Don’t Trust Health Insurance to Keep Your Costs Low

Last week, I related a story about how the cost of a procedure can be higher if you have insurance and use it than if you don’t. I have another story this week about the cost of prescription medication if one uses their insurance.

Although it may not be this way for everybody, I  have found that there are some medications – mainly maintenance medications – that can be less expensive if you shop around for the best prices for them rather than just hand your insurance card over to your pharmacist, under the delusion that your insurance company wants to keep your health care costs low. If you really like your current pharmacist, I would recommend that you ask him or her what the cash price is for your prescriptions. The cash price may be lower than your contracted copayment. If so, just let your pharmacist know that you do not want to use insurance to pay for your medication.

If you find that the cash price is higher than you would pay to have your health insurance pay for the medication, I would suggest that you make an effort to call around to a few pharmacies in your area and ask for cash prices before you give in to using your insurance. The sad fact is that some medications are just plain expensive, but that is a conversation for another day.

I learned this last year when I had read an article or two about how paying cash rather than using your insurance is a better deal when getting prescriptions filled in many cases, which may be especially true of medications you are taking long-term.

So I decided to apply what I had read to my own situation. The cash prices for the two maintenance medications I take – levothyroxine and pravastatin seemed particularly high at the pharmacy where I had been habitually using my insurance to pay for them. So, when I was doing my weekly shopping at Walmart, I provided the pharmacy technicians with my prescription information, and they printed out prices for both a 30-day supply and a 90-day supply for both medications.

It turned out that the cost of a 30-day supply for my dosage of levothyroxine was $4, and a 90-day supply was $10. Then for my pravastatin, the 30-day supply would be $15.50, and the 90-day supply would be $42.72. Okay, so my copay for a 30-day supply of pravastatin would have been $15.00. However, if you add that up over a 90-day period, the cost of copayments would be $45.00 because, generally speaking, many insurances just cover a 30-day supply, and the 90-day supply without insurance would be $42.72. These may not seem like huge differences, but they add up over time if they are maintenance medications.

What really brought home to me the rip-off that people experience when paying for prescription medications with their insurance is what happened around Christmastime when I had to get my thyroid prescription refilled. I had forgotten that I had given the Walmart pharmacy my insurance information in a big dust-up over the insurance paying for a considerably more expensive medication. So, when the pharmacy filled my regular prescription they automatically sent it through my insurance.

I discovered this very quickly as I was walking away from the pharmacy. I looked at a note that had been stapled to my bag, saying that the pharmacy generally relied on a Puerto Rican manufacturer for its supply of levothyroxine, but because of the recent hurricane there, Walmart was experiencing supply problems. As a result, the note read, cash prices had temporarily increased to $9 for a 30-day supply and $24.00 for a 90-day supply.

Then I looked at my receipt and it said I was supposed to pay $13.73 for a 30-day supply of my prescription. Needless to say, I was thinking, “What the heck?” Then I read the rest of it that listed IHC as my “payer” (ironic wording). So I went back to the pharmacy counter and asked why I had only received a 30-day supply when I was used to a 90-day supply and why it had been “charged” to IHC (SelectHealth, Intermountain Healthcare). I quickly realized that they had my insurance information (DRAT!) and had automatically sent my prescription refill through that. Clearly, I need to be more careful about letting the pharmacy know when I don’t want to use my insurance because the Walmart staff had told me that just because they have my insurance  information, I don’t have to use it for every prescription.

I was also told that the insurance would only allow me to have a 30-day supply, but I won’t go into the details of that debacle.  What bothered me was that I was paying $4.73 MORE THAN the current cash price for that prescription to have it charged to my insurance. Again, what the heck?

I decided a little later to call my insurance carrier about that higher charge and all the representative would tell me is that they had a certain “contracted” amount for medication co-payments ($15), but some pharmacies might get a different contracted amount. Either way, that contracted amount was HIGHER than the cash price.

Why? Clearly the pharmacy would have at least a slight mark-up on anything it sold. After all, profit is needed to stay in business. However, why would I be paying almost $5 more for a prescription that I could get for much less if I paid cash.

According to an editorial on the website of Association of American Physicians and Surgeons, author Dr. Keith Smith states that the insurance coverage for medication “represents an additional contracted layer- a toll booth – through which the exchange between you and the pharmacist must take place.”

In conclusion, I would advise anyone who reads this to learn what the cash prices are for any prescription medications you need, compare it to the cost of letting the insurance “cover it,” and decide which way you want to do it.

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