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OT - Meds with insurance are expensive than without insurance

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Ulcerative Colitis
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Posted 10/21/2014 9:29 AM (GMT 0)
Hello folks,

I ran out of my Hydrocortisone and Mesalamine enema. Called up CVS for a refill and the cost of mesalamine enema with insurance is ~$2000, then called up Rite Aid (they don't have my insurance information) and the cost is $160. I am pretty sure I didn't hear it incorrectly as the price on OptumRx shows up same, around $2K.

Secondly, OptumRx tells me that Sulfasalazine DR manufacturer has a backlog so they can not fill up my Rx until next month, whereas CVS can fill it up in 2 days, costs way less than what insurance charges me (but I still have to use insurance to meet the deductible).

I am no clue what is going on. Anyone insider can explain this?
Posted 10/21/2014 12:39 PM (GMT 0)
Ha...this reminds me of something that my dad went through last year. With insurance a procedure was going to run him 2200$. He went to a different (better) hospital and claimed he had no health insurance and paid 642$ out of pocket. I guess you can say two different hospitals are two different variables also but I have a hard time believing it would be any significant difference in costs if you just accounted for hospital X vs. Y.
Posted 10/21/2014 1:35 PM (GMT 0)
Delta, I called my bestie (who's a pharmacist) and he did some research for me.

The generic emema cash price is $176 for a 7 day kit. They also have a 28 day kit. Perhaps Rite Aid gave you the 7 day price?

He also said that Sulfasalazine is orderable and he would have it next day.

Sorry your having trouble. Hope this helps.
Posted 10/21/2014 2:43 PM (GMT 0)
If my deductible isn't met then ordering generic melamine enemas from Canada is my lowest price. At the moment I'm at 50% insurance coverage so ordering from Walmart will be close to the Canada price.
I have not found US RX prices without insurance is lower than with insurance but I'm in Florida.

Canada is not always the lowest price for all Rx, you have to check. Canasa supps are much lower from Canada however.

The thing that burns me is that US pharmacies will not give a price for Rx unless they have your script in hand and then they run it through your insurance plan. I think that sucks.
Posted 10/21/2014 3:00 PM (GMT 0)
"The thing that burns me is that US pharmacies will not give a price for Rx unless they have your script in hand and then they run it through your insurance plan. I think that sucks."


you mean if you want to pay cash ?
Posted 10/21/2014 3:27 PM (GMT 0)
No, you have it right. LiamsGram you need to get into specifics with your bestie because that's not the right information. Get 28 hydrocort enemas for just a little north of 200$. Use goodrx coupon and bring it down in $100s. 28 bottles of the generic rowasa is $160ish. Prices will vary of course, but not vary by the 1,000's. Insurance price will always be more, but doesn't really matter because there is an allowable amount for the drug for each insurance company anyway. They may charge $2000, but the allowable amount may be like $500. You want the different amount you would tell the pharmacy you didn't want it billed to insurance.
Posted 10/21/2014 3:36 PM (GMT 0)
What insurance claims they paid for my drugs is sometimes 3 times the cash price .Blue cross did this for 3 years with colazal. The cash price for colazal has fluctuated between $85 and $325+ in the last year which is unexplainable. It is really in the best interest of insurance to make you think they are paying a fortune for drugs and since many people have a copay not coinsurance or a deductible on drugs, it might be possible they aren't legally required to tell you the truth in that case. I also wonder if drug companies don't have deals with insurance companies to rebate some of the price they pay the pharmacies for preferred drugs and have a contract to do so . And then you have doctors legally selling your medical records to drug companies and writing scripts according to which company is buying.

Basically the system is rigged to keep the consumer in the dark and a mark.

You can check Rx prices on the net at Goodrx.com. You print off a discount card and take it to the pharmacy. If you belong to Costco, they quote prices on the net and have pretty good prices on many drugs.

Why exactly are 5asa meds not over the counter? Safer than most OTC drugs.
Posted 10/21/2014 3:48 PM (GMT 0)
I have no idea why the system is the way it is.

I went to Rite-Aid and what was told ~$150 over the phone for 4 packs of mesalamine enema turned out to be false. Went to CVS, they have goodrx info in my account, turned out to be ~$250 for pack of 4 i.e. 28 enema. I would have paid about $1200 with my insurance. What a crazy system.

GoodRx has always came handy for me. Those who pay cash should take a look.
Posted 10/21/2014 3:49 PM (GMT 0)
whoops tested Goodrx on generic rowasa and got this notice:
"We are currently unable to show coupon prices for mesalamine, but you can still use a GoodRx discount to purchase at your pharmacy."

Estimated price of $462 for 28

Canasa is $727 best price for 30

Colazal is $100 for 280

asacol hd is $911 for 180

and Costco prices aren't so good anymore for UC stuff
Posted 10/21/2014 3:58 PM (GMT 0)
460$ from walmart. My zip code is 40505 Lexington KY. Rite-aid gives me $160 on generic rowasa for 28
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