prescription prices and maybe some remedy

[herb fellows]

Over the past 6 months or so, I have become aware of something you may not know.

On 3 occassions, I went to the drug store and was hit with what I considered to be a high co pay amount. Respectively, $71, $60 and $84.
I have what is supposed to be good coverage. These prescriptions were all between $350 and $600 (obscene to begin with)..

In all 3 of these cases, I went online to the manufacturers website (Google 'manufacturer of........) and paid nothing for a co pay.
It seems as if the manufacturers are well aware that the prices they charge are ridiculous, and I'm guessing they don't want government interference with the prices they can charge.
So to offset that possibility, they have 'coupons' that ANYONE can use towards their co pay. There is no means test to qualify for a coupon, at least in the 3 instances when I made inquiry.
All 3 times, I just printed out a coupon or card, brought it to the druggist, and...poof.... no co pay! No hoops to jump through, simple as pie.
So the lesson here is, when you get a prescription, take a minute and go online and check the manufacturers website for coupons. If your doctor calls the prescription in and you get surprised by the co pay when you go to pick it up, tell the drug store to hold the prescription while you go home and google the manufacturer.

DON"T RELY ON YOUR DOCTOR OR THE DRUGGIST TO TELL YOU ABOUT ANY OF THIS, THEY WON'T! In all 3 instances, when I called back the doctor to tell them, they seemed surprised. I would hope they would relay this info to their other patients, but I can't control that.

Some coupons may only be for $15-$20 off also, but I'd rather see that money in my pocket (or yours) than in the hands of the drug companies.

[leehljp]

Thank you for this information. I am going to use it and pass it on to my family. Just having gone onto medicare, I know I am going to get into this and I hear my girls complain all the time about the high price of their co-pay.

[All Thumbs]

The drug companies don't offer coupons because they're worried about gov't interference. They offer coupons to prevent you from complaining to your doctor about the high copay costs. If you complain about hi copays to your doctor, then your doctor may prescribe a less expensive alternative.

In some cases, the newer (higher-priced) drugs don't work any better than the older (less-expensive) alternatives. You can Google "[drug name] vs" and Google will tell you the alternatives to your Rx. A little googling will tell you how effective the drug is (or perhaps how effective the drug's sales rep. may be).

[chopnhack]

I can appreciate your frustration Herb, but the doctor and pharmacist are not responsible for the financial side of the medical services. Don't get me wrong, if the drug is too expensive its as if the service wasn't rendered, we all agree with this.
The system is skewed and unfortunately the games that are being played are mostly because of big business and government regulations. The pharmacist certainly doesn't get anything more out these manufacturers cards being used, if anything they actually get less reimbursement because a pharmacy benefits manager charges them to transmit the claim online, not to mention the added headache of processing the codes and getting them to work with your insurance. Ever read the back of some of those manufacturers discount cards?
Most doctors that I deal with on a routine basis do not have a good idea of what meds cost, but they are encouraged to use the most effective medication for your condition. Keep in mind that to prevent a lawsuit in which they will be judged by their piers they are required to use the most effective med. regardless of cost.
Be proactive in your care and ask the doctor why they are prescribing an expensive medication. Sometimes that particular drug is the most cost effective med for your individual needs, if not look at your insurance company's drug formulary and bring in a list of alternatives to discuss with them. HTH

[jackellis]

I'm taking a prescription medication (lovastatin for cholesterol) on a regular basis for the first time. I've fought the idea for years, because it seemed more sensible to control the problem with diet and exercise.

Even before you look for low cost alternatives to medication, make sure the medication is necessary in the first place. Do some research, and be highly skeptical of the TV ads. Be aware of the potential side effects, and read the labels carefully. In my case, drinking grapefruit juice renders the medication ineffective. Who would have thought!

[chopnhack]

Be aware of the potential side effects, and read the labels carefully. In my case, drinking grapefruit juice renders the medication ineffective. Who would have thought!

Actually Jack, the interaction causes the simvastatin to build up in the blood, in some cases drastically high and can cause severe muscle and kidney problems.

[herb fellows]

I can appreciate your frustration Herb, but the doctor and pharmacist are not responsible for the financial side of the medical services. Don't get me wrong, if the drug is too expensive its as if the service wasn't rendered, we all agree with this.
The system is skewed and unfortunately the games that are being played are mostly because of big business and government regulations. The pharmacist certainly doesn't get anything more out these manufacturers cards being used, if anything they actually get less reimbursement because a pharmacy benefits manager charges them to transmit the claim online, not to mention the added headache of processing the codes and getting them to work with your insurance. Ever read the back of some of those manufacturers discount cards?
Most doctors that I deal with on a routine basis do not have a good idea of what meds cost, but they are encouraged to use the most effective medication for your condition. Keep in mind that to prevent a lawsuit in which they will be judged by their piers they are required to use the most effective med. regardless of cost.
Be proactive in your care and ask the doctor why they are prescribing an expensive medication. Sometimes that particular drug is the most cost effective med for your individual needs, if not look at your insurance company's drug formulary and bring in a list of alternatives to discuss with them. HTH

I am proactive, constantly questioning the efficacy of what is being prescribed. Unfortunately, despite much talk to the contrary, there can be significant differences between brand name drugs and generics.
I'm not saying they are responsible, but it would be nice if they were at least aware of the things that could save their customers money.
When the Dr says the brand name is needed after I bring up the generic option, then I'm pretty much stuck with the brand name. Not to mention the brand names which don't have generic availability yet.

[cwsmith]

I'm also "proactive"... in that I question every prescription that I have. But all too often it is to no avail. The Doc wants to prescribe and he insists and gets rather upset when I question him about it. But otherwise I really like my Doc, and consider him the best I've ever had. His only fault seems to be he is part of the "Guthrie" system here which had over the last 20 years almost formed a monopoly.

But here are the kinds of things that make me wonder: My cholesterol is absolutely fantastic, being something like 135 (without looking it up), but I'm paying $5 a day, out of pocket (after the insurance payment) for two different cholesterol medicines.

Ten years ago about the only "pills" that I took was a once-a-day vitamin and a couple of asperin. I'm now taking nine different prescriptions for a total of 16... and that doesn't count anti-headache over-the-counter pills.

The "cost" just keeps going up and up and is "unbridled", no controls at any level that I see. Same with Dr's visits. In 1973, my visit would cost $6... today it costs $160!

And if that isn't ridiculous, it doesn't begin to compare to physical therapy. I have a serious neck injury that I deal with. They put me in physical therapy, where I got 20 minutes of ultrasonic massage and 20 minutes of a "hot towel"... that 40 minutes at the local "Guthrie" center was charged at $340. After seeing the bill at the end of the first month, I refused to go anymore. My insurance paid for 100%, so no direct expense out of my pocket, but I considered this a complete rip-off. I complained to the insurance company, but they had no problem with it.

I go to the medical center for my Dr. visits, and the waiting room is just packed. Yet, on almost every visit you see a half-dozen "druggies" (Phamaceutical Reps) parade in and out of the office. They bring "lunch", unbelievable stuff like fresh fruit trays, pastries, deli food, and on occasion even hot-food trays. Then before you blink the office is pushing the "latest and greatest". IMO, the whole health care system is really broken.

There's no regulation and unfortunately about the only alternative is for the patient to run the risk of "educating" themselves and weaning off of some of this stuff... but that of course can be very risky.

CWS

[cabinetman]

I am proactive, constantly questioning the efficacy of what is being prescribed. Unfortunately, despite much talk to the contrary, there can be significant differences between brand name drugs and generics.
I'm not saying they are responsible, but it would be nice if they were at least aware of the things that could save their customers money.
When the Dr says the brand name is needed after I bring up the generic option, then I'm pretty much stuck with the brand name. Not to mention the brand names which don't have generic availability yet.

I used to be on brand names, and if no generics are available...end of story. If there are generics, and brand is prescribed, I found our pharmacy needed the prescription written "Dispense as prescribed".

Since I'm with AvMed, generics are free.

.

[BigguyZ]

I won't touch the RX issue, but I'll say similar things happen with Medical issues/ items.

Last year, I got a CPAP machine. Very much something that was needed.

The machine was a rental at first, but after 14 months or so it's a purchase. I think it cost me/ my insurance a combines total of nearly $3000. I looked online, and at one point I found one on Amazon for $500. Either way, $3k is way too much!

For that machine, my hose got punctured (thanks to my cat). I asked how much for a replacement, and they told me $60 for the hose. Again, I went online, bought the exact same hose (literally) for $5/ hose or so. Shipping made it more, but I got 3 for half the price of one at the hospital supply store.

They also push you to get a mask every 6 months, since your insurance covers is. They run $400+. My mask has parts that are replaceable, but of course the sections that may wear out aren't available alone. You have to buy a whole new mask!

It's all a rip-off...

[Richard in Smithville]

The one thing that is really good about my employers benefit package is the drug plan. For myself, wife, and kids, we only pay $2 for each prescription. They will cover only generic brands unless my doctor says that I need the name brand.

[cwsmith]

There was a story on CBS News the other night regarding the vast differences between hospitals on "procedures"... it was remarkable.

I know last year I was having some chest discomfort, spoke to the Doc about it at my regular checkup and he had me take a stress test right there in the office. He thought things were fine, but to check further he made an appointment for me to take a "better" test at the hospital and we made an appointment.

That test lasted about a half-hour and I was probably in the hospital for a total of an hour or so, counting the paperwork. That test was much more strenuous and involved an eco-cardiogram. The specialist noticed an "anomoly" and ordered another visit for a "Nuclear Stress Test".

That test was a bit more involved with most of the time waiting between stress testing and twice on a scanner; each about 30 minutes. Final opinion was that everything was just fine, no blockages or anything else and the discomfort was probably just stress.

A month later I got the bill: $9,850.00 !!! That was certainly stressful.

It was sort of a "WHAT?" moment for me, and I asked for an itemization of the charges. That took their accounting dept two more months to come up with and the actual items summed up to almost $8K... and then there was a $1,850 Misc item to top it all off. They still haven't explained that to me other than to state that it wasn't one more $ than my insurance would pay.

And that I'm afraid is what is wrong with our health care system... no real accountability. Like shop mechanics, these guys have their "books" which tell them exactly what the different insurance company's payment schedules are, what Medicare will pay, etc. and then they figure how much of a dent you personally should be able to take... and they go after every dime.

I told my Doc, life was a lot cheaper when we used to joke about the "take two asperin and call me in the morning".

At any rate, I got letter from my ex-employer last week... starting the first of next year, all of us retiree's over the age of 68 will need to find our own plan. They of course are going to send me a list of possible insurance providers which is very nice of them, don't you think?

CWS

[sscherin]

I found out something interesting last year when my prescription insurance changed from a $15 co pay to a 15 % copay.

I was used to always getting charged the $15 copay for my wife's monthly prescription..

Under the new plan it cost 67 cents! Huh??

Turns out with the fixed price copy my insurance had them charge the full copay even when cost without using insurance was less..

[woodturner]

Last year, I got a CPAP machine. Very much something that was needed.
...
My mask has parts that are replaceable, but of course the sections that may wear out aren't available alone. You have to buy a whole new mask!

When you get your machine through a home medical supplier, they are being paid for the "nursing labor" they provide - when you buy online, you are paying only the cost of the machine. IF you don't need the support they offer, buying online can save money, but usually insurance won't pay for online machine purchases.

All the replacement mask parts are available online from vendors such as CPAP.com. The problem, though, is the masks are designed to last 6 months, an the parts all fail around the same time, typically. For example, the plastic receptacle where the head strap attaches gets brittle and breaks, typically around 6 months. You could replace the soft parts like the cushion, but it doesn't make sense since the hard plastic parts will break anyway.

I'd love to know where you found a hose for $5 - lowest wholesale cost I have seen is more like $30.

[woodturner]

These prescriptions were all between $350 and $600 (obscene to begin with)

I can understand why one might think those prices are high, but they really aren't.

Think about two examples:
1. Drug company spends $1B getting a drug developed and approved. Over time they hold the patent, they have to recover the development cost - as well as manufacturing cost. So, they make a pill with a $1,000 amortized development cost but can only sell it for $600 a pill - so they lose money.
2. Auto maker spends $10M developing a revision of a car model. They will only sell it for one year, and their amortized development cost is $2,000 per car, plus $2,000 in manufacturing cost, so they sell the car that cost them $4,000 to make at an invoice cost of $25,000.

In the first example, the consumer is paying less than the cost and is getting a bargain but thinks they are getting gouged. In the second case, the consumer is paying $21,000 and a 500% profit and thinks they got a good deal.

The problems really are:
1. Consumers have no accurate perception of the cost to make things.
2. Government regulation makes it prohibitively expensive to develop new medicines.