Prescription Costs
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Prescription Costs
My wife lost her job, and thus our health plan. We just signed up for an ACA plan but the prescription costs seem high, stretching our budget to the max. How do we assure we get the lowest cost on our prescriptions?
- FreddieFIRE
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Re: Prescription Costs
Have you checked the prices on GoodRx?
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Re: Prescription Costs
also ask the pharmacist. I had one try three different discounts, including GoodRx before finally confirming that my Part D plan was still the best price.
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Re: Prescription Costs
Ask the manufacturer if they have copay assistant program.
Re: Prescription Costs
I'm assuming that you are getting generics, as brand name drugs (except where your doctor feels it is important) are quite a bit more expensive. Some drugs are cheaper if you use the health plan's preferred mail order vendor and get 90 days at a time.
Do you have a HDHP? If so, you are paying full negotiated costs of the drugs until your deductible is met. That obviously can be quite steep. Funding an HSA and (if needed) using the HSA money will at least get you a "drug discount" of the tax deduction.
If your ACA plan is unsubsidized, did you compare total costs to the companies COBRA?
Do you have a HDHP? If so, you are paying full negotiated costs of the drugs until your deductible is met. That obviously can be quite steep. Funding an HSA and (if needed) using the HSA money will at least get you a "drug discount" of the tax deduction.
If your ACA plan is unsubsidized, did you compare total costs to the companies COBRA?
Re: Prescription Costs
Leave no stone unturned looking for discounts. I thought I had covered all angles to reduce the cost of Xarelto. I enrolled in the Jansen program that brought the price down to $10 month. This only lasted a short time and then it will take off $200 of a 30 day script still leaving me with $286 out of pocket. I checked GoodRx , mail order, etc. I was coming up short on getting the price down.
Luckily I stumbled upon another program that may help those paying more than $85 month. (there are program restrictions) Got signed up quickly and can now get 1 month for $85, which is manageable and a huge savings.
My point is I looked high and low for savings, even considered getting it from Canada. My doctor was not aware of any of these programs and only discussed possibly changing script to something cheaper. My plan was to stick it out until the end of the year and try to pick up a more comprehensive prescription plan when enrolling for ins. for next year. Researching insurance is how I stumbled on this other program.
Luckily I stumbled upon another program that may help those paying more than $85 month. (there are program restrictions) Got signed up quickly and can now get 1 month for $85, which is manageable and a huge savings.
My point is I looked high and low for savings, even considered getting it from Canada. My doctor was not aware of any of these programs and only discussed possibly changing script to something cheaper. My plan was to stick it out until the end of the year and try to pick up a more comprehensive prescription plan when enrolling for ins. for next year. Researching insurance is how I stumbled on this other program.
Fools think their own way is right, but the wise listen to others.
Re: Prescription Costs
+1 on looking for the manufacturer's website and calling them to see if they can help. You are interested in their "customer support program" or "patient support program". This is typically well-funded for new medications, not so much for off-patent or medications that are older. Also ask the pharmacist what the uninsured costs are, in some cases they are prohibited from sharing that cost unless you ask and for some medications it can be quite a bit less than your insurance plan costs (depending on your plan, the specific medication and which pharmacy chain it is).
Edited to add: Not suggesting you misrepresent your situation, but you may want to ask about the 'no insurance' costs with the company and the pharmacy before you discuss your plan's coverage. That will ensure you get complete information on the true range of costs.
Edited to add: Not suggesting you misrepresent your situation, but you may want to ask about the 'no insurance' costs with the company and the pharmacy before you discuss your plan's coverage. That will ensure you get complete information on the true range of costs.
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Re: Prescription Costs
We are on ACA. We were worried about prescription costs also. When our COBRA ended, we signed up for a gold plan. Yes, premiums will be higher for a gold plan, but prescriptions costs are roughly the same as they were under our COBRA Blue Cross/Blue Shield plan. There really wasn't much of a difference.
So, if we were on a bronze plan, our prescriptions would have been the highest, silver would have been lower, and gold plan the lowest--even though prescriptions are still somewhat pricey.
You can enter your prescriptions to see if they are covered and look at the pricing so you will know exactly what you will be paying.
GoodRx made no difference in regards to the price of our prescriptions.
So, if we were on a bronze plan, our prescriptions would have been the highest, silver would have been lower, and gold plan the lowest--even though prescriptions are still somewhat pricey.
You can enter your prescriptions to see if they are covered and look at the pricing so you will know exactly what you will be paying.
GoodRx made no difference in regards to the price of our prescriptions.
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Re: Prescription Costs
I went with GoodRX when I switched from insurance to ACA.
Re: Prescription Costs
I have considered actually going to Canada for a combination get-away/prescription fill up. I’m fairly certain I’d save more than enough to pay for the entire trip. This was pre pandemic thinking.
I haven’t used them, but there are also online Canadian pharmacies worth checking out.
I haven’t used them, but there are also online Canadian pharmacies worth checking out.
Re: Prescription Costs
OP,
Even with my employer's medical insurance, in many cases, goodrx is a lot cheaper. By default, always check with goodrx for any prescription.
KlangFool
Even with my employer's medical insurance, in many cases, goodrx is a lot cheaper. By default, always check with goodrx for any prescription.
KlangFool
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Re: Prescription Costs
If all else fails, Costco pharmacy is often less expensive than other places. The prices in the store and at their web site may differ.
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Re: Prescription Costs
I can't remember that last time I have used my employer insurance for an RX. Always cash-pay, generics are usually $4-$10 per month at Walmart.
- FreddieFIRE
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Re: Prescription Costs
At least one of the major grocery chains with pharmacies has partnered with GoodRx to offer an annual subscription plan "driven by GoodRx." There is an annual membership fee but depending upon prescription needs it can be more than offset by getting prices even lower than the public GoodRx deals.
A house and a job. Once the American dream. Two things I'll never again have. Life is simple (and good).
Re: Prescription Costs
There are ACA plans which cover more of the cost of prescriptions.Cosmic Pony wrote: ↑Wed Aug 04, 2021 7:44 pm My wife lost her job, and thus our health plan. We just signed up for an ACA plan but the prescription costs seem high, stretching our budget to the max. How do we assure we get the lowest cost on our prescriptions?
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Re: Prescription Costs
Everyone's excitement about GoodRx is wonderful. But do realize that there are many, many prescriptions where GoodRx does not provided any help whatsoever. One needs to explore the various options with the specific drugs to be used in mind. I needed to go with a Gold ACA plan in order to keep my prescription costs down. This was almost entirely driven by one drug that I take. GoodRx offered no discount for it.
- RickBoglehead
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Re: Prescription Costs
It's not unusual that one or two medicines can drive a decision on medical plans. Of course should you stops taking that medicine, or it go generic, things can look quite different.PaunchyPirate wrote: ↑Thu Aug 05, 2021 7:11 am Everyone's excitement about GoodRx is wonderful. But do realize that there are many, many prescriptions where GoodRx does not provided any help whatsoever. One needs to explore the various options with the specific drugs to be used in mind. I needed to go with a Gold ACA plan in order to keep my prescription costs down. This was almost entirely driven by one drug that I take. GoodRx offered no discount for it.
Checking each time before filling or refilling a prescription is very smart.
Our current plan, which ends on 8/31, basically charges $10 for generic and $40 for brands for 90 days via mailorder. On 9/1 our new retiree plan doubles the cost. While $80 a year for a medicine isn't crazy, I can get that same medicine via GoodRx for $52 for a 365 day supply. My doctor said he would be happy to alter any prescriptions necessary.
I also got a script for an OTC allergy medicine. Turns out that it is also generic OTC. If I go to Costco, the generic is prescription... I can get a year of it for $42. Or I can pay $32 for 80 from CVS for their generic.
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Re: Prescription Costs
Anyone with a plan of any type will not get comments from pharmacies about what could be the best price for prescriptions since this is prohibited by regulation unless the patient asks the direct question of what is the least expensive way to obtain a specific drug. Just ask.
Tim
Tim
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Re: Prescription Costs
I spent yesterday afternoon at WalMart on my phone sorting through all of the different options to purchase the antibiotic for my daughter's earache. With our insurance it was $319, it was ~$220 with GoodRx, and we managed to get it down to $138 with something else. That was the generic. This is after spending $89 two weeks ago (with GoodRx, it would have been $179 with our insurance) for a different antibiotic that did nothing. I can not believe the current cost of (some) prescriptions.PaunchyPirate wrote: ↑Thu Aug 05, 2021 7:11 am Everyone's excitement about GoodRx is wonderful. But do realize that there are many, many prescriptions where GoodRx does not provided any help whatsoever. One needs to explore the various options with the specific drugs to be used in mind. I needed to go with a Gold ACA plan in order to keep my prescription costs down. This was almost entirely driven by one drug that I take. GoodRx offered no discount for it.
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Re: Prescription Costs
Also, you don't have to be a member at Costco to use their pharmacy.
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Re: Prescription Costs
I use GoodRx instead of my insurance not so much for cost, but for ease of use. Insurance always first rejects my $5 per month statin prescription. It becomes a pain for me, my doctor and the pharmacist. It just goes right through with GoodRx at the same $5 price.
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Re: Prescription Costs
One pharmacy I have never seen mentioned here is rxoutreach.org. They are mail order for low income people. I have used them in the past. They have income limits of 400% of FPL similar to ACA.
Re: Prescription Costs
Some other prescription discount programs to check:
https://www.blinkhealth.com/
https://www.wellrx.com/
https://www.rxsaver.com/
https://www.singlecare.com/
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- FrugalProfessor
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Re: Prescription Costs
Be careful with GoodRx (and equivalents). It's generally great, but drug expenses made using GoodRx do NOT count towards your insurance deductible. Consequently, you can paradoxically be significantly worse off by using GoodRx, even if you realize significant discounts.
This isn't a concern, of course, if you are far below your deductible.
My best advice is to google "drug name" + "manufacturer coupon" and try to get directly to the manufacturer's website (goodrx and equivalents won't help you here). Drug mfr's often run promotions/coupon plans. If there are alternative medicines available, google those too. We've saved <$5k over the past two years by doing the above (including asking a doc to switch medications to an equivalent that happened to have a mfr coupon available).
This isn't a concern, of course, if you are far below your deductible.
My best advice is to google "drug name" + "manufacturer coupon" and try to get directly to the manufacturer's website (goodrx and equivalents won't help you here). Drug mfr's often run promotions/coupon plans. If there are alternative medicines available, google those too. We've saved <$5k over the past two years by doing the above (including asking a doc to switch medications to an equivalent that happened to have a mfr coupon available).
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- FreddieFIRE
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Re: Prescription Costs
I was the first in the thread to mention GoodRx and I (and others) have not suggested that it is the only answer, nor that people shouldn't explore and understand all options. Even if somebody needs to use their insurance (or other options such as manufacturer's discount coupons), it shouldn't preclude consideration of GoodRx for other drugs where there may be a savings.PaunchyPirate wrote: ↑Thu Aug 05, 2021 7:11 am Everyone's excitement about GoodRx is wonderful. But do realize that there are many, many prescriptions where GoodRx does not provided any help whatsoever. One needs to explore the various options with the specific drugs to be used in mind. I needed to go with a Gold ACA plan in order to keep my prescription costs down. This was almost entirely driven by one drug that I take. GoodRx offered no discount for it.
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Re: Prescription Costs
I don’t understand why there are (or can be) such wildly different prices for the exact same drug.
It should be like a basic loaf of bread. One store might have it for 2.99 and another for 3.15, but I’m not aware of any store selling it for $10.25 and that price is only after you subscribe to a monthly plan that is $30 to just get access to the bread.
It should be like a basic loaf of bread. One store might have it for 2.99 and another for 3.15, but I’m not aware of any store selling it for $10.25 and that price is only after you subscribe to a monthly plan that is $30 to just get access to the bread.
Re: Prescription Costs
Bread pricing has transparency. You know exactly what you'll pay before going to the cash register and anybody charging $10.25 will wind up with a bunch of moldy bread.Random Poster wrote: ↑Thu Aug 05, 2021 12:05 pm I don’t understand why there are (or can be) such wildly different prices for the exact same drug.
It should be like a basic loaf of bread. One store might have it for 2.99 and another for 3.15, but I’m not aware of any store selling it for $10.25 and that price is only after you subscribe to a monthly plan that is $30 to just get access to the bread.
Re: Prescription Costs
Re: Prescription Costs
Ditto w/Sam's Club. I get a couple of my mom's Rxs that are $0 at Sam's not using insurance, as they're included at no cost for 'Plus' members, and they have ~500 generics for <$10. (Note that they need to be 30-day supply and not 90-day to get them for free, so we had to have her Dr. alter her original Rx a ways back. Worth an extra trip once a month though, since I'd be going there anyway for groceries and such).
Edit - Found Sam's Clubs Rx list - https://scene7.samsclub.com/is/content/ ... us-Members
Re: Prescription Costs
Interesting way to get folks into the store at least once every month.