I just can’t take it anymore. I had to sit down and write! The topic of this post is PRESCRIPTION COSTS and how to be sure you are paying the best price for each and every prescription, each and every time you fill or refill it.

I am fortunate to have “good benefits” in that I have subsidized medical and dental insurance as a retiree from AT&T. It’s basically the same plan offered to active employees, only retirees pay a bit more for the plan itself typically. And while I’m fortunate to have good benefits, I was unfortunate to get laid off from my AT&T job (after 31 years) when I turned 50. So now I’m a real penny-pincher.

This article actually applies to anyone who has a medical insurance plan…. regardless of how you’ve come to have it, OR what you happen to pay for it in terms of the cost of the insurance itself.

I will have to break this out into several posts as there’s so much to cover and I want to be sure that people really READ this and understand what I’m saying and take the action that they should take to ensure they are not overpaying for any out of pocket costs.

I have a long laundry list of things to share, but for now, I’ll start with the most recent thing I experienced — the cost of prescriptions.

In the AT&T retiree medical plan (at least for the options I chose for the plan year 2020 — AETNA coverage, retiree-only, bronze coverage — prescriptions are part of the medical plan and are administered through AETNA. AETNA uses CVS Caremark for the prescription arm of the insurance, and coincidentally, CVS (corporation) owns AETNA so that’s no surprise.

I had United Healthcare last year, which also used CVS/Caremark for prescriptions and my prescription plan number/card did not change. Said another way, since I was already in the CVS/Caremark system under UHC, CVS/Caremark did NOT re-issue a number plan number or card to me. That was was helpful.

The way the plan I chose works:

  • Prescriptions are covered under the Medical Plan (not a separate prescription plan)
  • If you use the in-network pharmacy (CVS/Caremark) you pay the full cost of the prescription until your deductible is met.
  • Your OOP cost for your prescriptions, if filled at CVS/Caremark will apply toward your overall medical plan annual deductible.
  • If you use any other pharmacy, you pay the full cost of the prescription (whatever that pharmacy charges) and it does NOT go against your network deductible. [But you can submit this cost manually to hit against your out of network deductible.]
  • You can choose to fill prescriptions either at a CVS retail location or via Caremark mail-order.

Sounds fine, right? Well, just following the plan as it’s written is not necessarily going to get you the best price on prescriptions. [It might, but it might not.] Here’s why.

DID YOU KNOW….

  • The price of your prescriptions can vary by [I’ve seen] as much as 87%?
  • The price of your prescription is apparently not static. You might actually pay a different cost EVERY TIME YOU FILL THE PRESCRIPTION.
    • For example, if you have a 1-year prescription from your doctor, and you send it to CVS/Caremark (or any pharmacy really), what you pay each time you fill that prescription can be different.
    • This is why when you refill a prescription through CVS/Caremark, they quote you an “estimated price” but they clearly state that the price you pay might be different.
  • Different pharmacy locations (even though the same company) may have different prices for the SAME EXACT PRESCRIPTION even though it’s the same store chain!!!

Yes, each and every statement there I have personally found to be true. And this applies to ongoing, maintenance-style medications you may take, as well as situation-based medications (like an antibiotic).

I discovered this quite by accident, which is why I am sure I’m probably one of the very very few people who realize this is going on.

You may or may not have heard of GoodRx. It’s a startup company formed by a few guys who were early employees of Facebook (and I heard one from Google). It’s basically a database that maps drug prices at various pharmacies. There’s a free APP and you can also sign up for a “gold” account (paid subscription) that gives you access to better discounts on prescriptions. It appears to be expanding into telehealth and lab work as well, but this post is really just about prescriptions, so we’ll leave the rest for another day. GoodRx is NOT an insurance plan. All it does is show you what the prices are for your prescriptions at various pharmacies and various locations.

Pretty handy right?!

So when I actually started looking at the prices, I realized I was paying sometimes 2x more than needed for prescriptions. Here’s the thing though, it’s really hard to figure out what you’re paying. You basically have to keep careful track of it all. I created a spreadsheet:

  1. I downloaded all my prescription history from CVS/Caremark
  2. I added it to a new spreadsheet
  3. I added a tab for “non-insurance” items
  4. I added a column(s) for “GoodRx” research
  5. For each prescription, I looked it up in GoodRx, carefully matching the exact prescription (name brand vs. generic), the quantity (30 days, 60 days, 90 days) and the dosage.

Once I had this spreadsheet in place, I could easily compare the price of prescriptions through my medical plan vs. what I could pay “retail” at any other pharmacy (not using my insurance at all). Often, the “retail” prices were HALF of what I was paying through my insurance plan.

So what did I do?

I started checking the prescription costs EVERY TIME I FILL A PRESCRIPTION. Yes, if I have a 6-month prescription that gets filled monthly, I go into my spreadsheet and see where I got that prescription filled last, what that price was, and I pop into GoodRx and see what the prices look like NOW. Often, where I filled the prescription last does NOT have the best price. Like they give you a low price for the first fill and then jack it up for the rest….. I don’t know for sure if that’s how it’s done, but I do know that I have data showing how much more I paid to fill prescriptions on the 2nd, 3rd, 4th refill vs. the first.

It’s kind of annoying to feel like you’re being taken advantage of… And here’s how the pharmacies can get away with it:

  • you’re basically a hostage — once your doctor sends a prescription to a pharmacy, the expectation is that you’ll fill the whole thing there – the original fill plus all the refills. And, because of that, you end up paying more:
    • There’s nothing that states specifically that what you pay for the first fill is going to be what you’ll pay for every fill after that.
    • Pharmacies are busy – they aren’t super-willing to make a phone call [at your request] to move your prescriptions to another pharmacy
    • There are strict laws on the handling of prescriptions, and doctors don’t write them out and give them to you in a way that makes it easy to refill it somewhere different EACH MONTH.
    • Pharmacies would have doctors call in a new prescription if you want to move an existing prescription, but doctors surely have better things to do.

I will say, we all need to give a big shout out to GoodRx and it’s creator…. who took a massive step to give we consumers some level of much-needed transparency in prescription costs. That’s huge. But it’s not enough.

The only way to ensure you’re not overpaying for prescriptions is to do what I did: create a spreadsheet of your own prescriptions, populate it with what you pay for your prescription every time you fill it, and look up each prescription each time you need a refill to see if there’s a lower price elsewhere. If there is, you need to call the pharmacy with the lower price and have them call the pharmacy holding your prescription and request that the existing prescription is moved.

Yes, it’s work. Yes, it’s a lot of work for the pharmacies. But maybe, if the work they have to do at our request becomes more costly than offering prescriptions at the best price possible and holding that price steady for the duration of the prescription, they’ll change how they do things.

What I’d really like to do is get to a point where prescriptions are in the secure possession of the patient, who can choose to fill it anywhere they want without having to make a bunch of phone calls, having the pharmacies make a bunch of phone calls, or having doctors have to make a bunch of phone calls.

That’s what I’m working toward. Making everyone AWARE of this is step one. So now, you know. Take action. Save yourself the money, even if it’s a little work for you now…. hopefully we can change things for the better by doing so!

Just to share an example so you can see some REAL numbers. Here’s a screenshot of some current prescription cost comparisons. Note, I’ve blurred out the personal info…

prescription-drug-costs

So what’s the net/net of all this? It’s a bit of work for me to keep track of all the prescriptions, but I send them to whichever pharmacy offers the best price every single time I refill. And I’m sorry if it’s extra work for the pharmacists (who have nothing to do with setting prices) and workers who have to make calls and trade paperwork to move prescriptions (actually, in this digital age, it shouldn’t be all that much work!), but I simply refuse to pay more than I should.