end up in third party hands even if you abstain from doing business with them for that very reason.

The convenience of getting mail order 30 day supplies automatically sent without thinking, all for the same lowest possible price I could pay for these meds? I like it.