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Old 10-10-2018, 07:53 PM  
'Hamas' Jenkins 'Hamas' Jenkins is offline
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Trump signs bipartisan bill lifting gag orders on drug prices

Thought you all might want to know about this, as there are certain circumstances where it could save you money.

https://www.nbcnews.com/politics/whi...prices-n918721

The gist of it is that pharmacists have long been prohibited from disclosing the difference between cash and insurance price, because there are certain instances where it is cheaper to pay out of pocket than a co-pay (this was more common when the $4 lists were more substantial, and won't be as helpful now as a few years ago, unfortunately). Now, if you so desire, you can ask the pharmacist what the cash price would be.
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Old 10-10-2018, 08:10 PM   #2
vailpass vailpass is offline
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Thanks.
Any idea what the reasoning was behind the gag order?
Drug pricing is hard to figure.

Last week I had to get 4 prescriptions to treat the first case of hives I’ve ever had (**** sushi forever). Total cost: 19 cents. Why even charge?

A few months ago I had an ear infection. Little bitty bottle of medicine was ~$250, insurance only brought it down to ~$90 then I used a card my doc gave me to go to the manufactures website to get a code that brought it to ~$40. Like a shell game.
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Old 10-10-2018, 08:18 PM   #3
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Quote:
Originally Posted by 'Hamas' Jenkins View Post
Thought you all might want to know about this, as there are certain circumstances where it could save you money.

https://www.nbcnews.com/politics/whi...prices-n918721

The gist of it is that pharmacists have long been prohibited from disclosing the difference between cash and insurance price, because there are certain instances where it is cheaper to pay out of pocket than a co-pay (this was more common when the $4 lists were more substantial, and won't be as helpful now as a few years ago, unfortunately). Now, if you so desire, you can ask the pharmacist what the cash price would be.
What are the circumstances where you can save money?
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Old 10-10-2018, 08:22 PM   #4
'Hamas' Jenkins 'Hamas' Jenkins is offline
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Originally Posted by vailpass View Post
Thanks.
Any idea what the reasoning was behind the gag order?
Drug pricing is hard to figure.

Last week I had to get 4 prescriptions to treat the first case of hives I’ve ever had (**** sushi forever). Total cost: 19 cents. Why even charge?

A few months ago I had an ear infection. Little bitty bottle of medicine was ~$250, insurance only brought it down to ~$90 then I used a card my doc gave me to go to the manufactures website to get a code that brought it to ~$40. Like a shell game.
Pharmacy Benefit Managers pretty much run health care for the end user at this point. They're a middleman that connects your employee health plan (in most cases, or Medicare Part D or government plan in many others) and drug companies. They make decisions about what drugs are included on the formulary (what they will pay for) for your prescription drug coverage, along with negotiating contracts for pharmacy reimbursement.

In most cases, pharmaceutical companies will offer the rebate cards because they write off the losses while also building some brand loyalty.

What you ran into is an example of what is or isn't on your formulary. Unfortunately, it's not always based upon what is best for the patient, but what is most cost-effective for the PBM.
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Old 10-10-2018, 08:23 PM   #5
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I wonder if my wife’s 30 day supply of pills for her MS will be cheaper with cash than it currently is at $8500

Better than her monthly IV treatment was . It was $13,500for a one hour treatment.
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Old 10-10-2018, 08:37 PM   #6
'Hamas' Jenkins 'Hamas' Jenkins is offline
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Originally Posted by HonestChieffan View Post
What are the circumstances where you can save money?
It would depend on which pharmacy you went to and their contracts with their suppliers, TBH.

If a woman had a UTI, she can take Bactrim for three days. Average cost for that course could be as low as $2.50. Some people have plans that require them to have fixed copays (say $10 for every generic Rx). Now, the actual cash price they charge won't equal the cost of acquisition, but markup on the pharmacy end generally isn't very high. In that case, you could pay twice as much despite having insurance.

There are more extreme examples, but it's an arcane industry.
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Old 10-10-2018, 08:40 PM   #7
'Hamas' Jenkins 'Hamas' Jenkins is offline
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Originally Posted by Dayze View Post
I wonder if my wife’s 30 day supply of pills for her MS will be cheaper with cash than it currently is at $8500

Better than her monthly IV treatment was . It was $13,500for a one hour treatment.
Teriflunomide? Fingolimod?
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Old 10-10-2018, 09:09 PM   #8
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Quote:
Originally Posted by 'Hamas' Jenkins View Post
Thought you all might want to know about this, as there are certain circumstances where it could save you money.

https://www.nbcnews.com/politics/whi...prices-n918721

The gist of it is that pharmacists have long been prohibited from disclosing the difference between cash and insurance price, because there are certain instances where it is cheaper to pay out of pocket than a co-pay (this was more common when the $4 lists were more substantial, and won't be as helpful now as a few years ago, unfortunately). Now, if you so desire, you can ask the pharmacist what the cash price would be.
Uh ... they've been doing this for years at my pharmacy.

Just ask, and they tell you.

FAX
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Old 10-10-2018, 09:11 PM   #9
'Hamas' Jenkins 'Hamas' Jenkins is offline
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Originally Posted by FAX View Post
Uh ... they've been doing this for years at my pharmacy.

Just ask, and they tell you.

FAX
Depends on the state and pharmacy. TBH, most of the places I've been will tell you, but there are significant professional sanctions if someone higher up finds out that it's happening.
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