Prescription Drugs
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By In Around the Web, Prescription Drugs

How PBMs Work, or, Why Being an Active Health Care Consumer Is Both Hard and Necessary

I was sitting down to write something and then saw this thread on Twitter and decided, to hell with it, this is a brilliant dissection of how pharmacy benefit managers (PBM’s) work and why and how they’re contributing to high prices in health care.

There are several ways to read this thread. Certainly PBM’s are not practicing fairly and with consumers in mind. But their dance partner, insurance companies, are to blame as well for turning the other cheek to the “kickbacks” that the DJ, pharmaceutical companies, are paying the PBMs for promoting certain brand-named drugs over available (and much cheaper) generics.

This scenario is not an uncommon abstraction. In fact, I’m dealing with two similar scenarios right now:

1) a drug I’ve taken for 15 years isn’t covered through my pharmacy of choice, Walgreens, because my PBM is CVS Caremark.

Price to buy through CVS: $12
Price to buy through Walgreens: $421

2) A drug prescribed for my son that is not yet available in generic form costs $309 after the GoodRx discount. I don’t have any option other than to go without or take my chances on a different drug with different/more side effects.

I wrote about a similar type of phenomenon on my LinkedIn profile last week, with a link to the definition of a “Mexican standoff.” For the uninitiated, that’s when two or more people have guns pointed at each other and the only way out is mutually assured destruction…or working together. It’s a favorite movie trope of Quentin Tarantino, and it usually doesn’t end in cooperation.

Until the lords of health care figure out how to work together, it’s on us to look out for our own interests.

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By In Health Insurance Utilization, Prescription Drugs

Another Example of Why You Should Always Ask the Price

My wife went to the pharmacy the other day to refill a prescription. We changed insurance on January 1, so when they told her the first time she got the it filled three weeks ago that our plan didn’t cover the prescription we needed for one of our kids, it didn’t seem out of the ordinary. In fact, the pharmacy was nice enough to give us a discount through GoodRx — something I talked about in this post.

Well, it turns out that the discount was a whole lot more than we should have paid, anyway.

When the pharmacist told my wife our Rx would be $152, she texted me just to commiserate about the high cost and ask if it was because of our new insurance. I said yes but that they gave us a discount to get it down to $90 and that she should be sure to ask if they can give it to us again. That ask set off a series of events that blew our minds.

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By In Do the Math, Money-Saving Tips, Prescription Drugs

Do Prescription Discount Cards Work? It Depends

I recently rolled off of my previous employer’s health insurance plan and bought an individual ACA plan for the first time. As a result, our prescription drug coverage changed as well and when I went to renew a prescription, I was asked to wait until Monday to get a reply. I couldn’t wait until Monday (it was Friday afternoon) for these two scripts, so I asked my options. Without coverage, they would cost $1,000 and $259, respectively, for a full order of each. Zoinks!

That’s when I remembered that I had gotten a prescription discount card at a healthcare conference I attended. I pulled the card from my wallet and asked the pharmacist if this would bring the cost down any. She looked at the card, smiled and said “This might actually make it cost more.” Ugh!

“The only discount card that usually works with us is GoodRx,” she said. I asked why and she didn’t seem to know the answer. So, I searched and found a bit…

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