Drug Prices

[Tom Bender]

About 15 years ago I started on a med that was not covered. It was over $600/month so I went shopping. Got it at an 80% discount thru what seemed to be a Canadian pharmacy on-line. Shipped direct from India and seemed to be the same. No problems. Then GoodRx came around and It was available at a discount of 75% from my local pharmacy. No problems and I felt more confident in the quality, though there was nothing discernible.

The discount varies from one pharmacy to the next and varies over time. The full price had risen slowly and the discount had improved to 95%. But just this week my usual pharmacy changed their 'GoodRx' discount to 55% while others in town raised theirs to 96%. I spoke to my usual pharmacist about cost and he said the store may have a better discount,,,'yes we can give you 94%' Sold.

So the lesson is that you should shop for better prices and understand that it's not all happening in Washington or at the manufacturer. Much of the problem and some solutions are real close to home.

[Doug Garson]

I've always been puzzled by GoodRx, getting an 80% discount just by saying the magic word GoodRx makes no sense to me.

[dennis thompson]

Tom
I couldn’t agree more. Just ask, this applies in so many cases. This summer we were getting three new central air conditioners installed. I wanted to use a local company but their bid was $42,000 while I had two other bids for about $30,000. I was about to go with one of the lower bids , when I called my local guy and said I’d like to go with you but I had two much lower bids. Five minutes later he called me back and matched the lower bids.

[Tom Bender]

Hi Doug
Good Rx is a wonder. They say they just asked every pharmacy for their best price on every drug and then report the best prices to customers. Pharmacies wanting the business are driven by competitive pressure to get on board, and pay Good Rx a commission. At least that's how I understand it. Hopefully that's how Medicare watches our tax dollars for us. Insurance companies, I don't know. There seen to be some laws that protect big pharma from this type of thing.

[Brian Elfert]

Insurance companies get huge discounts on most drugs. I bet GoodRX does similarly by having a huge base of customers who buy drugs in order to get discounts.

Most large trucking companies get substantial discounts on diesel from truck stop chains. I have an app on my phone that gives me similar discounts as the owner of the app negotiates discounts based on directing a lot of customers to them. I paid $4.12 at a truck stop on Tuesday while the retail price was $4.86. I would not have stopped there to pay retail as $4.86 is a bit above what others were charging at retail. I used about 600 gallons on my trip and only 50 to 60 gallons was purchased at retail pricing. The rest I used my app to get a discount. The app doesn't have many locations in Nevada and California.

[Keegan Shields]

The US healthcare system has so many perverse incentives and competing interests, it distorts normal market signals and from an outsiders view - seems to defy free market logic.

As I understand it, much of this comes from the insurance companies who extract value out of the system by sitting in the middle and making things complicated.

I heard about a cool company that manufactures and sells drugs only direct to consumer. They will not work through insurance companies because of the added cost and required price hikes - https://costplusdrugs.com/ (funded by Mark Cuban).

Might be an option for those who regularly take medication. Its pretty refreshing to see a company break down their costs between manufacturing/mark up/ and pharmacy labor.

[Curt Harms]

I'll be the devil's advocate for a bit. I knew a guy in the pharma R&D biz. He told me about a drug that was looking really good and the company was pouring lots of resources into it. Just about when they were to go for FDA approval a problem popped up that killed that product dead; may have killed a tester or two, not sure. That flushing sound was $850 million put into the development of that drug being flushed down the toilet. They need to make enough on the products that get approval to cover the products that end up expensive failures.

[Andrew More]

IIRC, GoodRx is basically burning investor money to get market share, same as Uber, and a few other startups. The current strong decline is likely killing this, hence the drop in the discount Tom experienced.

[Stan Calow]

I've made use of GoodRX a few times as well, and wondered how that works.

Clearly the nature of drug-pricing in the US is completely warped by the profit-driven insurance-pharma-provider cabal we have. Its a conspiracy to prevent the consumer from having any ability to make market-based decisions on their own care. I understand Curt's point completely, but what I don't think is right, is that it is American taxpayers, via insurance and artificially high prices, who subsidize all those development costs and failures, while other countries benefit from low prices. Follow the saga of insulin prices in the US, and wonder why they still make money marketing it cheaply in other countries.

[Kev Williams]

About 15 years ago I started on a med that was not covered. It was over $600/month so I went shopping. Got it at an 80% discount thru what seemed to be a Canadian pharmacy on-line. Shipped direct from India and seemed to be the same. No problems. Then GoodRx came around and It was available at a discount of 75% from my local pharmacy. No problems and I felt more confident in the quality, though there was nothing discernible.

The discount varies from one pharmacy to the next and varies over time. The full price had risen slowly and the discount had improved to 95%. But just this week my usual pharmacy changed their 'GoodRx' discount to 55% while others in town raised theirs to 96%. I spoke to my usual pharmacist about cost and he said the store may have a better discount,,,'yes we can give you 94%' Sold.

So the lesson is that you should shop for better prices and understand that it's not all happening in Washington or at the manufacturer. Much of the problem and some solutions are real close to home.

This applies to much more than just medical. My personal pet peeve is the gasoline prices here in the SLC area:

National gas price averages, highest to lowest, above $4 per gallon:
1- $6.29 California
2- $5.42 Nevada
3- $5.36 Oregon
4- $5.23 Washington
5- $5.23 Hawaii
6- $5.21 Alaska
7- $4.43 Arizona
8- $4.43 Idaho
9- $4.17 Utah
10- $4.17 Michigan
11- $4.15 Illinois
12- $4.00 Indiana

--so we have the 9th highest gas prices in the country-- ok, but:


How many oil refineries are in Salt Lake City?
five oil refineries...
The state's five oil refineries, all located in the Salt Lake City area, can process
about 204,000 barrels of crude oil per calendar day.Apr 21, 2022
--These 5 refineries are less than 15 miles from where I'm sitting. The bulk of
the oil they refine comes from Utah (a top-10 oil producer in the US), Wyoming,
Colorado and Canada. So most oil comes by truck from less than 400 miles away...

Yet the cheapest gas I can find nearby right now is $4.16 a gallon... WHY?

back in '08 when gas prices went thru the roof, a local news station sent a crew to one of these refineries,
and asked them essentially 'what's the reason for charging so much for gasoline around here?'

Their answer was, essentially, 'because we can'...

aka: greed. :mad:

Methinks the medical supplies business ain't far behind the oil business in that respect...

[Doug Garson]

I wouldn't shed too many tears for big pharma. According to this study, they are doing just fine.

How do the profits of large pharmaceutical companies compare with those of other companies from the S&P 500 Index?
Findings

In this cross-sectional study that compared the profits of 35 large pharmaceutical companies with those of 357 large, nonpharmaceutical companies from 2000 to 2018, the median net income (earnings) expressed as a fraction of revenue was significantly greater for pharmaceutical companies compared with nonpharmaceutical companies (13.8% vs 7.7%).

Meaning

Large pharmaceutical companies were more profitable than other large companies, although the difference was smaller when controlling for differences in company size, research and development expense, and time trends.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054843/

[Keegan Shields]

I'll be the devil's advocate for a bit. I knew a guy in the pharma R&D biz. He told me about a drug that was looking really good and the company was pouring lots of resources into it. Just about when they were to go for FDA approval a problem popped up that killed that product dead; may have killed a tester or two, not sure. That flushing sound was $850 million put into the development of that drug being flushed down the toilet. They need to make enough on the products that get approval to cover the products that end up expensive failures.

As I understand it, this is an often repeated talking point by the pharma industry, but I remain skeptical for several reasons:

1. Drug companies producing patented (novel) drug formulas continue to post record profits from those divisions. So do companies producing generic versions for that matter...

2. For-profit companies leave unprofitable market segments. Clearly, they are doing well enough to continue investing in new products.

3. Drug companies spend far more on marketing and advertising than on R&D.

4. Perhaps most importantly, most of the risk in drug development is in the early stage drug trials. These stages are most often funded, at least in part, by the National Institute of Health (tax payer dollars). Essentially, the American tax payer pays for the R&D of the vast majority of the worlds new drugs. Then on top of that, we pay the far higher prices in the US than in other countries. If the market was functioning correctly, we (American citizens) should get a discount given the public resources that were spent to assist in development and the size of our market.

Layered on top of this are the insurance companies who obscure the normal market signals with "discounting" and complex billing procedures. Ask one element of the healthcare system and they will blame another. All of this leads to the proverbial $500 aspirin at the hospital.

***This is based on what I have read but I'm not an expert and have no professional experience in the health care industry - so feel free to correct this if you see any errors. I'm always up to learn new things!

[dennis thompson]

I worked for the company that invested the $850 million on a failed drug.
It certainly isn’t necessary to feel sorry for the pharma companies, but I do find it interesting that we hear a lot of complaining about pharma companies but very little about tech companies. Microsofts pre tax margin was 42% while Mercks was 32%. No need to feel sorry for either of them!

[ChrisA Edwards]

Difference, I can choose to use a Microsoft product, may not have that option for prescriptions.

[Bill George]

This applies to much more than just medical. My personal pet peeve is the gasoline prices here in the SLC area:

National gas price averages, highest to lowest, above $4 per gallon:
1- $6.29 California
2- $5.42 Nevada
3- $5.36 Oregon
4- $5.23 Washington
5- $5.23 Hawaii
6- $5.21 Alaska
7- $4.43 Arizona
8- $4.43 Idaho
9- $4.17 Utah
10- $4.17 Michigan
11- $4.15 Illinois
12- $4.00 Indiana

--so we have the 9th highest gas prices in the country-- ok, but:


--These 5 refineries are less than 15 miles from where I'm sitting. The bulk of
the oil they refine comes from Utah (a top-10 oil producer in the US), Wyoming,
Colorado and Canada. So most oil comes by truck from less than 400 miles away...

Yet the cheapest gas I can find nearby right now is $4.16 a gallon... WHY?

back in '08 when gas prices went thru the roof, a local news station sent a crew to one of these refineries,
and asked them essentially 'what's the reason for charging so much for gasoline around here?'

Their answer was, essentially, 'because we can'...

aka: greed. :mad:

Methinks the medical supplies business ain't far behind the oil business in that respect...

FYI Gas prices where I live here in Iowa -Today $3.39/9 for 10% ethanol blend.

[dennis thompson]

Difference, I can choose to use a Microsoft product, may not have that option for prescriptions.

I used Microsoft as an example, I could have used Google, or Nvidia,or any one of probably 50 companies that are so integrated into our daily lives that we cannot do without them. For example my last two doctor visits were Zoom calls, now you could say I could have gone to the doctors office but that would have required a 60 mile trip to the office and who, in the time of Covid, wants to go sit in a doctors waiting room.
Again my point is, people are quick to criticize the pharma companies, maybe too quick, without understanding all the financials of the companies.

[Tom Bender]

Yes what happens in Washington is important but local factors can still make a big difference. So if you have to pay for a medication you should shop.

1. You can ask for your script on paper and use it anywhere. This works with internet pharmacies.

2. Or when the doctor asks what pharmacy you use you can ask the doctor to hold on a minute while you check Goodrx. Doc may even have staff check for you or know another way. Or may have samples, especially if it is a new med.

3. You can ask your pharmacy if there is a better price.

4. If the script is for 30 or 90 days you can buy just a few pills. They will hold the rest of the script so you can buy more if the med works.

[Stan Calow]

3. You can ask your pharmacy if there is a better price.

In some states, pharmacists are not allowed to tell you. When I inquired once about what a drug would be with a GoodRX coupon, the pharmacist told me she could not tell me unless I presented the coupon to her. Contracts with the drug companies, who apparently are just victims.

[Alan Lightstone]

Let me throw in an even better choice than Goodrx. Look up Mark Cuban CostPlus Drugs. I believe a non-profit company setup to give amazingly low prices on a limited (but growing) number of drugs. Some of these saved us literally thousands.

https://costplusdrugs.com/?iss=https%3A%2F%2Fauth.costplusdrugs.com%2F

They didn't have all of our prescription drugs, but for the ones they did, the savings were truly amazing. Unfortunately, I had never heard of them until I read a recent article about saving money on prescription drugs from Consumer Reports. Worth looking for that article too, as they mentioned a number of companies setup to save you money on drugs.

And I'm not going to get into a rant about pharmaceutical companies and what they have done to insulin prices (though I should). Truly should be criminal.

[Jim Koepke]

There is one thing to remember about discounts, usually if you don't ask for one, you won't get one. Occasionally this has even worked in our local supermarket.

jtk

[John Goodin]

So the lesson is shop around and ask for a discount. Sure would help a lot of people if Medicare could take that advice.

[Curt Harms]

Difference, I can choose to use a Microsoft product, may not have that option for prescriptions.

Theoretically, you could choose to not use a Microsoft or Adobe product but if you digitally interact with most companies it might be difficult if not downright impossible. Looking almost the same may not cut it. I've had to buy generic drugs in the recent past. A doctor in New Jersey put me onto a neighborhood pharmacy whose prices were about 1/3 of Walmart pharmacy. I suspect their source(s) are in India but what are the sources of Walmart's generics?

[Bill Dufour]

So the lesson is shop around and ask for a discount. Sure would help a lot of people if Medicare could take that advice.


The drug companies keep lobbying so that medicare is not allowed to bargain for prices. I wonder if the military and VA are allowed to bargain for drug prices?
Bill D

[Michael Weber]

but what are the sources of Walmart's generics? My understanding is that practically all generic drugs are made in India and China. It’s also my understanding the FDA has little or no resource or legal ability to inspect such facilities.

[Dwayne Watt]

My understanding is that practically all generic drugs are made in India and China. It’s also my understanding the FDA has little or no resource or legal ability to inspect such facilities.
I have personally met a person in China (in line at Beijing airport) that had a US government passport of a unique color (neither blue nor brown). He was there to inspect the suppliers of drug filler (essentially clay earth which makes up the bulk of the pills one takes). He told me that virtually all drug (pill) manufacturers use Chinese filler, not just generics. That said, those manufacturers probably use supplies from other countries as well.
The FDA can prevent import of drugs that do not meet US standards and do this by inspection of shipments, not inspection of the manufacturer directly.

[roger wiegand]

I worked in the pharmaceutical industry for a long time.

IMO, the innovators are getting paid too little, and the patent trolls and copycats too much. Much of current drug pricing is completely screwy, an artifact of mis-regulation and market manipulation.

The scientific staff at FDA are very good, and do the best they can with limited resources and limited political sway. I can't say so much for the leadership that bends the science to fit the assorted lobbying groups that assail them from every side.

Insulin seems to me to be the perfect opportunity for a patient-driven co-op to disrupt the current madness. Some group (the diabetes association for example) could create a co-op, hire a toll manufacturer to make and package the product, and sell it at a very reasonable price to co-op members, bypassing those who currently profit outrageously on this very generic product. Even just the threat of such a solution would probably drop current prices significantly. There's no reason for patients not to band together to create non-profit alterntives to getting gouged.

[roger wiegand]

The FDA can prevent import of drugs that do not meet US standards and do this by inspection of shipments, not inspection of the manufacturer directly.

FDA routinely inspects overseas manufacturing facilities (I know this from direct experience), they must meet the same standards as US-based facilities. FDA is woefully underfunded to do this comprehensively, either in the US or abroad.

[Brian Deakin]

I live in the Uk, the charges for prescriptions regardless of the cost of the drug are set out below


My question

Would you swap the system you have in the USA for the system available in the Uk

Other I am a retired pharmacist and the most expensive drug i dispened which was free of charge cost $3500 per month


NHS Prescription Prepayment Certificates (PPCs)


A PPC could save you money if you pay for your NHS prescriptions.
The certificate covers all your NHS prescriptions for a set price. You will save money if you need more than 3 items in 3 months, or 11 items in 12 months.
The prescription charge in England is £9.35 per item. A PPC costs:


£30.25 for 3 months
£108.10 for 12 months
Who can get free prescriptions



You can get free NHS prescriptions if, at the time the prescription is dispensed, you:

are 60 or over
are under 16
are 16 to 18 and in full-time education
are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx)
have a specified medical condition and have a valid medical exemption certificate (MedEx)
have a continuing physical disability that prevents you going out without help from another person and have a valid medical exemption certificate (MedEx)
hold a valid war pension exemption certificate and the prescription is for your accepted disability
are an NHS inpatient

You're also entitled to free prescriptions if you or your partner (including civil partner) receive, or you're under the age of 20 and the dependant of someone receiving:


Income Support
income-based Jobseeker's Allowance
income-related Employment and Support Allowance
Pension Credit Guarantee Credit
Universal Credit (https://www.nhs.uk/nhs-services/help-with-health-costs/help-with-health-costs-for-people-getting-universal-credit/) and meet the criteria

If you're entitled to or named on:


a valid NHS tax credit exemption certificate – if you do not have a certificate, you can show your award notice. You qualify if you get Child Tax Credits, Working Tax Credits with a disability element (or both), and have income for tax credit purposes of £15,276 or less
a valid NHS certificate for full help with health costs (HC2)

People named on an NHS certificate for partial help with health costs (HC3) may also get help.
Read more about who can get free NHS prescriptions (https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/free-nhs-prescriptions).
Check you're eligible for free prescriptions

There's a simple way to find out if you're eligible for free NHS prescriptions and any help with other NHS costs.
Use the eligibility checker (https://services.nhsbsa.nhs.uk/check-for-help-paying-nhs-costs/start).
Free prescriptions for certain medical conditions

People with certain medical conditions can get free NHS prescriptions.
Medical exemption certificates are credit-card-size cards. They are issued if you have:


cancer, including the effects of cancer or the effects of current or previous cancer treatment
a permanent fistula (for example, a laryngostomy, colostomy, ileostomy or some renal dialysis fistulas) requiring continuous surgical dressing or an appliance
a form of hypoadrenalism (for example, Addison's disease) for which specific substitution therapy is essential
diabetes insipidus or other forms of hypopituitarism
diabetes mellitus, except where treatment is by diet alone
hypoparathyroidism
myasthenia gravis
myxoedema (hypothyroidism requiring thyroid hormone replacement)
epilepsy requiring continuous anticonvulsive therapy
a continuing physical disability that means you cannot go out without the help of another person (temporary disabilities do not count, even if they last for several months)

Find out more about medical exemption certificates (https://www.nhsbsa.nhs.uk/exemption-certificates/medical-exemption-certificates).
How to apply for a medical exemption certificate

Ask your doctor for an FP92A form to apply for a medical exemption certificate.
Your GP will sign the form to confirm that your statement is correct. At your GP's discretion, a member of the practice who has access to your medical records can also sign the form.
Your certificate will be valid from 1 month before the date the NHS Business Services Authority receives the application form.
The MedEx lasts for 5 years and then needs to be renewed. You may receive a reminder that your certificate needs to be renewed.
If you do not receive a reminder, it's your responsibility to make sure it's renewed.
Check if your exemption certificate is valid (https://services.nhsbsa.nhs.uk/check-for-help-paying-nhs-costs/start-exempt)
Free prescriptions for pregnant women

If you're pregnant or have had a baby in the past 12 months, you get free prescriptions if you have a valid maternity exemption certificate.
To apply for a maternity exemption certificate, contact your doctor, midwife or health visitor.
Your certificate will be sent to you by email or in the post.
The certificate will last until 12 months after the expected date of birth of your baby.
If your baby's born early, you can continue to use your certificate until it expires.
If your baby is born late, you can apply for an extension.
If you apply after your baby is born, your certificate will last for 12 months from your baby's birth.
Find out more about maternity exemption certificates (https://www.nhsbsa.nhs.uk/exemption-certificates/maternity-exemption-certificates).
Free prescriptions if you have a low income.

If you have a low income, you may be eligible to receive financial help through the NHS Low Income Scheme.
To apply for an HC2 certificate, complete form HC1, which is available from Jobcentre Plus offices or most NHS hospitals. You might also be able to get an HC1 form from your doctor, dentist or optician.
You can also get an HC1 form by calling 0300 123 0849.
You qualify for a full help HC2 certificate (which includes free NHS prescriptions) if your income is less than or equal to your requirements, or your income is greater than your requirements by no more than half the current English prescription charge.
You qualify for a limited help HC3 certificate if your income is greater than your requirements by more than half the current English prescription charge.
The HC3 certificate shows how much you have to pay towards your health costs.
Certificates are usually valid for between 6 months and 5 years, depending on your circumstances.
Find out more about the NHS Low Income Scheme (https://www.nhs.uk/nhs-services/help-with-health-costs/nhs-low-income-scheme-lis/)
How can I claim a refund on a prescription charge?

Ask the pharmacist, hospital or doctor for the refund form (FP57) when you pay for your prescription. You cannot get one later.
You must apply for a refund within 3 months of paying the prescription charge.
If you receive Universal Credit and meet all the criteria to be entitled to help with health costs (https://www.nhs.uk/nhs-services/help-with-health-costs/help-with-health-costs-for-people-getting-universal-credit/) but did not get a refund form (FP57), contact the NHS Business Services Authority. They'll consider applications for refunds on a case-by-case basis.


If you paid for a prescription prepayment certificate (PPC) and have become exempt from paying for prescriptions, you may be able to get some or all of the money back for your PPC.

[Ken Combs]

Let me throw in an even better choice than Goodrx. Look up Mark Cuban CostPlus Drugs. I believe a non-profit company setup to give amazingly low prices on a limited (but growing) number of drugs. Some of these saved us literally thousands.

https://costplusdrugs.com/?iss=https%3A%2F%2Fauth.costplusdrugs.com%2F

They didn't have all of our prescription drugs, but for the ones they did, the savings were truly amazing. Unfortunately, I had never heard of them until I read a recent article about saving money on prescription drugs from Consumer Reports. Worth looking for that article too, as they mentioned a number of companies setup to save you money on drugs.

And I'm not going to get into a rant about pharmaceutical companies and what they have done to insulin prices (though I should). Truly should be criminal.

I'll second this recommendation, at least with some reservations. I placed my first order but haven't yet received it. But, I see no reason to believe I won't.

$12.50 for 90 pills. Same prescription from a Canadian online provider is $120. Local well over $200.

It's my understanding that they sell all drugs at 15% over cost.

The price list on the web site is eye-opening.

[Alan Lightstone]

I'll second this recommendation, at least with some reservations. I placed my first order but haven't yet received it. But, I see no reason to believe I won't.

$12.50 for 90 pills. Same prescription from a Canadian online provider is $120. Local well over $200.

It's my understanding that they sell all drugs at 15% over cost.

The price list on the web site is eye-opening.
Being a physician, I was able to save some time by sending them the prescriptions myself, instead of waiting for my doctor to send them (still can't believe that we're faxing medical stuff instead of e-mailing it. Welcome to the 21st century folks. Thanks, HIPAA).

Assuming your doctor faxed them the prescription, it was my experience that the send the medicines out quite quickly.

[Ken Combs]

Being a physician, I was able to save some time by sending them the prescriptions myself, instead of waiting for my doctor to send them (still can't believe that we're faxing medical stuff instead of e-mailing it. Welcome to the 21st century folks. Thanks, HIPAA).

Assuming your doctor faxed them the prescription, it was my experience that the send the medicines out quite quickly.


My doc's office sent the fax Friday, I got the acknowledgement from the company same day. Hasn't shipped yet but should be soon. The web site states 5-7 day delivery in most cases.

[Brian Elfert]

Neither of the prescription drugs I take is sold by Mark Cuban's company, at least not yet. I can get the generic for one of them through Walmart for less than my insurance co-pay. The other has a generic, but not on Walmart's generic program.

[Bill Dufour]

Mark's company does not seem to have the name brand(expensive) drugs I take. it does have the generic ones for about 1/3 the price at CVS with my insurance discount.
Bill D

[Bruce Wrenn]

Years ago, doctor put me on a "Name Brand Drug." Co-payment was $72. Pharmacist told me I should just pay for drug. When asked why, he told me retail price for this drug was $54. Because of a gag rule from insurance company he couldn't tell me retail price unless I directly asked him what it was. Remember my co-payment was $72, or $18 more than retail price. So I asked what happens to overage from retail price. He said insurance company didn't pay retail price, so their cost was less than retail, and excess funds were sent to insurance company. In essence, insurance company, to who I paid premiums, was ripping me off every time I bought drug. I was paying retail price, plus a kick back to them. In any other business, this would be called fraud. Another time, pharmacist couldn't gt my insurance to work, so I paid for a drug. Total out of pocket cost was $42. Next month with insurance, they sent me a benefits notice telling me that having insurance had saved me over $100. Co-payment was only $20, with retail being $42, so how did I save over $100 when paying a co-payment of $20 on a drug that retails for $42? Wife took an antibiotic that with Good Rx was was less than seven bucks, but with her insurance, the co-payment was about $45. In most states, you don't have to be a Costco member to use Costco pharmacy. Same goes for Sam's and BJ's.

[Alan Lightstone]

My doc's office sent the fax Friday, I got the acknowledgement from the company same day. Hasn't shipped yet but should be soon. The web site states 5-7 day delivery in most cases.
Just got an e-mail today from them that says that due to skyrocketing demand, most orders won't be sent out for 5 days and should be received between 10-14 days. So need to plan ahead, but the savings on drugs they carry is impressive.

And, just to say this once, I have no association with the company, except as a customer. But they have saved me a ton of money in a short period of time.

[Brian Elfert]

Years ago, doctor put me on a "Name Brand Drug." Co-payment was $72. Pharmacist told me I should just pay for drug. When asked why, he told me retail price for this drug was $54. Because of a gag rule from insurance company he couldn't tell me retail price unless I directly asked him what it was. Remember my co-payment was $72, or $18 more than retail price. So I asked what happens to overage from retail price. He said insurance company didn't pay retail price, so their cost was less than retail, and excess funds were sent to insurance company. In essence, insurance company, to who I paid premiums, was ripping me off every time I bought drug. I was paying retail price, plus a kick back to them. In any other business, this would be called fraud. Another time, pharmacist couldn't gt my insurance to work, so I paid for a drug. Total out of pocket cost was $42. Next month with insurance, they sent me a benefits notice telling me that having insurance had saved me over $100. Co-payment was only $20, with retail being $42, so how did I save over $100 when paying a co-payment of $20 on a drug that retails for $42? Wife took an antibiotic that with Good Rx was was less than seven bucks, but with her insurance, the co-payment was about $45. In most states, you don't have to be a Costco member to use Costco pharmacy. Same goes for Sam's and BJ's.

I had to get a prescription on the very first day of switching to a new insurance plan at work. The health insurance worked, but the prescription plan was not active yet. The prescription I needed was a little expensive at retail. The pharmacist had one of those prescription discount cards and used that to get me a much lower price.

[Ken Combs]

Just got an e-mail today from them that says that due to skyrocketing demand, most orders won't be sent out for 5 days and should be received between 10-14 days. So need to plan ahead, but the savings on drugs they carry is impressive.

And, just to say this once, I have no association with the company, except as a customer. But they have saved me a ton of money in a short period of time.


I received the same email. I also received one a couple of days ago listing several more drugs they are adding.

[Bill George]

This has been a very useful Thread, learned a lot!! I just got a notice from Cigna that my Plan D was going from $31 per month is now going to cost $52 !! I am paying more out of pocket than they are and by the time you figure in my payment per month for the plan, Wow.

[Michael Weber]

This has been a very useful Thread, learned a lot!! I just got a notice from Cigna that my Plan D was going from $31 per month is now going to cost $52 !! I am paying more out of pocket than they are and by the time you figure in my payment per month for the plan, Wow.
Same thing with my Cigna coverage. Current plan is discontinued and will be replaced with one priced twice as much ($32 to $68) It does have a lower deductible but still not keeping it. I only chose it as it had a much better co-pay on one particular maintenance drug taken daily. The only good thing about the Medicare drug plan process is the ability to make yearly changes. The rest of my opinions of the Medicare drug coverage option and process are low. Very low.

[Bill George]

Same thing with my Cigna coverage. Current plan is discontinued and will be replaced with one priced twice as much ($32 to $68) It does have a lower deductible but still not keeping it. I only chose it as it had a much better co-pay on one particular maintenance drug taken daily. The only good thing about the Medicare drug plan process is the ability to make yearly changes. The rest of my opinions of the Medicare drug coverage option and process are low. Very low.

So Medicare is suppose to send out on Oct 15 a website link that's lets you input your drugs and lets you know what the cost is for each plan.

[Mike Henderson]

So Medicare is suppose to send out on Oct 15 a website link that's lets you input your drugs and lets you know what the cost is for each plan.

Medicare has done that every year for quite a while. https://www.medicare.gov/plan-compare/#/?year=2023&lang=en

I use it every year. It's easy to do.

Mike

[My first wife had a medical issue that required very expensive medication. Medicare Part D was a life saver for us.]

[Michael Weber]

So Medicare is suppose to send out on Oct 15 a website link that's lets you input your drugs and lets you know what the cost is for each plan.
Yes. If current cost is the only criteria then the decision is simple. But ……………

[Mike Henderson]

Yes. If current cost is the only criteria then the decision is simple. But ……………

Are you concerned that the price of a drug you presently take will skyrocket? Or that you may be prescribed an expensive drug during the year?

Mike

[Regarding super expensive drugs, there's a maximum out of pocket and then the insurance covers (all?, most?) of the cost. I don't remember exactly how it works any more.]

[I suppose you can always find something wrong, but it's a heck of a lot better than no insurance, especially if you're hit with very expensive drug costs.]

[Alan Lightstone]

Wanted to add the list of discount online pharmacies that were listed in that Consumer Reports article. In alphabetical order:

http://Amazon.com/pharmacy

http://costco.com

http://costplusdrugs.com

http://geniusrx.com

http://healthwarehouse.com

http://honeybeehealth.com

http://ro.co/pharmacy

http://scriptco.com

A few of these companies have yearly membership charges, and the amounts they charged for the 5 sample drugs that Consumer Reports listed varied significantly. But most were lower or significantly lower than other sources. Of course, if they don't carry your particular medication, this won't help.

HTH and saves money. It did for us.

[Steve Demuth]

(still can't believe that we're faxing medical stuff instead of e-mailing it. Welcome to the 21st century folks. Thanks, HIPAA).



HIPAA does not prohibit use of email for medical information. It requires some controls on emails that doctors (or other covered entities) send via email, and many medical institutions look at those controls and decide it's easier to tell everyone email isn't a permitted channel for medication communication, rather than actually doing the work of setting things up right. But even then, nothing in HIPAA prevents a patient from using email to send their information to a provider.

[Brian Elfert]

HIPAA does not prohibit use of email for medical information. It requires some controls on emails that doctors (or other covered entities) send via email, and many medical institutions look at those controls and decide it's easier to tell everyone email isn't a permitted channel for medication communication, rather than actually doing the work of setting things up right. But even then, nothing in HIPAA prevents a patient from using email to send their information to a provider.

For providers using Mychart (Pretty much everyone local uses it.) it is normal to send an email stating there is a message in your Mychart instead of sending the actual information via email.

[Bill George]

I used the Medicare site and switched from Cigna to MedicareBlue Rx Select PDP from 2023 price $52 at Cigna to $17.50 per month.

[Steve Demuth]

Yes. Epic (the company that built the medical records system for which MyChart is the patient portal) chose to do it that way, because it's the lowest common denominator for h ow to meet the requirements for use of email for communication from doctors and laboratories to patients. By sending such an email, they provide a reasonably convenient way for people to get communications, without running very far afoul of HIPAA. To someone who wanted to make trouble, those emails could in many cases be HIPAA violations. For example, if XYZ Cancer Center, identifiable by their email address, sends a notification that my new test results are ready to my email through unencrypted SMTP, that message conveys the fact that I am a patient at XYZ to every mail forwarder between their email server, and my inbox - often including, e.g., my ISP. The fact that I am a patient at a particular specialty center is protected health information under HIPAA, and the message contains a HIPAA identifier (my email address), so voila ... HIPAA violation.

I'm reasonably certain, however, that nobody wants to make MyChart even less use friendly than it already is, by eliminating these notifications.

Every health care institution I know tells people not to put sensitive health details in emails to doctors or nurses, often intimating that this is because of HIPAA. This is nonsense. Communications from the patient to the doctor are not HIPAA violations - you can stand in the town square and shout your symptoms to your doctor across the street if you want. HIPAA doesn't care. But institutions don't want information to come via email, because 1) it is rarely the most convenient way for a doctor to get information (things you put in MyChart get a defined place in physicians workflow; email probably not so much), and 2) if the doctor replies via email, and the email channel carrying the reply doesn't meet all the requirements for HIPAA allowed email, then the doctor's institution has committed a HIPAA violation.

[Doug Garson]

Yes. Epic (the company that built the medical records system for which MyChart is the patient portal) chose to do it that way, because it's the lowest common denominator for h ow to meet the requirements for use of email for communication from doctors and laboratories to patients. By sending such an email, they provide a reasonably convenient way for people to get communications, without running very far afoul of HIPAA. To someone who wanted to make trouble, those emails could in many cases be HIPAA violations. For example, if XYZ Cancer Center, identifiable by their email address, sends a notification that my new test results are ready to my email through unencrypted SMTP, that message conveys the fact that I am a patient at XYZ to every mail forwarder between their email server, and my inbox - often including, e.g., my ISP. The fact that I am a patient at a particular specialty center is protected health information under HIPAA, and the message contains a HIPAA identifier (my email address), so voila ... HIPAA violation.

I'm reasonably certain, however, that nobody wants to make MyChart even less use friendly than it already is, by eliminating these notifications.

Every health care institution I know tells people not to put sensitive health details in emails to doctors or nurses, often intimating that this is because of HIPAA. This is nonsense. Communications from the patient to the doctor are not HIPAA violations - you can stand in the town square and shout your symptoms to your doctor across the street if you want. HIPAA doesn't care. But institutions don't want information to come via email, because 1) it is rarely the most convenient way for a doctor to get information (things you put in MyChart get a defined place in physicians workflow; email probably not so much), and 2) if the doctor replies via email, and the email channel carrying the reply doesn't meet all the requirements for HIPAA allowed email, then the doctor's institution has committed a HIPAA violation.
Seems to me all you would need to do is give the clinic an email address that your ISP or anyone else doesn't have like patient123@gmail.com. Any reason that wouldn't work?

[Steve Demuth]

Seems to me all you would need to do is give the clinic an email address that your ISP or anyone else doesn't have like patient123@gmail.com. Any reason that wouldn't work?

The contents of an email are readable by any organization handling the mail from the application that sends the mail (say Epic, running on a clinic's servers) up to and including the mail server that services your email, unless both the sending and receiving ends are properly configured to encrypt the transmission. So, for example, if my wife's doctor at Mayo Clinic were to send her an email with protected information to her email account on gmail.com, there are (when I last checked) 13 routers belonging to 5 different corporate entities that handle the mail. Under HIPAA rules, those corporations are considered to have received the content of the email, since they can read it. Configuring mail servers to use encrypted transmission is a pairwise problem - you can't just set a switch that says encrypt outgoing mail; you have to have an encryption agreement between your server and any you want to send the encrypted email to. That would obviously be extremely onerous for most clinics, so it is only done for certain circumstances.

But even if you do that, the receiving mail domain can read the mail (Google, or gmail, in my example). So they are a recipient of the protected information and you've still got a HIPAA violation. You have to encrypt the contents of the email with encryption agreed between the actual recipient (not their mail host) and the sender. Almost no one does this.

This is all because the mail protocol on the internet was never intended to protect information - its inventors trusted the ISPs, network providers and hosting organizations to respect the privacy of email, and didn't try to build a secure or private model. And, to be fair, with mail hosting services like ISPs and Google as the actual destination for messages, with the intended recipient only viewing them using services provided and managed by the hosts, it's not an easy problem to solve. The tech exists today to do it, but it would require significant changes in the way email works.

[Doug Garson]

Steve, what if all the email says is "you have a message, sign in to your secure account to read it"? No links, no confidential information. Since your email address is basically anonymous anyone reading the email would only know someone has a message from the clinic but not who or what the message says.

[Steve Demuth]

Steve, what if all the email says is "you have a message, sign in to your secure account to read it"? No links, no confidential information. Since your email address is basically anonymous anyone reading the email would only know someone has a message from the clinic but not who or what the message says.
It's an interesting question. I think the health care business, both providers and tech companies, with no objection from HHS OCR (The Federal organization that enforces the HIPAA privacy rule) has collectively decided that what you describe is acceptable, whatever the regulations may actually say. What you describe is essentially what Epic MyChart sends by default (the links don't make a difference one way or the other, since every email identifies it's sender and recipient, and those are the things that make it identifiablle - whether or not you imagine your email to be inscrutable, it is one of the named identifiers in the HIPAA rule, and so legally identifies you). I could make a case that such an email is in fact Protected Health Information, but the public would scream loudly if someone were to actually prohibit such notifications, and the fact that nobody has been busted pretty much means it's ok. HHS OCR is not reticient about busting orgs that violate HIPAA, and letting the world know.
(https://ocrportal.hhs.gov/ocr/breach/breach_report.jsf)

[Curt Harms]

..................................
This is all because the mail protocol on the internet was never intended to protect information - its inventors trusted the ISPs, network providers and hosting organizations to respect the privacy of email, and didn't try to build a secure or private model. And, to be fair, with mail hosting services like ISPs and Google as the actual destination for messages, with the intended recipient only viewing them using services provided and managed by the hosts, it's not an easy problem to solve. The tech exists today to do it, but it would require significant changes in the way email works.

Recent versions of Thunderbird make it pretty easy to set up PGP encryption. The problem of course is that [I]every[I] email provider would have to do that, including web mail providers. would have to provide easy-to-setup PGP (Pretty Good Privacy) or something like it that the entire industry agrees on. I think there's a demand for encrypted email just as there is/was a demand for secure internet connections. I imagine getting every email provider to agree on its implementation would make herding cats seem trivial.

[Mike Henderson]

They could send out the information using Whatsapp. Whatsapp encrypts end-to-end. Of course, both the sender and receiver have to use Whatsapp.

In encryption, the problem is usually getting the encryption key from the sender to the receiver. There are ways to do that, for example https negotiates a key between the sender and receiver, so it would be possible to do end-to-end secure mail on a web browser using https.

Mike

[And thanks to Steve Demuth for the very interesting discussion of the problems of communications in HIPAA.]

[Bill Dufour]

I wonder how the lawyers get around HIPPA for insurance fraud from whiplash and doctors who treat the phony injuries?

[Steve Demuth]

In encryption, the problem is usually getting the encryption key from the sender to the receiver. There are ways to do that, for example https negotiates a key between the sender and receiver, so it would be possible to do end-to-end secure mail on a web browser using https.


It's actually rather challenging, although clearly not impossible. The challenge comes from the fact that because email delivery is a send-store-retrieve, rather than a simple send-receive, the mail host (gmail.com, e.g.), is always a "man in the middle" between the sender and the intended recipient. You can easily enough set up encryption between the sending server, and the mail host server, but the email only goes as far as the mail host server, where it lands and is stored. So the mail host ends up with an unencrypted copy of the message. You can't do end (sender to receipient) key exchange, because the recipient is generally not reachable when the mail is sent, so they can't negotiate the key pair. Most email recipients don't even have a publicly accessible ip address, as they are behind NAT, so you can't even try to reach them.

[Mike Henderson]

It's actually rather challenging, although clearly not impossible. The challenge comes from the fact that because email delivery is a send-store-retrieve, rather than a simple send-receive, the mail host (gmail.com, e.g.), is always a "man in the middle" between the sender and the intended recipient. You can easily enough set up encryption between the sending server, and the mail host server, but the email only goes as far as the mail host server, where it lands and is stored. So the mail host ends up with an unencrypted copy of the message. You can't do end (sender to receipient) key exchange, because the recipient is generally not reachable when the mail is sent, so they can't negotiate the key pair. Most email recipients don't even have a publicly accessible ip address, as they are behind NAT, so you can't even try to reach them.

You're right. I just didn't think it through far enough.

Mike

[Bill George]

Drug prices, this discussion saved me money today!

How many folks realize there is more than one drug price? Insurance or Medicare Plan D, Cash and GoodRX (R) price.

What happened today brought that out in a big way. Went to refill one prescription and the cost told to me by the cashier in Training was $60.28 and I said that is way too high! I said what is the cash price? The cashier in training and the other gal agreed it was $80! Of course I took the Plan price.

FYI the pharmacy is forbidden by Medicare to tell you a lower price.... Unless you ASK the cash price.

When I got to my next stop I pulled out my Iphone and used GoodRX to research prices in Town and the prices they give you are Coupon prices that show on the Phone and you show the pharmacy that Coupon. The price ranged from less than $10 to $32 for the exact Same drug!

Well my pharmacy does not take GoodRX coupons, BUT it turns out the Cash Price was not $80 as I was told by the Casher in Training but $35, wow. Needless to say I have a refund coming.

Lesson, ask the Cash price after getting your Plan D or Ins cost. Use GoodRX to do the research first.

IF your on Medicare D DO NOT sign up for GoodRX plan, just use the coupons as above. YOU Can not have two Plan D programs.


PS Use the Medicare website to compare prices for your drug list.... Cigna raised my Plan price from $32 to $53, I found MedicareBlue RX Select PDP at $17.50 per month.

[Stan Calow]

I thought that the coupons were the GoodRX plan.

I was HIPAA trained and certified for awhile. It only apples to care providers and associated admin staff. If you share your info with your lawyer she can tell anyone she wants.

[Michael Weber]

Today’s supplemental Medicare plan mail. Can’t wait for tomorrow /s.
488351

[Mike Henderson]

I thought that the coupons were the GoodRX plan.

If you share your info with your lawyer she can tell anyone she wants.

I would think that attorney/client privilege would apply to that kind of information.

Mike

[Bill George]

Thanks to this Thread once again! I dumped Cigna for 2023 it was going to cost me $52 per month plus drugs prices all over the place for generic. The Medicare Blue RX PDP is $17.50 per month and most drugs for my standard 90 day refill was $4 for the exact same drug, exact same pharmacy.

[Bill Dufour]

My insurance does not cover 90 day drugs they limit it to 30 days. This increases drug co-pays by about 50%. They used to charge a little more for 90 days, now they charge less but more often. I do not remember the exact numbers but it was like $10 for three months or now fifteen dollars for the same three months worth but charging me only $5 every thirty days. Plus 3x the gas to go to the pharmacy.
Bill D

[Jeff Clode]

I don’t see this has been mentioned, but something to be aware of using GoodRx cash price, is that many (if not all??) Medicare Part D plans will not credit the money spent to one’s overall plan deductible - not sure about commercial insurance. Would be nice if the recent legislation to allow Medicare to negotiate drug prices would address that issue (that’s the excuse I have been given when inquiring as to why the credit is not allowed- it’s viewed as “competition”)

[Bill George]

My insurance does not cover 90 day drugs they limit it to 30 days. This increases drug co-pays by about 50%. They used to charge a little more for 90 days, now they charge less but more often. I do not remember the exact numbers but it was like $10 for three months or now fifteen dollars for the same three months worth but charging me only $5 every thirty days. Plus 3x the gas to go to the pharmacy.
Bill D

What insurance plan is that a Non Medicare related? Will they let you mail order in X number of months?? Or does it all need to be local Rxs?

[Alan Lightstone]

Today’s supplemental Medicare plan mail. Can’t wait for tomorrow /s.
488351
Only 5 letters? Slow day. :rolleyes: