Insurance drug pricing (higher with insurance)

I think the only reason to go through insurance is if the prescriptions go towards your deductible. If not, there is absolutely no reason to have the insurance lol. I notice this happened to me too, where it was less expensive in canada than it was in the US with insurance. My current insurance is slightly better so it's no longer cheaper to go outside the country, but if it were, I would definitely be doing it. Why pay more?

I think this also heavily draws on generics. So for 6mp or generic 5asa enemas, it works real good.

I use Lialda because I like the fewer pills, and it has been working. The prices with approx 17% coupon in my area varied from $576 to $587 for 90 tablets. With my insurance I pay about $170. With the addition of a manufacturers Lialda discount card, I pay about $50.

It is not clear if this particular discount card is in the goodrx system, because it offers upto $120, which is more than the 17% discount they say their coupon can offer.

I use sfRowasa, and it immediately offers me very 7 cheap generic 5asa enemas which vary from $3 at a few local pharmacies to $102 at CVS where I generally shop. Or somewhat pricy Rowasa varying from $290 to $293.

sfRowasa is not even in the system.

This would be great if I could tolerate the regular Rowasa or the generics.

But, I use generic Ambien, and the insurance co-pay at CVS is about $0.67. Zolpidem 10mg is available with their coupons form $8 to $11 (at CVS) supposed to be a 93% discount vs cash. I guess this is the CVS cash price. Because Caremark (my prescription coverage plan) says the price using their insurance is $2.64, and my $0.67 is the 25% copay. This is wierd though because Caremark and CVS have the same parent company Caremark/CVS.

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This has got my head in a whirl this morning. I do like the convenience of one pharmacy. I like CVS online system for refills, and their service to contact doctors office for renewals. My doctors also generally prefer to send prescriptions electronically, which means I might have to tell them in advance different pharmacies for different drugs, and it could get confusing.

My prescription coverage has co-pays but no deductible, but I know some plans do. I wonder if someone who uses the coupon instead of insurance can submit their receipt towards their deductible?

Post Edited (DBwithUC) : 11/29/2012 9:55:57 AM (GMT-7)

I guess the prices vary quite a lot based on the pharmacy you go to. I get my medication from RiteAid Pharmacies, now brace yourself for these crazy prices on the receipts for my meds:

1.) $913.00 for a 30 day supply of Lialda (120 pills). I use the Lialda discount card from Shire and my copay is therefore only $10 a month but without that card it would be a $40 copay each month. No idea what my insurance actually pays up for those pills it is probably just the list price for the pills in RiteAid's computer system.

2.) $439.00 for a 30 day supply (30 units) of Meslamine Suspension Enema (4g, 60/ml). I pay a $10 copay.

This literally scares the crap out of me that I'd have to pay that out of pocket should I loose my insurance from my work, or if my work cuts back on prescription coverage next year.

deltaforce

I suggest calling your health insurer and asking your question. They should be able to justify why medco price is higher than mail-order. I suspect you are seeing wrong information but cannot tell.

When my Rx gets priced out at Walgreens, for instance, asking the pharmacist to price it with medco (mine is that also) almost always results in a lower price except for very low cost generics.

However I recently inquired (before ordering) the cost of an Rx novocaine cream and was quoted a price (I forget) and when I went to pick it up it was 30% higher. Pharmacist then punched some keys and it got lowered. I suspect there are many, many prices for the same meds, just depends on what keys are pressed. Smells like fraud to me but then the whole system is set up wrong IMO.

I say it should be one price of meds for all, and remove the middlemen taking their cuts (such as dispenseries and insurers, etc). The middlemen arekilling the economy and killing sick people who skip meds because they cannot afford them or are embarrassed to say they can't when the cashier rings it up. It makes me sad to think of sick people (mostly middle-class) without alternatives.

I'm not sure if this is your question but will respond in case others are interested:

You've gotta be low income with high medical expenses to see much benefit to choosing to "itemize" your deductions (health expense is just one of them).

You can only deduct health/medical expenses that exceed 7.5% of your AGI (adjusted gross income). So if your AGI is $40,000 the first $3000 is not deductible. Allowable medical expenses over 7.5% hurdle are deductible--not from your taxes however, just from your AGI which determines what tax you owe.

Most years (99%) it's better for us to take the standard deduction.
However there can be a trick to achieving maximum deductibility:
keep your income low if possible and do as many necessary medical expenses in one calendar year as possible such as colonoscopy, expensive lab tests, order "vacation" meds in December to cover January also (I've done this when out of town extended period), etc. Some mail-order pharmacies will supply 3 months of Rx at a time also.

In the past 12 years I've only had one year that itemizing was worth it and it wasn't more than $200 better than standard deduction.

A better idea is a Medical Savings Account (MSA) or Health Savings Account (HSA) because you avoid income tax on that money entirely. Much better than a deduction on 1040 form.

imagardener2 said...
Your price comparisons:

Did you double check with Walmart and medco that they were both quoting the same drug?
Balsalazide (Walmart) is generic. Perhaps medco was quoting Colazal (brand name).
Some people on this forum feel they do much better with brand name Colazal.
I've never taken brand name, always on generic Balsalazide for which I pay $119/mo (270 pills 750 mg).

Maybe I should go back to Walmart to save $40/mo (which I left 2 years ago because they were snotty and never had my order done on time, like days late).

Thank you for your previous reply on tax but I may need some more info. Can I write you off the forum?

To the drug question,
Yes, I confirmed with Medco. Colazal costs $397 for 270 capsules and the generic is $181 (for my insurance). Same drug Walmart sells it for $77.88 WITHOUT any insurance but with goodrx.com coupon. (I am very very curious about goodrx business model). I confirmed with CVS too (closer to me) so I am just going to fill up from CVS. The prices could vary from state to state or even neighborhood. Check goodrx.com I will post a screenshot if you want.

I have always used Mylan in the US (used to use Colazal in Sweden, called as Colazid there), so far no troubles.


With your complaint about walmart, no point in complaining pharmacists or the folks working there. A friend of mine is a pharmacist with similar big chain pharmacy (who is opening his own in new year) and I asked him for this reason (because in my case Rite-Aid used to take more than 2 days to fill up my Rx). From his point, they spend more time with the insurance companies than filling up the prescriptions. So if anyone has to be blamed, its the insurance companies. In addition to that, many doctor's offices expect pharmacist to call them instead of the way around to get the prescriptions. And finally, the working conditions are deplorable (surprised? me too but then it will become a HUGE post).