When January 1 hit, we got some good news ? and some bad news. The good news is that we?re finally back in an employer-sponsored health insurance plan. As I reported in the middle of last year, we?ve been on a COBRA plan for the second half of 2017, paying a monthly premium of $1,875. But my wife?s part-time job since became full-time, and brought a new plan. Our new premium is down to $400+ per month. That?s blessed relief. The bad news is it comes with a very poor prescription plan. But I think we found workarounds for high prescription costs.
We needed to. My wife and I are both on prescriptions, me for cholesterol and high blood pressure, and her for type II diabetes. Needless to say, prescriptions have become a part of our lives. It happens when you get north of 50.
GoodRX.com ? The Ultimate Workaround for High Prescription Costs?
The hospital network in our area has an excellent outreach program. They appoint a nurse coordinator to anyone who has used the facilities. The coordinator acts as a point person to help you navigate the complex healthcare and health insurance systems. I?ve never experienced this before, and it?s a welcome service.
When I explained to the nurse coordinator that our new prescription coverage is poor, she promptly recommended a website that can help. GoodRX.com is prescription medication aggregator, that provides you with the best prices in your area.
That?s good news. Under our previous employer plan, including the COBRA, we typically paid no more than $10 for prescriptions (and frequently less), to a maximum of $50 for recently released name brand drugs. Of course, those are just the co-payments. The actual cost of the meds are many times higher in each case.
Under the new plan, the minimum is $20 for the least expensive generics, but up to $200 for the newer name brands. If you?re on two name brand meds, you?re paying the equivalent of a car payment, just for the co-payments.
How GoodRx.com Works
What GoodRx.com does is provide you with a list of each medication offered by providers in your area. This gives you an opportunity to comparison shop, without having to research individual pharmacies. You can choose the source that offers the best price for your situation.
The screenshot below shows the availability of Lipitor (generic, Atorvastatin). Neither my wife nor I are on this med, but it is a common one. When you enter it in GoodRx.com, you get a list of each pharmacy in your area where it?s available. It provides both the cash price and the discount price that are offered by each provider.
Based on the results of this search, the least expensive option for Lipitor is CVS at $13.01. Now if you look further down the chart, you can see that the popular chain pharmacies, Rite Aid, CVS and Walgreens (not shown), have a cash price for the drug at around $140. If you use your prescription plan, the price you will pay will be based on the cash price. On our plan, that could mean that you?ll be paying a minimum of $40 per refill.
The moral of this story for us is that your prescription plan isn?t always the least expensive way to get the meds that you need. It can actually be cheaper to purchase them outside your plan.
The GoodRx.com Caveat
Now one thing you do have to be careful of with GoodRx.com are the orange and green boxes on the right-hand side of the page. They give the special stipulations that come with the discounted prices. If the button is green, it?s a one-time discount. For example, you can purchase Lipitor at Costco for $7.84 ? but that?s only the first time you buy it.
In the case of CVS, the orange LEARN MORE box reveals that you have to enroll in the GoodRx Gold membership plan, at a cost of $9.99 per month. That gets you the discounted price on a permanent basis. But it also enables you to purchase other meds at discounted prices through CVS and other pharmacies.
But you don?t have to go that route either. Pay close attention to the cash prices listed. The search reveals that the cash price for Lipitor at Costco is normally $14. That?s an even better deal than the CVS discount price, and it?s permanent. Knowledge is power.
The $4 Prescription Plans
This is a program that I was already aware of, but the nurse coordinator presented it as well. Most of the big box retail chains that have pharmacies offer a $4 prescription plan. They also typically offer $10 for a 90-day supply ($4 covers a 30-day supply).
Big-box retailers that have $4 prescription plans include:
The $4 prescription plans generally apply only to generic maintenance type medications. The discounted price level does not apply to recently released brand-name meds, the kind you typically see advertised on TV.
The pharmacy chains also have flat price generics, though they?re not as inexpensive. For example, Walgreens has 30-day supplies ranging from $5 to $15, and $10 to $30 for a 90-day supply. There?s also an annual membership fee of $20 for individuals, and $35 for families.
For what it?s worth, I got my first prescription filled at Walmart for $4. I had been paying a $10 co-payment under the previous plan. It never occurred to me to look into less expensive options. It turns out that I didn?t even need to use health insurance for this particular med.
And that?s really the whole problem. We get into a health insurance plan, and assume ?they know best?, and have everything covered. That?s almost always a misguided assumption. I?m guilty of making it, even though I know better. But with healthcare costs rising across the board, we always need to find less expensive ways to get the services that we need. That?s true even if you have a health insurance plan.
It?s probably not an exaggeration to say that health insurance makes us all lazy. We stop looking for better deals.
Discount Programs for Newer Brand Name Meds
As I?ve been saying, the discounted prices apply only to generic meds. If you?re on a new name brand drug, you?ll be stuck paying a higher price. But as is the problem with our coverage, the co-payment alone can be as high as $200.
There are workarounds for that problem too. The manufacturers of the newer name brand drugs are well aware of the affordability issues. They typically offer discount programs to make the meds more affordable.
An example of a common name brand med is Jardiance. It?s used in the treatment of type II diabetes. The drug has a cash price in the $500 range. The co-payment can be anywhere from $50 to $200. That?s a tight squeeze on top of a monthly health insurance premium.
To soften the blow, Jardiance offers a discount program that enables you to get a 12-month subscription with a co-payment. At the end of 12 months, you can renew the discount for another 12 months. After a couple of years ? hopefully ? a generic substitute will be available at a much lower price.
The catch with these discount plans is that they only work in concert with a prescription drug plan. Jardiance will cover the cost of the co-payment, up to $250 per month. But it?s not offered if you don?t have a prescription drug plan. The only alternative if you don?t is to switch to a generic alternative, which may not be as effective as the name brand.
I suspect pharmaceutical companies don?t make this offer because they?re being charitable. They know that if affordability is a problem, then the new med will not be well received. After all, people won?t pay for what they can?t afford. By offering discounts, pharmaceutical companies are expanding their market penetration.
Final Thoughts on Workarounds for High Prescription Costs
I realize that these workarounds can be more complicated and less convenient than simply going with whatever your prescription drug plan is offering. But as I?ve said many times in the past, there are no perfect health insurance plans anymore. The noose is tightening as the cost of healthcare continues to rise out of all proportion to the rest of the economy.
There?s little chance that health care will be reformed ? that is, truly reformed ? until it completely blows up due to its own excesses. That day is coming. Healthcare is gradually sucking the life?s blood of the US economy, and particularly the middle-class. Though it?s not discussed in the media or in political circles, that means that the current healthcare system itself is on life support.
But until it blows up, and is replaced by something more workable a long-term basis, all we can do is muddle through. It?s a relentless effort to save nickels and dimes while costs are rising in dollars. But what choice do we have?
Do you have any other suggestions for workarounds for high prescription costs?