Retail pharmacist here with a few pointers (and sassy commentary):
I'll expand on a couple suggestions already made:
- Any "$4/30 day or $9.99/90 day" pricing programs are NOT billed to your insurance therefore they do NOT count toward your deductible- though you CAN still use HSA/FSA to buy them. They are simply discounted prices offered by whichever pharmacy is offering it - usually large grocery/big box who are more than happy to lose $10 on the prescription you fill as long as you buy $300 in groceries while you wait for them to fill it.
- There's a big difference between manufacturer coupons/vouchers for brand name drugs and the discount cards that show up in your mail unsolicited:
Manufacturer cards will reduce your out-of-pocket costs by a certain amount, usually AFTER your insurance is billed- they all advertise as "Pay as little as $15!***" or some similar BS with a very important note in the fine print that the maximum benefit per 30 days is ~$50 or so. This leads to a couple interesting scenarios:
Scenario 1, with Mfr card and before HDHP's were prevalent: Your Dr writes for brand drug that costs $300, we bill for $400 (yay healthcare system!), your insurance's negotiated formulary says that it's worth $355. They reimburse pharmacy $290, and you owe $65 copay. You use Mfr card, which pays the next $50 out of pocket, so you only end up paying $15 copay. You're happy that you get a "cheap brand drug", drug company is happy that they're moving product and still making buttloads of money even with the $50 discount they're providing. Insurance company is sad that you made them spend $290 when there's a perfectly good generic alternative for $60, which they would've given to you for a $10 copay.
Scenario 2, with Mfr card and HDHP: Your Dr writes for brand drug that costs $300, we bill for $400 (yay healthcare system!), your HDHP insurance agrees to cover it at $355. Manufacturer card covers next $50 out of pocket. Assuming you are still far away from the deductible, you still owe $305 copay. Don't forget to yell at your pharmacist that the card says you should "pay as little as $15***."
Now where it gets wild with HDHP plans is that, in my experience, they calculate the amount you would spend BEFORE any Mfr discounts as the amount counted towards the deductible. So there are some Mfr cards out there that will knock as much as $300 off your out-of-pocket (rare, usually for unnecessarily re-branded topical meds- your dermatologist is generally the most "in-bed" with the drug companies of all the different practices) - so I've actually got a couple customers on HDHP's who are practically doing "manufactured spending" for prescriptions with high-value Mfr cards to burn up their deductible:
Scenario 3, with HDHP and high-value Mfr card: Evil dermatologist writes for topical brand medication that costs $300, we bill for $400, HDHP covers it at $355. Mfr card covers next $300. It costs you $55 to pick up med but the insurance counts $355 off your deductible. Nobody notices that there's a perfectly acceptable generic alternative for $40, and the healthcare system continues to collapse under its own absurdity.
As for the general discount cards, they are similar to the $4 lists - they do NOT go through your insurance and therefore do NOT count towards your deductible. We can not bill them after your primary insurance to further reduce the out-of-pocket--- we can bill the insurance, or the discount card, but not both. You may still use your HSA/FSA funds to pay for them, though. Best case scenario, they will only get you close to the average insurance-negotiated price for a med. So, they are not really any benefit to HDHP users.
Now there are obviously a lot of different approaches you can take, depending on your projected health care costs. If you don't think you're ever going to come close to hitting the deductible, then the $4 lists and everything are totally reasonable to keep costs at a minimum.
I unfortunately have a kid with type 1 DM, so between insulin, supplies, and pump equipment, I'm burning through that MF'ing deductible every year no matter how savvy I am to the system. This happens to a lot of people with chronic conditions.
Everyone's situation is different- regarding tweaking your medications (splitting pills, finding a similar med that has a generic, etc) your local pharmacist is *generally* a great resource for finding lower cost alternatives, but you have to find one that doesn't look 5 minutes away from a stress-induced stroke and see if you can peel them away from the workflow for 10 minutes.
While the occasional physician is price-savvy, you should generally be under the assumption that the Dr writing the prescription has no fucking clue how much it costs. I can't tell you how many times a patient comes in and says "The Dr said it should be on the $4 list!" for a $90 prescription.
While we (local pharmacists) can suggest alternatives, we DO NOT KNOW YOUR FORMULARY and can not generally "check prices" until we actually have a prescription order in hand. Prescription formulary info and plan info is always available to members, although awareness on this is terrifyingly low. In a perfect situation, you would have a complete personal medication list, formulary/ preferred drug info from your insurance, 15 minutes with a knowledgeable pharmacist, and an accommodating physician.
