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Confusing drug pricing

I have Silver Script Part D. I had to refill a couple of heart medications I take. One for BP and the other for Cholesterol. I put a refill in with CVS and both had gone up over almost 100% since I last filled around 90 days ago. I called Silver Script to see if their tier status had changed. It hasn't and I told the agent these were huge increases. I take 6 prescription drugs on a daily basis for various health issues. I had already had met my deductible early in year. Frustrated I searched on the Internet for lower costs. I had seen GoodRx on TV and thought it was some gimmick. I went to site and see that you have to click on coupons. I priced the two drugs at a local supermarket chain using the coupons and the price is for real. One drug price dropped from around $90 to $14 for a 90 day supply. It was the identical drug. It was already a generic but under Silver Script it was ranked as a tier 3. The other drug was a brand name and I am getting the same drug at the supermarket.

 

Why do they make it so difficult to find the lowest price for a drug for seniors. There should be one price under medicare Part D and one if you don't have Part D. Obviously with GoodRx I am not using Part D. This is a game like buying a used car or a new mattress. Every senior on Medicare should pay the same price. What's sad is someone like my father who is in his nineties and is not on the Internet is paying higher prices for drugs because he is not computer savvy. So now I have to fill two of my drugs at a supermarket and four at CVS because the price on the other four was still lower with Silver Script. I am saving over $400 a year a now because I shopped the drug prices. 

 

I shouldn't have to do this. GoodRx does show you the pricing at the various outlets so if I went to the site first when I got Medicare 3 years ago I would have seen the price difference. Not using SilverScript doesn't work every time. Another drug I take is $177 for 90 and the best price on GoodRx was $456 for $90. That is the point I am getting too. The lowest price should always be the Part D plan but that is not the case and the price difference is significant on two of the drugs. 

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@MikeD848313 wrote:

Why do they make it so difficult to find the lowest price for a drug for seniors. There should be one price under medicare Part D and one if you don't have Part D. Obviously with GoodRx I am not using Part D. This is a game like buying a used car or a new mattress. Every senior on Medicare should pay the same price. What's sad is someone like my father who is in his nineties and is not on the Internet is paying higher prices for drugs because he is not computer savvy.

 

The lowest price should always be the Part D plan but that is not the case and the price difference is significant on two of the drugs. 


Medicare Part D are (private insurer prescription drug ) plans which every senior, that pays for their own way, can pick and choose the BEST plan for themselves based on the medications they take.  ONE SIZE DOES NOT FIT EVERYBODY - everybody takes different meds.

 

The Federal government describes how Medicare Part D works for every private insurers as well as for beneficiaries.  Private insurers develop their own formularies depending upon the price THEY can negotiate with the pharma companies.  The Federal government tells them that they have to have at least (2) meds in each of the drug classification except for (5) classes; within these (5) classes, they have to cover every drug. 

 

The Federal government tells these insurers what each of the break points are for the type of Medi D which YOU pick - some people choose to have a deductible; some opt to pay a higher premium to NOT have a deductible.  When your drug cost get so much (meaning the cost of not just what you pay but the private insurer too - added together *), then the beneficiary has to pick up more of their cost until they reach a catastrophic level.

 

ALL Insurance is a sharing of cost.  What you pay helps out someone else and vice versa.  What most beneficiaries don't realize is that the Federal government is also picking up some of your cost for your meds. 

 

Now if you think everybody should just be on certain meds and anything outside of that is for them to figure out a way to pay - that can be worked out by establishing a National Formulary and only drugs on that list is applicable for a coverage.  The VA & CHAMPVA works kind of like that method.

The also fill from a generic equivalent if one is available - whether your doc orders brand or generic.

 

I agree with somarco - when open enrollment for Medicare Part D comes around pick the best plan for your needs & pocketbook.  You have to have one or pay a premium penalty if you EVER want one and you are outside of your initial enrollment period - that's for that "sharing" of insurance.  Understand the plan - when you pay the least; when you pay more during your TOTAL medication spending cycle *. 

 

Yes, always check to make sure that using your insurance is the best price available during your medication spending cycle * or if using a way outside of your insurance is a cheaper way.  However, people have to look at their total exposure when using this method because if you aren't using the insurance to purchase your meds, depending upon the total cost of the meds, some people will be shorted in getting to that catastrophic point.

 

Sounds like you are becoming wise to some things in the Med D program - now keep on learning it and then your can help out your Dad with his choice of plans.

 

Keep in mind also that many people, pick one and that is the end of their involvement forever or at least for a long time OR they pick a Medicare Advantage plan with an included Prescription Drug Plan (PDP) which is not any good for the drugs that they are on.

 

One final point - Of course, since they are paying a share,  the government has designed this program to incentivize beneficiaries to use the cheapest drugs (usually generic), to buy in quantity (90 days) when & if possible,  they encourage insurers to use "step-therapy" and "prior authorizations"  and even some "off label" use.  That's all about saving money - you have to do the same.

It's Always Something . . . . Roseanna Roseannadanna
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@MikeD848313 drug plans charge different premiums, have different formulary's and different "networks". There is no such thing as "one size fits all" when it comes to drug plans.

 

In my area we have 28 different plans with premiums ranging from $14 to over $100 per month.

 

As a general rule, the higher premium plans cover more drugs than those required by Medicare. They usually have lower copay's on higher priced brand name drugs. Many drug plans have generic copay's that are less than cash/GoodRx pricing but some of their drugs are higher than cash/GoodRx

 

There are many reasons why your copay is not the same each time you fill the prescription. Generic drugs especially have fluctuated quite a bit this year. Many are made in China and some have had recalls due to adulteration's in the product that can be harmful to your health.

 

When a drug is banned due to safety issues the pharmacy may seek out a different wholesaler who has a "safer" drug albeit at a higher price.

 

The first thing you should do is make sure you are using a preferred pharmacy.

 

Always (ALWAYS) compare cash/GoodRx pricing vs your copay.

 

PDP's are not logical and almost impossible to understand. The good news is open enrollment is coming up and you can look for other plans.

 

I have not found SilverScript to be particularly competitive in my area for at least 3 years. I can't think of the last time I recommended them to a client.


Bark less. Wag more.
Super Contributor

"Always (ALWAYS) compare cash/GoodRx pricing vs your copay."

 

I second this! GoodRx saves our family of four over $200 a month on assorted prescription meds I can't replace with wild herbs.

The medicine man at www.medicinemanplantco.com
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