topic CVS Caremark Price Gouging in Medicare & Insurance

CVS Caremark Price Gouging

DavidT731263 — Tue, 20 Aug 2024 16:21:11 GMT

$450 for a prescription that other providers sell for $11 to $16? This is price gouging on a scale that sent Martin Shkreli to jail. I've got a new job and with it, new insurance, a high-deductible policy with an HSA for the first time. Under my old policy, I had been making $25 copayments for 90-day supplies of my one prescription. I had no idea what it might cost without coverage. When I refilled it for the first time under my new policy, CVS Caremark (my new insurer's only supplier of 90-day refills) called to authorize the sale at $450. I would not be eligible to make a $30 copayment until my deductible was satisfied. I was shocked, but I concluded that this must be the regular price for my prescription, a price I had never paid in full before. So, I agreed. Only later did I think to look at other prescription drug providers, even if my insurance would not cover them. For the same prescription, CostPlusDrugs.com would charge $16, delivered. Amazon Pharmacy would charge $11 with free delivery because of my Prime membership. These are both lower than my copayment. CVS Caremark's price is so high, I wonder how their corporate officers avoid prosecution, like Martin Shkreli.

Re: CVS Caremark Price Gouging

GailL1 — Tue, 20 Aug 2024 17:51:37 GMT

Since, it seems, you are new to the concept of an High Deductible Health Plan with a HSA, it may pay to understand how it works for you. You should be getting a really good tax savings with the HSA.

Healthcare.gov - Understanding HSA-eligible plans

Your current employer coverage doesn’t cover THIS drug as the one you had before -

It is ALWAYS wise to check some of the low cost pharmacy outlets to see if you can get your Rx there - they don’t carry every drug but it does pay to check; some of them are limited to the generic equivalent but others have a somewhat wider formulary.

Each insurer negotiates their own prices on the pharmaceuticals on their formulary.

Sounds like you aren’t on Medicare yet so, this point about checking with the low cost pharmacy outlets is doubly important if you are on a Medicare Plan D.

Also, just a heads up, if you are close to 65, or want to keep working with the employer, you need to understand how Medicare works with a HSA - that’s also covered in the above link and at this one so that it does not trip you up when it is time to change to Medicare.

SSA.gov - 2024 MEDICARE

Good Luck -