Insurance and medication costs

By Type1Lou Latest Reply 2017-12-08 11:09:09 -0600
Started 2017-11-25 13:28:53 -0600

I've just selected my Medicare options for 2018. I want to share what I've discovered over the past several years when I've used a Medicare Plan D for drug coverage. During 2017, I found it cheaper for me to purchase 2 of my generic drugs without using my Silver Script Choice Plan D insurance. Two of my generics are Tier 1 drugs on the Silver Script Choice Plan D (lisinopril and atorvastatin) while my levothyroxine is a Tier 2 drug (the more expensive Silver Script Select Plan has levothyroxine in Tier 1 but the monthly premium is an additional $50/month. Tier 1 drugs for 90 days would cost me $10 per RX through Silver Script Choice. Their Tier 2 co-pay for 90 days of levothyroxine was around $44.96. I am getting my 90 days of lisinopril for $0 co-pay at my local Publix Pharmacy and my levothyroxine through Walmart for a $10 co-pay. The atorvastatin cost for 90 days through Walmart and Silver Script Choice for 2017 was $10. In 2018, if I get my atorvastatin via the Silver Script mail-order option, my co-pay for that will be $0. So, for 2017, by getting my lisinopril (via Publix) and levothyroxine (via Walmart) without insurance, I'm saving $44.96 every 3 months ($10 savings on the lisinopril and $34.96 savings on the levothyroxine) or $179.84 per year. In 2018, since I'll get my atorvastatin via mail-order, but will continue to get my lisinopril through Publix and my levothyroxine via Walmart, my saving will be $34.96 (baring any price increases) every 90 days or $139.84 per year. Although I'm grateful to have insurance, it pays to check out the individual drug prices and it is sometimes cheaper to obtain them without your insurance. It shouldn't be this complicated…

10 replies

Dr Gary
Dr GaryCA 2017-11-27 13:03:50 -0600 Report

Hey Lou, I am a couple of years away from Medicare myself, so I read your post with great interest. To be honest, I was a little overwhelmed by all the work you had to do to get decent pricing. You sure are a role model of what it means to be a good healthcare consumer. You must have put in a lot of time here, but it sure did pay off. And I totally agree. It should not be this complicated.

Type1Lou 2017-11-28 12:20:09 -0600 Report

I haven't gotten here without mistakes along the way. When I first signed up for basic Medicare with a supplement, I chose a Medicare Plan D with the same company as my supplement (United Healthcare/AARP). It had an annual deductible and I discovered that, because my RX's are mostly generic, I was paying the full cost of those drugs because I never fulfilled the annual deductible. (Because I pump insulin, Medicare covers my insulin under Medicare Plan B (Durable Medical Equipment). If I injected insulin, I would have to obtain my insulin under Medicare Plan D and would have no problem meeting an annual Plan D deductible.) I subsequently changed from an Plan D with a deductible to one with no deductible that had the same premium cost per month (around $27)…the many Medicare options are truly mind-boggling and frequently make my head spin…and I graduated Phi Beta Kappa, magnum cum laude, and spent years working as an analyst for an insurance company.

suecsdy 2017-11-27 12:56:13 -0600 Report

I'm very fortunate to have Tricare as my part D coverage. Generic drugs have a $0 copay through the mail order pharmacy and Bydureon and test strips are $20 copay for a 3 month supply. If it's a long term med, I can buy it off the economy twice, but after that I will be charged more. Things I need immediately like antibiotics are different. And then there are a few things they just don't cover, like the phentermine, but I'll pay the $25 for it as long as it keeps working.

Type1Lou 2017-11-28 12:21:45 -0600 Report

I'm happy that your plan is working well for you Sue! Trying to manage our diabetes is difficult enough, without these insurance hurdles.

Just Joyce
Just Joyce 2017-11-26 15:07:49 -0600 Report

Lou, here is something I discovered last week while getting the results of my Sleep Apnea test results.

If I had had insurance from the VA or Medicare, my results were totally different. With Medicaid which i have I stopped breathing 81 times per hour. Medicare was 89 and VA was 101. No matter each time would have required a CPAP machine. However, i asked why the results were different based on insurance coverage. I was told that with Medicaid I had to use it 90% of the time and Medicaid will cover it fully. With the VA it was fully covered regardless how often the machine was used and with Medicare there could be a co pay for the machine.

I know three people who already has a machine. Two of them are retired Vets so everything is fully covered. The other friend is employed by the Hospital I used and is covered by their health insurance so her's is fully covered.

With Medicaid at Wal-Mart, Rite-Aid and Walgreen's all of my meds are covered at no cost with the exception of Metformin and I pay a dollar for that. Without health insurance my Metformin is $10.00 at Wal-Mart.

I have a friend with a lung disease that is in remission. one of her medications is $1000.00. Our State has a statewide pharmacy card. My sister checked the cost of her medication with the card and it dropped to $655-$875.00 depending on the pharmacy.

No wonder people can't afford medications. The cost should be the same no matter what pharmacy you use for all medications and medical supplies.

Dr Gary
Dr GaryCA 2017-11-27 13:11:14 -0600 Report

Joyce, I totally agree. This system we have is just so confusing and ultimately unfair. You need a PhD in healthcare economics to be able to figure out how to not to pay and arm and a leg for your medications. I am saddened by the stories of people who don't know how to get their needs adequately met and pay more than they should pay, or end up going without. Just amazing.

Just Joyce
Just Joyce 2017-12-04 13:11:56 -0600 Report

It seems as though insurance companies and pharmaceutical companies play Russian Roulette with peoples lives. It is bad enough that patients either play the same game or totally ignore what the doctors tell them to do and they end up making their own health issues worse.

When I was working and had good health insurance, my doctor sent me to a specialist who ordered me a medication that cost $198.00 that was not covered by health insurance. I researched the drug and found out their was a generic version of the medication. I called his office and asked for the generic version. He said he would rather I not take it because I would have to take three a day of the generic version and 1 a day of the name brand. I said let's do some math. If the generic version of the same medication is $10.00 and the name brand is $198.00 wouldn't it be more cost effective for me to take the lower cost three times a day and get the same results or are you taking kick backs from the pharmaceutical company and this is why you are pushing name brand which if I do find out that is the case I will report you to the state medical board for taking bribes and you could be in trouble. Once I said that, it was no longer a problem with me taking the generic version. He called it in right away.

I don't let them get away with anything if I can help it. I will speak up in a heartbeat and people don't like being called out and will comply if they are in a position where it will hit them in the wallet.

GabbyPA 2017-11-25 13:32:56 -0600 Report

This is great information. I do that and purchase many of my health care needs without insurance intervention. This also allows me to buy as I need and as much as I need without worry that they will restrict me. I was on the phone today to get mine taken care of, but had to hang up. Another day....

Betzie 2017-12-03 22:09:39 -0600 Report

Gabby, I can't find my original post? It took me a long time to compose the proper wording, hahaha. Where do I go to get my post & answers? Thanks. Betzie

Type1Lou 2017-12-08 11:09:09 -0600 Report

In addition to Gabby's suggestions, you might also try going to your Profile page (click on "Profile" in upper right corner of this page and select "View Proflie". Once there, part-way down the page you can check/select "What I've done" and it should list your posts and responses.

GabbyPA 2017-12-07 18:02:16 -0600 Report

I am not sure what you mean? If you posted in our site, you can do a search if you recall the title or part of the title you listed. If you offered the tags at the end of the post, you can type that in as well in the search and it should pop up. What you may want to do is make sure you have notifications turned on in your profile so that when people comment on your post, you will know about it.

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