Can someone PLEASE explain this about prescription drugs?

1. 82

   habeeposted 12 years ago

   Hubby went to get his warfarin refilled yesterday. We have good insurance, and with our insurance, our co-pay is $11. Without any insurance, the drug is $10 - at the same pharmacy! ????????? The druggist couldn't explain it. Can you?

   replyreport
   1. 69

      teaches12345posted 12 years agoin reply to this

      A friend of mine told me has good insurance and had to pay 900 out of pocket, without insurance it would have been 800. Don't know why.

      replyreport
   2. 67

      DragonflyTreasureposted 12 years agoin reply to this

      Usually when the med is cheaper than our co-pay, we pay the cheaper price. Example: my son has a sinus infection. We took the prescription to our regular pharmacy. It came to $4.95 instead of our normal co-pay of $12, so we were just charged the $4.95. Not sure why your pharmacy didn't do that. Give your Ins. a call on Monday and find out for future reference.

      replyreport
   3. 70

      Cagsilposted 12 years agoin reply to this

      Hey Habee,
      
      My mother is on that exact same drug because of a hole in her heart. Her prescription copay is $8.00 and I just refilled it yesterday come to think of it. She is currently on Medicare with a Supplemental insurance for Prescription Drug Coverage.
      
      She pays more for her insurance(supplemental) and Medicare combined, and she still gets bills for coverage not paid for. Example: A doctor's visit cost over $250 for an annual visit and blood work, it cost over $100 for an X-ray her doctor requested done(she had to pay $28 of that), and to finish it off, she also received a $10 bill in the mail for another test performed.
      
      Medicare covered most of it, but when you include $115 per month for Medicare, $37 for her supplemental insurance coverage for Prescriptions, add bills and copays, she is paying almost double what she was paying by getting her own insurance with full coverage(unlike Medicare and Supplemental Insurance- but was forced on Medicare which forced her to get a Supplemental insurance to pick up the slack of Medicare).
      
      It's completely absurd.

      replyreport
      1. 61

         Druid Dudeposted 12 years agoin reply to this

         Healthcare in the U.S. is a mess. The drug companies milk Americans....cause we are all rich. You and I both know we aren't, but, the fact remains that we are the drug companies cash cow. Repeat after me: Money talks!

         replyreport
         1. 70

            Cagsilposted 12 years agoin reply to this

            Yes it is and some of the steps taken within the Affordable Health Care Act will help a lot of people, but it will not solve the affordable issue. That's the truly sad part.
            Where this statement came from I don't know, but drug companies are like government, they know exactly how many people can actually afford their products/goods or services....not to mention the fact that all of them are now guaranteed incomes from taxpayers who are truly unable to afford any kind of insurance. And that's yet another sad and pathetic state of things.
            I don't about you and your financial situation, but I'm not rich by any stretch of the imagination. I'm presently lucky I'm not homeless. Having said that, if things, such as the pricing structure continues to go up on necessities(requirements to live) then more and more people are going to be homeless or living in poverty than ever before, and myself might be included.

            replyreport
   4. 69

      Ralph Deedsposted 12 years agoin reply to this

      I had identical experience when refilling my prescription for warfarin. I can buy it cheaper at Costco paying cash out of pocket than I can at my local drugstore using my insurance. The same goes for a couple of other generic drugs that I take. I don't know why I'm keeping my drug insurance except in the eventuality that I really need a drug that's not available in generic form.

      replyreport
      1. 70

         Cagsilposted 12 years agoin reply to this

         Hey Ralph,
         
         One experience my mother has had from going onto Medicare and getting the Supplemental Insurance is that she has two prescriptions which have no generic equal. And the prescriptions are $44 per month for each. Not having insurance these type of prescriptions are much more expensive and you cannot get them from any other place.
         
         With insurance companies changing their base models, which includes changing the Tier System many of them use to figure out coverage plans and what's covered in those plans, is where the government has apparently gone wrong.
         
         With the increased enforcement through government intervention, the companies are going to do things differently which are things the government has no control over, and pricing structure for things aside from month premiums are going to change because profit matters more than the patient.
         
         I call it unethical business based on greed, selfish behavior and growing ignorance.

         replyreport
   5. 81

      Dr Billy Kiddposted 12 years agoin reply to this

      Nothing to do with the Affordable Care Act. Here's what's going on.
      
      Insurance companies group together and hire companies to negotiate prices with the major pharmacies. Those prices get set and everyone agrees to them. Sometimes the negotiaions don't go all that well and people make mistakes. So the pharmacies can rectify those mistakes by charging lower prices.
      
      Yes, we're talking one dollar here. But with mine were talking $45 discount for simply showing my AAA card, rather than my insurance card. Some of this may be eliminated when the Affordable Care Act gets into place. It will allow for better negotiations. Medicare recepients allready are saving hundreds of dollars. My mother's bill is down to $50 a month.

      replyreport
   6. 74

      Ann1Az2posted 12 years agoin reply to this

      Maybe it's the difference in generic vs. the real drug. I know one of my husband's prescriptions would cost $1800 without insurance and that's the generic! I didn't ask what the real one would cost.

      replyreport
   7. 76

      IzzyMposted 12 years agoin reply to this

      Without knowing how the American insurance system of health care works, I would assume that what Dr Billy Kidd says about insurance companies reaching an agreement with the pharmaceuticals to be correct.
      
      But drugs are only really expensive in their first 8 - 10 years after being marketed. The reason for this is that drug companies apply for a patent as soon as they come up with a new formula.
      
      This patent lasts for 20 years, but it takes them 10 - 12 years of testing to bring the drug onto the market.
      
      After the patent is up, anyone can copy the formula, and this is where the generic drugs come in.
      
      They are just as efficient - after all it is the same formula - but sell at a fraction of the price of the original because there were no years of research put in.
      
      Once there are generic versions of an expensive drug on the market, I am assuming (because I don't know for certain) that the original makers drop their prices. But if the insurance companies have already signed an agreement, they can't drop theirs, so the price remains higher than the company now sell their drug for.
      
      This means that when you buy it without the insurance prescription, it will be cheaper.
      
      Just as well these companies weren't around when life began.
      
      "I've developed a new liquid drug from mixing 2 oxygen molecules with 1 hydrogen, It's my invention, and I am gong to call it water. When the patent runs out, you can call it anything else you like, but not water!"

      replyreport
   8. 60

      undermyhatposted 12 years agoin reply to this

      One is the price negotiated with the pharmacy the other is based on the tables used by your insurance to calculate covered costs.  Two buyers, two different markets.  The pharmacy negotiates a price for its entire companies sales.  It will cost much more and be harder to get once "fairness" is forced in to medicine by the government.  There is no greater cost to an economy or to liberty than the nebulous and subjective "fairness" of the Utopian reformer.

      replyreport
2. 59

   Keith Hamposted 12 years ago

   Maybe you have to pay some sort of 'insurance premium' or something along those lines. I feel bad being Canadian and having to only pay a $2 per prescription. We only have to pay for the bottle.

   replyreport
   1. 77

      Uninvited Writerposted 12 years agoin reply to this

      Where do you go?...the last time I checked I had to pay a dispensing fee of $11 when I had insurance coverage.

      replyreport
      1. 59

         Keith Hamposted 12 years agoin reply to this

         I just go to Sullivan's Pharmacy here, it only costs me a 2 dollar dispensing fee.

         replyreport
   2. 60

      undermyhatposted 12 years agoin reply to this

      You are paying far more than that for medicine.  You are just paying it at a different time to a different agency.  TANSTAAFL

      replyreport
3. 73

   Kangaroo_Jaseposted 12 years ago

   Holle,
   
   Im am wondering if your pharmacy has a branded warfarin and a generic warfarin at the cheaper price perhaps?

   replyreport
   1. 69

      Ralph Deedsposted 12 years agoin reply to this

      Rat poison is rat poison whether it's called warfarin or coumadin.

      replyreport
      1. 70

         Cagsilposted 12 years agoin reply to this

         What are you talking about?

         replyreport
         1. 76

            IzzyMposted 12 years agoin reply to this

            Warfarin stops blood from clotting and also makes an excellent rat killer.

            replyreport
            1. 70

               Cagsilposted 12 years agoin reply to this

               I know what it does, but that doesn't mean it should be used openly and stated in that way.
               
               Just because it can be used for that purpose, doesn't mean it isn't helpful to humans. It's presently the only thing keeping my mother from dying from strokes because her blood clots and slips out of a hole in her heart, which in turns allows unoxygeniated blood to the brain.
               
               She has suffered 5 TIAs(minor strokes) and had some brain damage because of it. Without it, she is as good as dead because the Insurance company won't pay to have the surgery to fix the problem.

               replyreport
               1. 76

                  IzzyMposted 12 years agoin reply to this

                  I feel for you. My mother also has had several TIAs and is on warfarin, but she also seems to have Alzheimer's now too. With the TIAs she still knew where she was, and who I am, but there are days now when she doesn't.

                  replyreport
                  1. 70

                     Cagsilposted 12 years agoin reply to this

                     Thank you and I can understand your situation as well. My grandmother went into the hospital for colon cancer surgery and when she returned home, as few short days later, dementia set in. She was immediately put into a place where she would be able to be monitored. She eventually passed away in a hospice. I can relate.

                     replyreport
      2. 0

         JaxsonRaineposted 12 years agoin reply to this

         But two companies are allowed to, and often do, charge different prices for the same product.

         replyreport
4. 81

   jenniferrpoveyposted 12 years ago

   This has never happened to me. I'd look into changing pharmacists - I'm on a medication that fluctuates in price between about $9 and about $11, and when the price is under my $10 copay, I pay that. I think you may be being ripped off there.

   replyreport
5. 94

   Cardisaposted 12 years ago

   I know our system here in Jamaica is different from the US but I always check to make sure that the pharmacies I go to accept my National Health Fund card and any other drug discount cards. I don't have health insurance but I am on a national program that pays a part of the amount for certain drugs. I take BP meds. For the last few months I have been collecting my meds at the hospital pharmacy free of cost.

   replyreport
6. 82

   habeeposted 12 years ago

   My family has been using this pharmacy for fifty years, and we trust them. The druggist charged hubby just $10, as if we didn't have insurance. The different prices were for the exact same bottle of pills. It makes no sense to me!

   replyreport
   1. 61

      Druid Dudeposted 12 years agoin reply to this

      Go to a different pharmacy. Comparison shopping.

      replyreport
7. 69

   Ralph Deedsposted 12 years ago

   The discrepancy is even worse between what hospitals charge people who are uninsured for tests and medical procedures compared to what they charge insurance companies for identical procedures.

   replyreport
   1. 61

      Druid Dudeposted 12 years agoin reply to this

      They know they will get their money.

      replyreport
   2. 60

      undermyhatposted 12 years agoin reply to this

      And the solution to that is Universal Insurance?  Or is it a total and complete take over of medicine?

      replyreport
8. 76

   Mighty Momposted 12 years ago

   I got a prescription for Prilosec  (Omepprazole) from my doctor. She sent the scrip downstairs to the hospital pharmacy to fill. They asked for $30.
   I had bought the same drug, non prescription, through the same pharmacy before and just for kicks asked the pharmacy clerk to check the OTC price.
   $16.
   Needless to say I had them put the prescription pills back and bought the over the counter version.
   Exactly the same pills. EXACTLY.
   

   replyreport
   1. 70

      Cagsilposted 12 years agoin reply to this

      Actually Mighty Mom, I don't think so. It wouldn't make any sense, not that much of what happens in America makes much sense, but usually OTC are not as potent at the Prescription medicine of the same Name. There's always a difference, such as it's missing an ingredient which makes it required by law to be Prescription based vs OTC.

      replyreport
      1. 76

         IzzyMposted 12 years agoin reply to this

         Don't mix up over-the-counter medicines with generic medicine, Cags.
         
         Generic have the same constituents as the brand name, though I suspect some minor constituent may be added or missing (like sugar or glycerine for example). The main ingredients are the same, however.
         
         Over the counter, on the other hand, are drugs that do not, by law, require a medical prescription, but are either brand name or their generic version, both being just as potent.
         
         It's a strange law, and I don't know who makes these decisions, but some of the most potent and the most dangerous or addictive drugs are available OTC.

         replyreport
      2. 76

         Mighty Momposted 12 years agoin reply to this

         Good point, Cags.
         My son's been skeptical of the fillers in generics for a long time.
         
         Of course I did ask if there was a difference and was told "No."
         The bottle I got is "branded" Kaiser Permanente.
         The pharmacy is a Kaiser Pharmacy.
         The pills in the pre-filled bottles look identical to the ones the pharmacist originally filled.
         The potency information is the same, active ingredient same, dosage same.
         I emailed my doctor and told her what happened. She didn't say a word.
         The ones I got are working just fine and I'm happier having saved $14.

         replyreport
         1. 70

            Cagsilposted 12 years agoin reply to this

            Glad to hear you saved money and didn't lose anything in the exchange.

            replyreport
   2. 0

      JaxsonRaineposted 12 years agoin reply to this

      The compounds between Prilosec OTC and Prilosec aren't exactly the same, although I don't know the difference in effects between the two.
      
      OTC
      
      
      RX
      

      replyreport
      1. 60

         undermyhatposted 12 years agoin reply to this

         It is much more than the understated "not exactly the same"  - those are two different compounds - entirely.

         replyreport
         1. 0

            JaxsonRaineposted 12 years agoin reply to this

            My chemistry isn't that good, haha.
            
            They call Prilosec OTC
            di-5-methoxy-2-[[(4-methoxy-3,5-dimethyl-2-pyridinyl)methyl]sulfinyl]-1H-benzimidazole magnesium
            
            And Prilosec RX
            5-methoxy-2-[[(4-methoxy3, 5-dimethyl-2-pyridinyl) methyl] sulfinyl]-1H-benzimidazole
            
            But like I said, I don't know how much difference a di- and a -magnesium makes

            replyreport
            1. 60

               undermyhatposted 12 years agoin reply to this

               Imagine di- and hydrogen missing from water.  A very different thing

               replyreport