Confused about Pharm. Drug Pricing VS. Health Ins. Drug Pricing?

Discussion in 'Fibromyalgia Main Forum' started by zenouchy, Dec 22, 2006.

  1. zenouchy

    zenouchy Member

    Hi All,

    I'm confused. (What's new?!) If a person has health insurance with medicines covered under that health insurance (which I do), then how is it that pharmacies play a part in dictating the price?

    For example, as part of my insurance, I have a mail order pharmacy called Medco Health....many you probably have heard of it and use it also. When I call them to get medication pricing, THEY TELL ME HOW MUCH MY MEDS WILL COST. There's 3 different tiers- Tier 1 is the cheapest, Tier 2, is more pricey, and Tier 3 which is very expensive.

    As an example, Medco Health tells me that Tier 1 meds are $5 filled at a local pharmacy for one month and $10 if filled by mail for three months. If the drug is going to be used long term, it must be used by mail-order. Obviously, it's cheaper to fill the RX by mail if possible.

    *Therefore, if Medco Health has told me that it's $5 at a local pharmacy, then how can a pharmacy change the price or dictate the price? (Although occasionally, the pharmacy I use charges less than the $5 if the medication doesn't cost that much.....hmm, maybe that's where it depends on the pharmacy and not all of them would charge less?)

    Thanks for your replies and for clearing up my confusion!


  2. zenouchy

    zenouchy Member

    is everyone as confused as me? :)
  3. joyfully

    joyfully New Member

    Your insurance company strongly urges you to use the mail order if it is a long term use drug. I think the ins. co gets a better rate from medco than your local pharmacy.

    Yes, the INSURANCE co. dictates how much you are going to pay for the prescription copay. Yes, it is a less expensive copay when you use the mail order for your prescriptions. This cost scale is explained in your health insurance policy up date that you receive each year from your employer.

    I don't know if you MUST fill by mail order if the drug is long term use. I have one medication that I refill each month at my local Walgreens because I prefer the manufacturer that Walgreens uses versus the manufacturer that medco health uses. so I pay extra for the drug by having it refilled at the local pharmacy. The extra cost is worth it to me because the arthritis RX from medco health really upsets my stomach; the RX from Walgreens doesn't.
  4. zenouchy

    zenouchy Member

    Thanks, y'all for taking the time to respond! I always use Medco Health pharmacy by mail and have done so for a long time unless it's a new RX and I need the medicine quickly, or I'm trying it out for the first time before committing to 3-month supply. It's definitely much cheaper (although often still pricey!). I've just been reading and hearing a lot about how pharmacies "dictate" pricing for drugs....which didn't make much sense to me when I have insurance.

    I was wondering if I was missing a component of drug pricing. When I hear about pharmacies "dictating pricing", it must be for people who don't have insurance, or who don't have a mail-order pharmacy option.

    I agree with you all- it's nice to have the convenience of the mail order option. The only thing I don't like is when it's the extreme heat of the summer time and the meds are going to sit in my mail box, even for a few hours. I try to get them from my mail right as the postal carrier delivers them, but that's not always possible.

    Thanks so much again everyone. Have a great day, and Happy/Healthy Holidays!

    Warmly, Erika
  5. joyfully

    joyfully New Member

    Hey. I live in central Texas and have the same problem

    A few suggestions:
    Pay the extra and have them "Expedite shipping". It used to be an additional $9, I think it may have gone up to $13 now. Order all your maintenance drugs at once so you pay one $13 charge for the entire lot. The expedited shipping is a few days less time that they are sitting out in the heat. The stuff is delivered to my door rather than cooking out in the mail box.

    It is always a big gamble how long it will take for the pharmacy to "process" your order. Try filling it on a Friday. It will go into the system on Monday, get filled (hopefully on Tues) and arrive the next Friday.

    This doesn't always work, but never refill on a wed or thurs because that is taking a chance that it will sit in a truck for the entire weekend.

    If you order "online" and the screen doesn't give you the option of the expedited shipping, disconnect and call them directly.
    [This Message was Edited on 12/23/2006]
  6. zenouchy

    zenouchy Member

    Thanks so much for your great suggestions!!

    Warmly, Erika

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