Author Topic: Prescription Costs and HDHP?  (Read 3416 times)

VioletVixen

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Prescription Costs and HDHP?
« on: February 18, 2015, 10:24:15 PM »
Does anyone have any idea how to decrease expensive prescription costs when you have a HDHP that only kicks in after you hit the deductible (mine is $3000)? I know about the 90-day $9.99 prescriptions, but I'm talking about medicines that aren't on those 'discount' lists. Thoughts?

rayt168

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Re: Prescription Costs and HDHP?
« Reply #1 on: February 19, 2015, 04:34:10 AM »
For what it's worth, I don't think there is any way around it.

I had a prescription that was close to $400 per month.  It helped me reached the deductible that much quicker.  My deductible is 3K as well.

mskyle

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Re: Prescription Costs and HDHP?
« Reply #2 on: February 19, 2015, 05:32:31 AM »
Have you tried other medications? Tell your doctor that it's a financial burden and ask if there are other options. Drug companies are always coming out with new versions of drugs with very slight changes to the formulation basically just so they can charge more.

Obviously this doesn't work for everyone or every prescription. You could try talking to your pharmacist, too - they usually actually know how much drugs cost, unlike doctors.

nienajadly

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Re: Prescription Costs and HDHP?
« Reply #3 on: February 19, 2015, 05:44:15 AM »
There are some medications (not the time-released ones) that allow for splitting of pills.  You may see a line in them.  Check with your doctor is yours will work the same way if split.  He/She can give you a script for double the strength and then split your pill in half.  You will pay basically the same but get twice the doses.  Some meds do go up in price a bit as the strength goes up but it is still cheaper overall. 

MayDay

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Re: Prescription Costs and HDHP?
« Reply #4 on: February 19, 2015, 06:02:38 AM »
We've done 3 things. 

1.  Split pills.
2.  First use the discount card at the local pharmacy, usually these last the first year.  They provide the best price, but not everyone takes them (ie not the mail order ones).
3.  Then once that year is up, call around to all the pharmacies you can think of, including costco and mail order ones, to find the best price.
4.  Finally, look up the generic availability date and wait patiently.  In the case of the $$$$ one that H is taking, it goes generic in 2016, wheeeeeee!

Another thing we did this year is order a new 90 day supply at the end of December, since we had hit the 2014 deductible.  This may not always work out timing-wise, and if we hit our deductible again this year it's  a wash, but are always optimistic that *this* is the year we won't hit the deductible. 

suburbandad

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Re: Prescription Costs and HDHP?
« Reply #5 on: February 19, 2015, 07:35:53 AM »
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.

Gin1984

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Re: Prescription Costs and HDHP?
« Reply #6 on: February 19, 2015, 09:07:48 AM »
Some plans, like mine will discount your 90 supply compared to buy 30 supplies.  My $190/month med can be bought every three months for 2.5 times the $190 cost. 

Gimesalot

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Re: Prescription Costs and HDHP?
« Reply #7 on: February 19, 2015, 09:28:48 AM »
One thing I learned from watching a PBS show, is to go to pharmacies that mark-up generic medication, as opposed to discount generics.  The report stated that Target, Walgreens, CVS, etc. all price generic medication based on the brand-name cost.  For example, if the brand-name medication is $500 a month, they discount 40% and you pay $300.

Costco and some local pharmacies, mark the cost of generics up by a standard percent.  For example, they buy the generic for $20 a month, and mark up 20%, resulting in a price of $24 a month. 

Source: http://www.pbs.org/newshour/bb/health-july-dec13-costlygenrics_11-02/

Notice that Costco lets non-members use their pharmacies.

One last thing that my friends and family have done is to buy their medications outside of the US.  We all travel regularly, so it works for us.  We just go to the pharmacy in other countries and buy or medication there.  It is SOOOO much cheaper and normally you don't need a prescription.