Drug pricing during this time of hyper inflation

[lugbolt]

GF has to take a medication, 30 day supply. With insurance it's typically $1200 a month. Without, $1000. Her sister is a pharmacist at a hospital just down the road. Said she can get a family discount on the exact same medicine, they will sell it to family members at cost. Great so we run down there with the script from the dr. Her sister fills it and we go to pay for it, $7. That's for the entire month's supply.

One would say that they're raping us. In theory yes. But remember there are costs involved. It costs to work with the insurance companies, the PBM's, basically everything has a cost and it all adds up. Oh and don't forget that the hospital, doctor, pharmacist, pharmacies, etc--all have employees that need to be paid and that adds into it too.

but it still is ridiculous

And those costs keep going up and up and more up; and in part because of more regulations and laws that cause price increases. Sure wish there was an easy solution to it. I suppose I could quit my job and become unemployed and after a while might start getting stuff for free but I'm not sure that's even worth it.

 

[Biker1mike]

My 2 cents.
I have a decent Medicare Advantage insurance. The prescription side is just over 40 dollars a month. I take 6 meds daily and they are all $0 co-pays.

 

[D2Cat]

There is a lot of government BS causing medicine prices to be high. It's about making the stockholder's satisfied.

Trump was in the process of negotiating with pharmaceutical companies to reduce their prices on everything sold to the federal government to the lowest prices they charged anywhere in the world. Instead of following his business-like plan, Joe decided the federal government would pay big Pharma full retail price for 12 drugs being used by Medicare recipients. The pharmaceutical companies love that idea.

 

[Henro]

One would say that they're raping us. In theory yes. But remember there are costs involved. It costs to work with the insurance companies, the PBM's, basically everything has a cost and it all adds up.

This is certainly true. But the costs are similar whether it is an aspirin or a pill that is charged at $100 or more each. Granted there are also research and development costs, and so on.

My problem with it is that the same drug is often sold in other countries MUCH cheaper than we have to pay here. So it seems like the net effect is that American consumers are subsidizing the drug companies, who then sell drugs elsewhere at much lower prices than we pay.

 

[chim]

$13.25 is what YOU pad. Not what THEY got paid

Yep. Picked up a BP prescription and it was around $6 for 90 pills. Saw on the receipt that my prescription coverage allegedly paid over $300. Poor drug company isn't gonna suffer too much

 

[jyoutz]

Yep. Picked up a BP prescription and it was around $6 for 90 pills. Saw on the receipt that my prescription coverage allegedly paid over $300. Poor drug company isn't gonna suffer too much

$300 is what they billed the insurance. But the approved rate is what they got paid.

 

[lugbolt]

Local pharmacy (independent) is top notch. The owner (now retired) fought long and hard to get knowledge out in the open, and finally did. The trump administration even acknowledged his work. I cannot find the article that he wrote that the state legislature was looking into, may be on the other computer (bad screen).

Anyway they use pharmacy benefit managers. They are the third party that is responsible for paying and processing prescriptions.

The local pharmacist who I've spoken of wrote an article about Rx drug prices and how they are "managed". BAsically the PBM dictates what the Rx costs to the end customer (payer). In the past, the pharmacy billed the insurance company, and then the insurance company would deal with the pbm, then usually negotiate. They might get billed $500 but that's not what was actually paid. So what was found out was that the pbm's that this particular pharmacy used, was owned by.......CVS. CVS the major drug store chain. Thus, it could be said that since small independent pharmacies are trying to survive, and cvs being a major competitor, they (CVS) is more or less dictating what the pharmacies get paid, and independent pharmacies weren't getting paid the same as the big ones for the exact same drug. This is where the fed was looking into it but it never was really in "the news" so not many knew about it. Because a lot of it was brought out into the open by our local pharmacist owner, it was on the local news for a 15 second segment, then noone ever knew anything else of it beyond that. Almost as if it was swept under the rug? Dunno.


I wish I could find that article. It's good.

 

[Daren Todd]

Insurance just changed last year for me on specialty prescription drugs.

I got contacted just before the change went through from someone employed as a patient advocate for my insurance company to handle the company I work for.

Basically they changed from covering all but a $50 copay for specialty meds to only covering %70 of the cost.

That medication that I'm on costs $5000 a month. So my portion is over $1,000 a month. I had to sign up for copay assistance in order to afford that medication.

Getting back to the advocate, that's what she helped with. Giving the information on the program, where to sign up. As well as assisting if I run into any issues with getting any of my meds.

Several years ago, the pharmacy was running two profiles on me. One with insurance. One without. The reason was I was locked into a certain cost for prescription meds through my insurance.

A flat rate for 30 day supply or a better deal for a 90 day supply. The reason for the two profiles was because one of the meds was actually cheaper for me if insurance was not used.

Work happen to send out a benefits survey that year. They got lambasted over the prescription drug coverage. Those meds that were cheaper without insurance are now available at no cost.

They sent out another survey this year and got lambasted by those of us on specialty meds that had to sign up for a government program to be able to afford it. I actually had to sign up for two separate programs. Once the first one runs out, the second one kicks in. Takes me about 45 minutes to order the medication each month due to the hoops I have to jump through.