The insane price of prescriptions

[disneysteve]

My mother has good insurance but there is one medication she takes that isn't covered by her plan. We've shopped around for the best cash price and checked out the discount coupon companies like GoodRx and LowestMed. The best prices are excellent but what really struck me was the range from low to high.

Best price for a 90-day supply: $108.02
Worst price for a 90-day supply: $351.07

For the SAME drug.

I realize that prices for anything will vary a bit from store to store, but that spread is ridiculous. How can pharmacy B possibly justify charging $243 more than pharmacy A? That's more than triple the price.

Buyer beware, and do your homework before you walk out the door.

[moneybags]

Prescription drug prices are tricky. I take an Rx that is made by at least 3 different companies as a name brand and some generic companies. Generic is not a great option with this drug. The version my doctor prescribed was $80/month. The pharmacist told me about another brand that only costs $10/month (which I switched to). My doctor did not have this info, and I would not have known if the pharmacist did not tell me.

I later found out that drug companies run their own coupon programs to lower the cost you pay at the pharmacy. I could have gotten my $80/month drug for $25/month through this program. I got this info from a friend, not the doctor or pharmacy. Check the company's website for drug discounts.

[disneysteve]

I later found out that drug companies run their own coupon programs to lower the cost you pay at the pharmacy. I could have gotten my $80/month drug for $25/month through this program. I got this info from a friend, not the doctor or pharmacy. Check the company's website for drug discounts.

This is definitely true for many brand name drugs. There are often coupons that can lower the copay to as little as $0 if you have commercial insurance. We get a ton of those coupons at my office though I virtually never give them out because most of our patients don't have commercial insurance (mostly Medicaid and Medicare which aren't eligible to use the coupons).

I've also found that many pharmacies don't know what to do with the coupons and just tell the patients they didn't work so you need to do your homework and be persistent if you're sure you are eligible. Some of the coupons also need to be activated before you go to the pharmacy by calling a number or visiting a website so read the fine print.

[disneysteve]

The other thing to watch out for is the price of different doses of a medication. Sometimes it can be cheaper to take 2 pills of a lower dose than 1 pill of a higher dose. Or it may be cheaper to take 1/2 a pill of a higher dose than 1 pill of a lower dose. You have to check prices and figure it out.

For the medicine my mom needs, the 2.5mg is $108. The 5 mg is $278 at the same pharmacy. So if someone needs 5mg, it would be cheaper to just take 2 of the 2.5mg pills.

There's really no rhyme or reason to the pricing structure.

[Gailete]

At one point I had a prescription for Amlodipine and Benazapril combined. Then suddenly the cost for the combo jumped sky high and I got separate scripts for each of them for a great savings

One of the things I want to do this coming year as part of my way to saving money, is to find out how much my three vitamins/minerals that I have prescriptions for that aren't over the counter. My drugstore always sends them through my MC-D program where they aren't covered and I get charged a price for them. I plan on finding who has the lowest price for them and not have them combined with my MC formulary meds. I find it interesting that when they add up the amount that you have paid out of pocket for meds before upping you into a different section on MC-D those meds don't qualify! So if I can find them cheaper elsewhere as long as it is close to my regular errand route, I'll be switching to save if at all possible.

I figure the more I don't have to spend, the less I need for expenses and that is the route that I am going to try to follow for 2018. I want to find ways to make more and find ways to spend less. I already am geared up to save about $1K/year on my meds, and finding those meds at a lower cost where they don't know I am on MC should be a help.

[disneysteve]

At one point I had a prescription for Amlodipine and Benazapril combined. Then suddenly the cost for the combo jumped sky high and I got separate scripts for each of them for a great savings

This is one of the "tricks" the industry uses to boost profits.

A drug comes out called Norvasc (generic name Amlodipine).
Another drug comes out called Lotensin (generic name Benazepril).
Each company sells their brand name drug for years until the patents expire.
Then other companies are able to start selling generic versions of each product for a fraction of the price of the branded agents.

Along comes a company, possibly one of the original two but not necessarily. They decide to combine generic amlodipine and generic benazepril into one tablet and call it Lotrel. Suddenly, it's a "new" branded agent with a brand new patent. They get to sell it as the hot new thing and charge top dollar for it.

Now doctors and patients actually like these combination products because they simplify dosing and improve patient compliance. The problem, as explained above, is that the cost of the combo pill is way higher than the combined cost of the generic individual agents, so of course insurance companies refuse to pay for it, rightfully so.

[creditcardfree]

Someday the US needs to allow more competition in the drug market. The drugs in the UK and Canada are just as good as the ones here, but that isn't allowed. And I think it's our government and insurance and pharma lobbies protecting the market as it is...for nothing more than profit. They may say it's for safety, but do Canadians and Europeans really getting unsafe drugs? I think not.

[disneysteve]

Someday the US needs to allow more competition in the drug market. The drugs in the UK and Canada are just as good as the ones here, but that isn't allowed. And I think it's our government and insurance and pharma lobbies protecting the market as it is...for nothing more than profit. They may say it's for safety, but do Canadians and Europeans really getting unsafe drugs? I think not.

I'm curious what you are referring to here. Most drugs are sold worldwide. And many drugs sold in the US aren't produced in the US. So the drugs sold here are frequently the very same ones sold in other countries. That's not why prices are higher here. That's primarily due to government regulations and liability issues.

[Smallsteps]

The answer to most of the higher costs in every aspect of healthcare / drugs is directly tied to liability. The only way we can fix some of these costs is TORT reform.

[Gailete]

It is crazy what passes for a 'new' drug these days. When Zegirid first came out, my GI prescribed it for me instead of Prilosec. Along with the script came a $75 off coupon. Yeah sure, I'll be able to afford it! But I took it to my drugstore and asked to speak with the pharmacist that we have a really good rapport with. He literally led me down and isle so that we were along and told me that Zegirid (sorry for the spelling) was generic Prilosec and 3/4 teaspoon of baking soda. So, they were charging me around $100 for baking soda as well as my medication dose. I could get a box of baking soda in the baking isle at the grocery store across the street for less than $1! I choose to pass on it. I noticed that it quickly went from prescription to generic to OTC and I don't even know if they still make it, I haven't see it or a commercial for it for a very long time.

Any time a doctor hands you a script with a coupon, you can be pretty sure that it is an expensive drug, but not necessarily more efficacious than something already out there. When it comes to medications we can't go around blind.

[disneysteve]

When Zegirid first came out, my GI prescribed it for me instead of Prilosec.

That fact alone would make me question the knowledge of the provider.

Zegirid (sorry for the spelling) was generic Prilosec

Yep.

I haven't see it or a commercial for it for a very long time.

Once a product goes generic, most marketing for the brand tend to stop because it no longer pays to do it. Why advertise Prilosec when the customer then walks into the pharmacy and buys the CVS brand right next to it (for 1/3 the price)?

Any time a doctor hands you a script with a coupon, you can be pretty sure that it is an expensive drug, but not necessarily more efficacious than something already out there. When it comes to medications we can't go around blind.

Definitely you need to be aware and ask questions. You shouldn't assume the opposite either, though: that a new med with a coupon isn't better. For example, there is an entire class of diabetes medications (the SGLT2 inhibitors) that all came out within the past few years, are all still branded, and all have good coupon offers to go with them. They are completely different than any other diabetes drugs on the market. You just need to ask why you are being given any med and if there are less costly options available.

[disneysteve]

Sometimes the only real difference with a "new" drug is a lower price, so that's a good thing.

One of the best selling brands of basal insulin is Lantus. About a year ago, another company came out with an insulin called Basaglar. It is molecularly identical to Lantus but considerably cheaper. It is basically what we refer to as a branded generic. Many insurance companies responded by dropping Lantus from their formularies and replacing it with Basaglar.

[Gailete]

That fact alone would make me question the knowledge of the provider.

Yep.


Once a product goes generic, most marketing for the brand tend to stop because it no longer pays to do it. Why advertise Prilosec when the customer then walks into the pharmacy and buys the CVS brand right next to it (for 1/3 the price)?


Definitely you need to be aware and ask questions. You shouldn't assume the opposite either, though: that a new med with a coupon isn't better. For example, there is an entire class of diabetes medications (the SGLT2 inhibitors) that all came out within the past few years, are all still branded, and all have good coupon offers to go with them. They are completely different than any other diabetes drugs on the market. You just need to ask why you are being given any med and if there are less costly options available.

These were my 'GI' doctors, his PA who seemed to forget when prescribing that I have hypertension as well and all that sodium wasn't real good for my BP. I get tired of going to doctors that refuse to take their blinders off and look at the whole picture that a patient presents. The PA was also happy to tell me how to eat and when I explained to her some of the problems I was having with procuring food, making food, having an appetite to eat food she looked entirely mystified. And went right back to saying the party line of do this and you will be fine.

For years I had a good combo of Doctors. My Primary Care, my arthritis docs, and my ortho surgeon. Then my PC doc moved out of the area and we had to pick up a new one. Which is only a PA - the two doctors that I have seen at the office (just in the last 7 months), both are somewhere else now. I'd been referred to a pain doctor, which is a whole long story and when that didn't happen (not MY fault) before I saw her the last time, I almost fell off my chair when she started talking about how a pain doctor if he could help me get control of my pain (in my back since my bad fall in March), now instead of just my back pain, she thinks one of them should be able to 'cure; me and my pain well enough that I won't need to take pain meds anymore! Lets see I have severe RA everywhere. Can't take any anti-inflammatory meds, can't take steroids, and the list goes on, but the original referral for back pain and a possible injection has now turned into a cure-all for a disease that my arthritis doctor and her associates haven't been able to get a handle on and they have no problems with me being on pain meds.

I think a lot of is has to do with how everyone has jumped on the band wagon that narcotics are bad for you, and how people taking it are going to be addicted, and non-medical people are setting parameters on whether it should be prescribed or not. It is a real pain -- literally and figuratively.

One of the narcotic meds that I was on, when I called in to the doctor that I had seen a few weeks before and he said he would have no problem prescribing them, when I called for a refill, about them, he had his nurse call me and tell me he wasn't 'comfortable' prescribing them and to stop taking them, NO withdrawal plan, just cold turkey more or less. Thankfully I had been careful to only take them when absolutely necessary. But then my hubby went to the pharmacy one day and they had a floater pharmacist of some kind working there that day and he wouldn't fill hubby's script because he wasn't 'comfortable' dispensing it with another med that he had been on both for over 10 years. He shows up for one day and says no. What kind of care is that? Why suddenly is it more important for the doctor and pharmacist to be more comfortable than the patient?

Health care, and I don't even include the national health care when saying healthcare, is going down a long slippery path. It is sad to see and say. It is frustrating for patients and I'm sure for good docs as well.

[JoeP]

Why can't be as simple as the drug company selling the product for a fixed price? In other words, a single pill is made available at single wholesale price. So any retail establishment can sell it for whatever price they want.

[Gailete]

Why can't be as simple as the drug company selling the product for a fixed price? In other words, a single pill is made available at single wholesale price. So any retail establishment can sell it for whatever price they want.

Currently you can call 5 different pharmacies and get 5 different quotes and get 5 different prices, and then add in your drug insurance, you will get 5 more prices. It is so hard to comparison shop. If you are taking a med that is $10 or less, at this point I wouldn't do a lot of price shopping, but for a med in the higher range you have to unless you are tied into one pharmacies. For instance I have a drug contract that says I can only take pain meds prescribed by one doctor and have them filled at one pharmacy. So even if for some reason the price is $50 less elsewhere, I have to pay a higher price!

Anyone on a pile of meds, is up a creek after a while, since who wants to go to several different pharmacies to get the best prices for each individual drug.