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Medical Insurance Question

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I recently went to a local pharmacy to fill a perscription. My copay for this has always been $15.00 monthly. I explained to them that I am fixing to be without insurance and I wanted to know the cost without insurance. She said that it will be $8.99. What? That doesn't make since. I asked if she was sure. I walked away confused. Can anyone explain this? Just curious. Thanks! Doesn't this seem backwards?

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I recently went to a local pharmacy to fill a perscription. My copay for this has always been $15.00 monthly. I explained to them that I am fixing to be without insurance and I wanted to know the cost without insurance. She said that it will be $8.99. What? That doesn't make since. I asked if she was sure. I walked away confused. Can anyone explain this? Just curious. Thanks! Doesn't this seem backwards?

Another example of our wonderful insurance system.

 

Your tier pay, or whatever.....was $15.

 

The drug retails for $8.99....but if you ask them to run it on your insurance you have to pay the $15 Co-Pay.

 

I have one that is a $100 tier co-pay [Metropolol] for 60 days. If I pay cash, and don't use the insurance, it is $90 and change.

 

Neither goes towards my deductible.

 

In a Single Payer System, you would pay nothing, and it would be on a single , simple but level playing field between the Rx Company and the Single Payer Insurer to agree on what the lowest price would be.

 

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The price should be the same, with or without the co-pay. It always has been with me. If the regular price was lower than the co-pay, that's what I paid.

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The price should be the same, with or without the co-pay. It always has been with me. If the regular price was lower than the co-pay, that's what I paid.

 

I think that depends on the insurance.

 

In any case, co-pays will work in your favor at least as often as against it. Two of the four medications I take cost a total of about $19,000 a MONTH. If I had to pay that, I would have had to die.

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YIKES!!!!!!!

 

You're right. It may depend on the insurance. There may be some insurance plans that you pay the co-pay regardless of what the cash price would be. I know mine didn't work that way in the past. It was kind of bad, too. My co-pay was $50 and the cash price was $50.25. BUT I could use my Greystone Co-op Connection card and get it for roughly $45.

 

I think that depends on the insurance.

 

In any case, co-pays will work in your favor at least as often as against it. Two of the four medications I take cost a total of about $19,000 a MONTH. If I had to pay that, I would have had to die.

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We've had this happen before. But, our pharmacists let us know up front - I can't believe that you've been making this same purchase and your pharmacist didn't tell you this. I know one of hubby's meds are cheaper for us to just pay for rather than put through on the insurance. I think I'd re-evaluate my pharmacist.

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publix has offered free antibiotics for the last couple of years

 

target and walmart both offer $4 generic prescriptions.

 

what happens if you get a prescription at any of these place and show a insurance card? do they make you pay the copay based on your insurance carrier?

Edited by justme2

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Something does not sound right, if you have a co-pay it should only apply if the cost of the prescription is more then your co-pay.

 

If the retail cost is 8.99 then that is what they should be charging you co-pay or no co-pay.

 

Me thinks you have been getting ripped off.

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publix has offered free antibiotics for the last couple of years

 

target and walmart both offer $4 generic prescriptions.

 

what happens if you get a prescription at any of these place and show a insurance card? do they make you pay the copay based on your insurance carrier?

 

 

I can answer that,yes they do.:wacko:

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I can answer that,yes they do.:wacko:

 

if that was the case i think i would claim i didn't have insurance and get it for the reduced rate, and take the prescriptions that were cheaper to get with a co-pay to another pharmacy

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I can answer that,yes they do.:wacko:

I can answer that also, no they do not.

 

I get all my prescriptions from Publix. I have a $25 co-pay. If the prescription is less then that I pay the lower price. If it is free I get it for free.

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publix has offered free antibiotics for the last couple of years

 

target and walmart both offer $4 generic prescriptions.

 

what happens if you get a prescription at any of these place and show a insurance card? do they make you pay the copay based on your insurance carrier?

 

 

I can answer that,yes they do.:wacko:

 

This has not been my experience. I always pay the lesser of the co-pay/retail.

 

Somebody is getting screwed and I'm willing to bet it's the pharmacy supplying the lube.

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My insurance changed at the beginning of the year and my pharm checked all my meds to see if any were on the low price list they have at store and the ones that are lower I pay cash and they do not put through insurance. The others I pay my normal copay. I have wonder people at my pharmacy, I can see though were they may not check and you would pay higher price.

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Hubs takes a maintenance drug that is $57 if we run it on insurance (until deductible is met), but, it's 11.37 if we pay cash. My new meds were to be $84 with insurance and $4.70 if I paid cash. I've check with my insurance and with corporate at CVS. There are no rules about this. It's the negotiated rate with my insurance provider and, per my insurance company, if I claim it, they have to charge me the negotiated rate or they will not be reimbursed. I've learned an awful lot since putting us on a health savings account. Doctors visits, injections, meds - all of it - the charges are according to what insurance you have. This is why I know the new healthcare laws aren't addressing the issue. Edited to add that I go to Publix for all antibiotics because they are free - even for my dog! Regardless of insurance coverage.

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Hubs takes a maintenance drug that is $57 if we run it on insurance (until deductible is met), but, it's 11.37 if we pay cash. My new meds were to be $84 with insurance and $4.70 if I paid cash. I've check with my insurance and with corporate at CVS. There are no rules about this. It's the negotiated rate with my insurance provider and, per my insurance company, if I claim it, they have to charge me the negotiated rate or they will not be reimbursed. I've learned an awful lot since putting us on a health savings account. Doctors visits, injections, meds - all of it - the charges are according to what insurance you have. This is why I know the new healthcare laws aren't addressing the issue. Edited to add that I go to Publix for all antibiotics because they are free - even for my dog! Regardless of insurance coverage.

 

this just proves to me that regardless of obamacare, our health care system is seriously broken, and has been for a while

Edited by justme2
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I have CVS also and we use Kroger on Ridge Rd. I have never heard of this before. IF any of my rx's are cheaper by paying with cash Kroger will give me the cash price rx!!!!!!!!!!!!!! Someone needs to change their pharmacy or ask before filling EACH RX, what the cost would be.

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I think that depends on the insurance.

 

In any case, co-pays will work in your favor at least as often as against it. Two of the four medications I take cost a total of about $19,000 a MONTH. If I had to pay that, I would have had to die.

 

 

WOW.................What's the name of the drugs that costs $19,000 a month. That's what you call price gouging!!!!! (maybe) :pardon:

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WOW.................What's the name of the drugs that costs $19,000 a month. That's what you call price gouging!!!!! (maybe) :pardon:

 

My husband takes about $10k in meds a month. We were pushing that cost when he was still on his anemia shots a few years ago. I'm not sure what his cost is right now - he's on a new injectable drug and I haven't looked lately.

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I use cash at Kroger too. If I use my insurance at CVS I will be charged my co-pay which the minimum is 20.00. I take 7 prescriptions on a dally basis. So with my insurance I would pay 140.00 but when I pay cash at Kroger its under 50.00 for the same medications. Plus as an bonus I earn points on my Kroger plus card for gas.

Edited by Spunkywman

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WOW.................What's the name of the drugs that costs $19,000 a month. That's what you call price gouging!!!!! (maybe)

 

Well, probably not. They're both considered 'orphan drugs,' which means they were developed to treat a rare disease. Tracleer is used to treat three conditions of which I'm aware, and Tyvaso is solely for treatment of pulmonary hypertension (the disease I have).

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I have United and go to Rite Aid, and they don't do that. I've gotten cheaper generics as well as a partial prescription (3-5 pills), and they charge me less than the copay.

Edited by QOTSA

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I have one that is a $100 tier co-pay [Metropolol] for 60 days. If I pay cash, and don't use the insurance, it is $90 and change.

 

 

I take Metoprolol also and get a 90-day prescription from Ingles for $6.00. Lisinopril is the only other prescription I take and it is the same, 6-bucks! I used to have the cheapest Medicare part D plan I could get for which they deducted over $30 a month, and it usually didn't even cover the other occasional prescriptions I might need once a year or so (paid over $75 for a little bottle of eyedrops once). I dropped Part-D and will take my chances if something catastrophic happens.

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