Posted on 02/08/2020 12:32:30 PM PST by karpov
According to a PBS health report about a retiree on a Medicare Advantage plan, Z. Ming Ma was issued a prescription from her physician that cost $285 for a 90-day supply. “A month later,” the article says, “Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication.”
But her 90 days weren’t up, so Anthem wouldn’t cover it. “Ma asked the pharmacist how much it would cost if she got the prescription there and paid out of pocket,” the article says.
The total cash price was about $40.
This is not uncommon. In fact, a study from USC demonstrated that nearly 25 percent of all prescriptions filled at the pharmacy cost the insurer less than what the patient paid in a copay. Yes, that means paying cash is more affordable than using your insurance card.
Over the past several decades in the United States, the health care industry has become increasingly dominated by third-party payers. An individual’s health coverage, whether it is private, Medicare, or Medicaid, can significantly influence health care decision-making — through deciding what it will, and will not, cover.
A health plan can determine which medical professional is seen, which prescription drugs are filled, and even whether a procedure can be done.
Because it increased the power of third-party payers, the Affordable Care Act was essentially a benefit to special interest groups such as insurance companies and other middlemen. The United States health care system hasn’t always been dominated by third-parties but has become distorted from many years of government regulations.
The policy makers forgot about the patients and the medical professionals who provide the care.
The response from both groups has been entirely predictable — and rational.
(Excerpt) Read more at thehill.com ...
It’s called a “Clawback”, where the insurance company or benefits manager charges more for the Rx than it costs and they get that overpayment back from the Pharmacy, and the pharmacy cannot inform the patient of this practice.
It’s disgusting.
....” but evidence from numerous pharmacies show that companies are charging copays that exceed the value of drugs, increasing costs for customers.
This method is called a clawback. Basically, a clawback is when an insurance company claws back money from patients.
According to a New Orleans Fox affiliate, Fox 8 Live News segment, patients most likely don’t even realize this method is implemented by companies because they often times do not know the costs of their drugs without insurance.
The investigative report by the news organization shows a breakdown of a clawback using a document given to the news station by a pharmacist.
The document shows all costs for the drug Sprintec, a contraceptive and acne treatment. It shows the cost of the drug, tax, and the pharmacist’s fee.
All charges total $11.65. However, the customer was charged a $50 required copay. The document also highlights that $38.35 was sent back to the insurance company’s pharmacy benefit manager.
https://imedicare.com/articles/what-do-clawback-fees-mean-for-pharmacies-and-patients/
One would think that the pharmacies’ checkout system would automatically inform the customer of their best price. Why bill through insurance if it will cost the customer 5 times more than the cash price?
I take low-dose aspirin. It is not that expensive either way, but it is a lot cheaper to buy it off the shelf than to get it filled. Sometimes can get buy one get one free. And the insurance will only do 30 at a time whereas I can get 90 count on the shelf.
BkMk
GoodRx?
Talk to your pharmacist. Cash prices are very frequently less than a copay, especially for generics.
L
Not exactly. There are some drugs that are not discounted by Good RX for those over 65 because of........dig this........state and federal laws. Note that you do not have to be on medicare, just over 65! The government is forcing the pharmacy to charge you more because of your age!
If you are paying cash, why the Hell does the effin government want you to pay more? It costs them nothing.
When the GoodRX coupon comes up, in the upper right hand corner it will say "inside RX" if it is one of those drugs. But....there is another quirk there. If you a switch to a different pack size and a different retailer you may well get the discounted price. IMPORTANT - with the phone app, there is a bug that sometimes does not show the "Inside RX" notation, but it does work on a computer.
It pays to call the # for GoodRX if you have any issues, they are very helpful and will call the pharmacy for you if needed.
I also order my synthroid (brand, not generic) from Northwestpharmancy.com because they charge a fraction of what it costs here, even with GoodRX.
L8R
Better have a catastrophic plan. In the last seven months killing my newly found stage 3 cancer has hit close to $300,000.
If my spouse had paid cash bargaining with her medical admin background it still would have cost 100 to 150k and she would have committed suicidal acts.
flr
This is not news to some of us. My local Walmart pharmacy will quote me both ways and let me choose how I want to pay.
Here is a good example of what works. If you need surgery, this place should be on your list of places to consider.
The Surgery Center of Oklahoma
Because insurance gives weird incentives. And they have to make you think, “If I lose my insurance this medicine will cost me $900 a month.” But your $xx co-pay is more than enough to cover your self pay price.
So the insurance company looks helpful.
The pharmacy makes out better (in many cases) .
You think you got good value from your insurance, so you keep it.
All the time you are shooting your self in both feet.
It is a con game of sorts. With several players.
Customer/patient is the victim.
And how much do you think an oxygen concentrator machine should cost?
Even asking why get no results in Google" No results found for "why do oxygen generator machines cost so much".
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