Is This Legal

[Momma]

My health insurance company is charging me more for prescription medications than if I paid for it myself:eek:

I went to the Pharmacy to get my daughters medication and they said the insurance company would not pay for it until the 19th. I said, "Ok how much if I pay now."

The medication cost $9.00 without insurance. So, I paid it!

The co-pay that I have been paying for the medication is $15.00. That is what I have been paying every time to get her medication filled.

I feel like a dupe!

[BillBrown]

This isn't what you are asking, but my wife had a prescription filled the other day- $265 for THREE pills.

[gdoane]

My insurance went and did something even worse... any "maintenance drugs" have to be bought in three-month supply. The reason given for doing that was the insurance company would save money by only having to do the paperwork every three months instead of every month.

This cost-saving measure was great for them, not so great for the customer. If the meds are only $5 per month it's no big deal to spend $15 for three months. However, some of those meds max out the max copay of $70 per month and for those people, they've suddenly got to cough up $210 to buy three month's worth at one time.

That's a chunk of change that not everyone can just dig up out of their purse. The insurance company hurt a lot of people to make thngs easier on themselves and no amount of pleading or cajoling would get them to budge.

Insurance companies are more about the bottom line than about patients.

What I wonder about in the case of the OP is why the pharmacist didn't catch the copay being more expensive than the drug. Could it be the pharmacist gets a cut of the pie from the insurance?

[LouC]

My health insurance company is charging me more for prescription medications than if I paid for it myself:eek:

I went to the Pharmacy to get my daughters medication and they said the insurance company would not pay for it until the 19th. I said, "Ok how much if I pay now."

The medication cost $9.00 without insurance. So, I paid it!

The co-pay that I have been paying for the medication is $15.00. That is what I have been paying every time to get her medication filled.

I feel like a dupe!

Don't feel bad.

You always have the option of asking the pharmacist how much a medication is and possibly pay a lesser amount in cash rather than use your co-pay insurance.

Most people never think of or realize they can do that until a situation arises such as yours.

But now you have brought the subject up for others to learn from.

So that is good.

You can look at it this way that your insurance co-pay paid the $9 dollars for the medication and $6 dollars for the processing of the payment they made to the pharmacy.

If everyone with a co-pay would check first to see how much paying cash would be it would probably reduce the burden on health care insurance by millions if not hundreds of millions per year.

Sadly we get trained to do it one way.

[LouC]

This isn't what you are asking, but my wife had a prescription filled the other day- $265 for THREE pills.

I know that monetary pain first hand.

I always ask the doctor if they have any samples.

[ImNewHere]

Could it be the pharmacist gets a cut of the pie from the insurance?

Don't think so. But like any business, the better the profit margin looks, the better they look. So I wouldn't be surprised if it was done on purpose, but more likely they were just trying to get the prescription done and get to work on the next bunch he/she had to do.

Now as far as the 3 month supply thing....

What happens if you see your doctor the following week and changes your meds or adds new ones? Now you're stuck with several weeks worth of meds you can't use and can't return.

Damn insurance companies!

[MrShotShot]

My insurance went and did something even worse... any "maintenance drugs" have to be bought in three-month supply. The reason given for doing that was the insurance company would save money by only having to do the paperwork every three months instead of every month.

This cost-saving measure was great for them, not so great for the customer. If the meds are only $5 per month it's no big deal to spend $15 for three months. However, some of those meds max out the max copay of $70 per month and for those people, they've suddenly got to cough up $210 to buy three month's worth at one time.

That's a chunk of change that not everyone can just dig up out of their purse. The insurance company hurt a lot of people to make thngs easier on themselves and no amount of pleading or cajoling would get them to budge.

Insurance companies are more about the bottom line than about patients.

What I wonder about in the case of the OP is why the pharmacist didn't catch the copay being more expensive than the drug. Could it be the pharmacist gets a cut of the pie from the insurance?

I've had three prescription plans in the past 5 years and in every case the 90-day supplies cost me the same as the 1-month supplies.

That was the whole selling point, that and having them sent to me direclty in the mail.

Saved me hundred a year.

[Talk2Bill]

an HONEST pharmacist will tell you which way is cheaper. I saw a woman at a wal mart get really confused when they said they did not use her insurance because with insurance it was $10 without it was $4.

another thing is the Month at a time. But if there are 31 days in that month I have to skip a day?

And the stupid company refused to pay for my daughter's 2nd RX for tamiful? she got type B flu and then two weeks later she got type B.

[gdoane]

Don't think so. But like any business, the better the profit margin looks, the better they look. So I wouldn't be surprised if it was done on purpose, but more likely they were just trying to get the prescription done and get to work on the next bunch he/she had to do.

Now as far as the 3 month supply thing....

What happens if you see your doctor the following week and changes your meds or adds new ones? Now you're stuck with several weeks worth of meds you can't use and can't return.

Damn insurance companies!

I've seen it happen first-hand with an Uncle, guy's 85 years old and gets this deal on Medicare where he buys 3 months of prescriptions through the mail. This seemed like a good deal for him since he's got macular degeneration and is legally blind which makes driving a bad idea for him.

Anyway, the poor old guy had a stroke and after the hospital visit for that was all said and done, none of the meds stayed the same. Getting stuck with months of useless expensive meds is just adding insult to injury especially on a fixed income.

With so many meds being wasted like this, is it any wonder they're expensive?

[Talk2Bill]

and you have GOT to shop around. like any store any given pharmacy will have some meds at a higher price that other meds. And the price difference from on place to another can be significant. Also you can often get a gift card at that place if you bring a new RX.

Another cost saver we do (having 3 kids) is if it is a liquid medication we might just have one or 2 of the RXs filled as the meds often in a volume that is too much for one child. Once the twins needed some antibiotics. I noticed that the amount in each bottle was going to be nearly 3 times what they would need. So filled ONE and saved a bunch.

[Momma]

Thanks everyone for the replies. I to have been stuck with the 90 day supply deal. What do you do with the unused Meds??? Just a waste.

One other thing I did figure out with my insurance is that with my daughters medication if I get 120ml or 240ml it costs $15.00 so I got the Dr. to write for the larger amount.

Just a tip for all!!

I will be asking about the price from now on before I pay.

I also want to pass on another tip about the insurance company not wanting to fill a prescription before a certain date. Check out the dosing amount. My husband was on pain Meds and they were trying to refuse to fill before a certain date and I argued about the dosing prescribed by the Dr.

I had figured this out before I went to pick it up. Otherwise, I might have just gotten frustrated and left.

In my daughters Med case I did not figure out before I went to the Pharmacy and would have tried to make that argument had the medication not been cheaper.

FOR THE RECORD my insurance is UNITED HEALTHCARE:frown:

[wayoverthehill]

My insurance went and did something even worse... any "maintenance drugs" have to be bought in three-month supply. The reason given for doing that was the insurance company would save money by only having to do the paperwork every three months instead of every month.

This cost-saving measure was great for them, not so great for the customer. If the meds are only $5 per month it's no big deal to spend $15 for three months. However, some of those meds max out the max copay of $70 per month and for those people, they've suddenly got to cough up $210 to buy three month's worth at one time.

That's a chunk of change that not everyone can just dig up out of their purse. The insurance company hurt a lot of people to make thngs easier on themselves and no amount of pleading or cajoling would get them to budge.

Insurance companies are more about the bottom line than about patients.

What I wonder about in the case of the OP is why the pharmacist didn't catch the copay being more expensive than the drug. Could it be the pharmacist gets a cut of the pie from the insurance?Yeah, that can be a big bite. In my case, one of my meds has a high co-pay but I can get a 90 day supply for a 2 1/2 times copay rather than 3 times so even though I hate to lay out the money all at once, it does save me $22.50 on a 90 day supply.

[Samm]

My health insurance company is charging me more for prescription medications than if I paid for it myself:eek:

I went to the Pharmacy to get my daughters medication and they said the insurance company would not pay for it until the 19th. I said, "Ok how much if I pay now."

The medication cost $9.00 without insurance. So, I paid it!

The co-pay that I have been paying for the medication is $15.00. That is what I have been paying every time to get her medication filled.

I feel like a dupe!
The amount that Insurance Companies pay Pharmacies for drugs and the amount that you co-pay are both negotiated items. When you can buy drugs at a lower price than your co-pay, it is not because the drugs cost that much (that little) it is because the Pharmacy has a low-price (on certain drugs) policy. Walmart, Fred Meyer and Safeway (and probably other chains) Pharmacies all have such a policy. But that is a Corporate decision to attract customers into the stores, not a reflection of the actual price of the drugs.

[Momma]

The amount that Insurance Companies pay Pharmacies for drugs and the amount that you co-pay are both negotiated items. When you can buy drugs at a lower price than your co-pay, it is not because the drugs cost that much (that little) it is because the Pharmacy has a low-price (on certain drugs) policy. Walmart, Fred Meyer and Safeway (and probably other chains) Pharmacies all have such a policy. But that is a Corporate decision to attract customers into the stores, not a reflection of the actual price of the drugs.

I trade at a local Mom-n-Pop Pharmacy. We have CVS, Walmart, HEB, and Walgreens. I prefer to trade with the locals. I can't imagine they have that much buying power.

[Samm]

I trade at a local Mom-n-Pop Pharmacy. We have CVS, Walmart, HEB, and Walgreens. I prefer to trade with the locals. I can't imagine they have that much buying power.

When you say "they" do you mean the big chains? No... "they" are not relying on buying power to lower drug prices. They are relying on lower drug prices to attract customers into the store where they will buy lots of other stuff while they are there getting their prescriptions filled. Whether a Mom & Pop can afford that or not I don't know. Maybe they can if they limit the policy to just the most commonly prescribed generic drugs.

[Drew2]

My health insurance company is charging me more for prescription medications than if I paid for it myself:eek:

I went to the Pharmacy to get my daughters medication and they said the insurance company would not pay for it until the 19th. I said, "Ok how much if I pay now."

The medication cost $9.00 without insurance. So, I paid it!

The co-pay that I have been paying for the medication is $15.00. That is what I have been paying every time to get her medication filled.

I feel like a dupe!

I seriously doubt it's illegal. "Buyer beware", etc. I have a $10 co-pay on ANY prescription filled which I think is really a damn good price. I know of plenty of people who are required to pay a percentage of the cost of the Rx.

I take a maintenance medication that would cost me the typical $ 10 a month, but I don't use my insurance for that because I get it for $4 if I don't use my insurance.

At least you caught it and now can get a price check on your options before you pay. Don't feel like a dupe. It took me several refills before I figured it out myself.

[5thIDSoldier]

My health insurance company is charging me more for prescription medications than if I paid for it myself:eek:

I went to the Pharmacy to get my daughters medication and they said the insurance company would not pay for it until the 19th. I said, "Ok how much if I pay now."

The medication cost $9.00 without insurance. So, I paid it!

The co-pay that I have been paying for the medication is $15.00. That is what I have been paying every time to get her medication filled.

I feel like a dupe!

Unfortunately, it is perfectly legal. You do have the right not to process it under your insurance to avoid the co-pay.

[Momma]

Well, silly me. I just thought I was always suppose to use the insurance because it was cheaper. Live and learn!!

[Samm]

Well, silly me. I just thought I was always suppose to use the insurance because it was cheaper. Live and learn!!

Both Insurance companies and drug companies work on the premise of profit. A Pharmacy on the other hand... particularly one in a large store... can treat drugs just like any other item on their shelves and therefore can sell it below cost to attract customers, making up the loss on other items sold in their store. There is no mystery about it...

[MrShotShot]

Again, maybe I've just been fortunate, but my insurance only charges a 30-day copay on a 90-day supply - that's how they encourage you to use the 90-day option.

Also, if the actual cost of the drug is less than the co-pay, I pay the lower amount.

[Dr. Funkenstein]

Don't think so. But like any business, the better the profit margin looks, the better they look. So I wouldn't be surprised if it was done on purpose, but more likely they were just trying to get the prescription done and get to work on the next bunch he/she had to do.

Now as far as the 3 month supply thing....

What happens if you see your doctor the following week and changes your meds or adds new ones? Now you're stuck with several weeks worth of meds you can't use and can't return.

Damn insurance companies!

Most companies won't make you go to the three-month supply until you've re-filled at least twice. By then, you should have an idea of whether it's working or not.

Personally, I'm on four 90-day supply meds. I wait to do my follow-ups until I've got about a week's worth left, and if my doctor thinks something needs to be changed I just don't re-fill its counterpart.