RX cost on the ACA

[Exflyboy]

Hi all,

We will lose our HC coverage at the end of August. Like most people with great employer coverage we pay very little for drugs. My Wife has just got her prescription refilled and I noticed the cash price for her asthma inhalers is $205 and $64 respectively.. Thats $270/month just to breath!

Anyway, I was looking through the exchange plans and I couldn't see what we would pay for each of these drugs on say a Bronze plan prior to hitting the deductable (about $12,000)

Do we pay the full cash price or do we get the insurance company special negotiated price?

I have found much cheaper prices from Canada but before jumping through hoops to get a new prescription written I wondered how I might confirm our real costs?

Thanks

[Financial.Velociraptor]

I get a discount negotiated price on my ACA plan but I find I can do better with a Sam's Plus membership.  The savings are sufficient to cover the 100/yr membership price.

[Frankies Girl]

You can also try using apps like GoodRx to see if there are any discounts. I've gotten some significant savings using it instead of my insurance.

And don't forget to check with the doc to see if there are generics available for the drugs/inhaler setups. They may be perscribing a higher priced model when there are other options out there for less.

[jim555]

Each policy has its own drug pricing schedule.

[respond2u]

I get a discount negotiated price on my ACA plan but I find I can do better with a Sam's Plus membership.  The savings are sufficient to cover the 100/yr membership price.

Also check out CostCo. I was shocked to find that a year's supply of [none of your business :)] was cheaper if I didn't use my health insurance there.

But Drugs, in general, are incredibly expensive in the US because it's part of the protected racket.

I believe it's against the law to bring drugs into the US from Canada (see previous sentence).

[Exflyboy]

 Thanks all for your thoughts. I will have to do some more digging clearly.

I did check GoodRX and sadly Walmart is cheaper (at $209 for a stinking inhaler!)

I thought it was illegal too but apparently the mail order Canada folks seem to think its all legal and above board. I am currently looking at 25% of the cost for the 2 inhalers.

I'll look at Costco.

Not that I really care, I have folks who live in parts of the world where you can buy almost anything you want without a prescription.. What they gonna do open every package somebody sends to me? Probably too much hassle on an ongoing basis sadly.

Yes don't get me going on the corruption racket called the "US Healthcare system". I come from the UK, they have "death panels" over there don't you know?... Grrrrr.

We can get a high deductable Bronze plan for very little out of pocket so the Canada option is viable if we can get the Dr's office to give us the prescription.

Next step is to see if I can find out what I would be charged thru the local exchange plans.

[Exflyboy]

OK mystery solved.. Jim555 was correct in that each plan has its own list of drugs thats covered.

On the Healthcare.gov website you can put in your drugs and when the plans pops up it tells you if they are covered or not. The plan I was looking at has both non-generic drugs covered at $45 each. You can get high dose versions of each which should drop tour costs for drugs down to roughly $50 to $100/month with a premium of about $115 on a Silver plan.

Not too bad for now at least.

I am now wrestling finding a provider in our area which don't seem to exist when you search, but then they have an "affiliate link" and that brings up a list of providers in our area... So hopefully we will be able to find acceptable care.

[Paul der Krake]

If you are planning on using an HSA, keep in mind that you cannot claim drugs that you imported illegally.

See page 16 of this IRS booklet for guidance:
https://www.irs.gov/pub/irs-pdf/p502.pdf

[Exflyboy]

If you are planning on using an HSA, keep in mind that you cannot claim drugs that you imported illegally.

See page 16 of this IRS booklet for guidance:
https://www.irs.gov/pub/irs-pdf/p502.pdf

Good point. I don't think the silver plans are HSA compatible and the bronze plans wont cover the drugs anyway so I don't think its an issue.. Good to know though.

[jim555]

I use a very common high blood pressure medicine.  I was thinking order it bulk from Alibaba or some supplier and get a scale.  Backup plan right now. 

[T-Money$]

If you are interested in spending $0 on asthma medications consider learning Buteyko.   It's a method of breathing designed to reduce or eliminate asthma symptoms.   It has worked well for me.  I used to take at least 2 inhaled medications per day and occasional Prednisone.  I still have a rescue inhaler if I need it, but I haven't taken daily asthma medications since learning the technique. 

Sent from my Moto G (5) Plus using Tapatalk

[Spork]

I get a discount negotiated price on my ACA plan but I find I can do better with a Sam's Plus membership.  The savings are sufficient to cover the 100/yr membership price.

I was going to say exactly this.  The savings on one BP drug pays for our membership.  The wife also noticed that if the doctor writes the script for 2x the dosage (with instructions to half each pill) -- the price is about half of just buying the lower dosage.  We file the expense away towards an HSA.  So far, we've let everything ride and have not yet taken any reimbursement from the HSA, but our current plan -- while high deductible -- is not HSA compatible.... So at some point we may cash out the HSA.

[Evgenia]

We don't use inhalers but, FWIW, have brought them back for friends from the UK (where some family lives), Canada and Mexico with no problems at all.

There are a number of things that, when we've had less-than-great employer coverage (long before the ACA and long before our current ACA plan) we found it was actually worth flying to Mexico, getting everything there, and sending it home. When flights were cheap, we would do a day trip or fold it into a vacation. Many more things are OTC there than here (like birth control which, depending on the pharmacist I got and their belief system, was often a protracted trial in the US), and you can also get a prescription legally in Mexico, very cheaply, at a farmacia. Then, mail a box of the inhalers and whatever else to your home in the US. That way there are no airport surprises.

Not even kidding about airfare AND the stuff costing less than our co-pay would have been, WITH insurance.

Best of luck! Happy to answer any questions if you have them.

[Abe]

Are either of the inhalers combination inhalers? If so see if there are individual alternatives to the combination. That tends to be muuch cheaper because most of the drugs for asthma are >30 years old, thus the companies make their money on "convenience" rather than innovation. Also agree with cardio training. People with asthma and no other underlying heart/lung issues tend to have significant improvement in baseline function with improved exercise tolerance.

[Exflyboy]

Thanks all.. DW is in fact in pretty good shape and I'm sure as a result means she does not have to use the inhalers as much as listed on the prescription.

As to the drugs one is Ventolin and thats Albuterol for which there is a generic alternative. The other is Flovent which appears to be available name brand only.

Apparently the EPA made the companies provide CFC propellent free inhalers.. Which meant Glaxo Smith Klien (a Bristish company no less) was allowed to patent protect the Flovent all over again at $207 per inhaler for the US.

Mail order from Canada is 25% of the US cost so we hope that will be an option assuming we can get a prescription. If not we might be looking at alternatives such as Mexico.

[Shinplaster]

If you want meds from Canada because you want confidence they are legit, make sure the mail order from Canada actually IS from Canada.  There are a lot of companies out there with Maple Leaf flags plastered all over their websites that are actually shipping from other countries.  Pharmacists can't fill a prescription written by a U.S. doctor without a Canadian doctor cosigning it, unless the U.S. physician is also licensed here.  But if you pop across the border, walk in clinics in border towns are used to Americans coming in to get legal prescriptions written.  : )   Get lots of repeats, and your medication can then be mailed to the U.S.

[mandy_2002]

So far, we've let everything ride and have not yet taken any reimbursement from the HSA, but our current plan -- while high deductible -- is not HSA compatible.... So at some point we may cash out the HSA.

I was under the impression that there are two different "eligibilities" for HSA's: 
1) You have to have a compatible health plan to put money into an HSA, but
2) Once you have money in an HSA, even if you switch to non-HSA plans, you can still use the funds against any health care expense incurred after the money was put in the HSA

So if you want to take money out of the HSA, you just need to have the applicable receipts (which can be as old as your HSA) and the money comes out without penalty.  Please correct me if I'm wrong, because this is what I was planning on doing after I close my Peace Corps service.

[Exflyboy]

If you want meds from Canada because you want confidence they are legit, make sure the mail order from Canada actually IS from Canada.  There are a lot of companies out there with Maple Leaf flags plastered all over their websites that are actually shipping from other countries.  Pharmacists can't fill a prescription written by a U.S. doctor without a Canadian doctor cosigning it, unless the U.S. physician is also licensed here.  But if you pop across the border, walk in clinics in border towns are used to Americans coming in to get legal prescriptions written.  : )   Get lots of repeats, and your medication can then be mailed to the U.S.

Good info.. thanks!

[SachaFiscal]

I use a very common high blood pressure medicine.  I was thinking order it bulk from Alibaba or some supplier and get a scale.  Backup plan right now.

FYI. The true north center in Santa Rosa has had success in bringing down people's blood pressure to normal using supervised fasting and following a special diet afterward. It's not easy to fast or make the dietary changes but some people are able to do it. If you were able to, you might be able get off your meds.