Pharmacists Can't Tell You if it's Cheaper to Pay Cash

[ThatGuy]

I discovered that it's soetimes cheaper to pay cash than it is to use insurance.  I didn't know that pharmacists couldn't tell you if it's cheaper unless you ask.

https://www.nytimes.com/2018/02/24/us/politics/pharmacy-benefit-managers-gag-clauses.html

[rantk81]

Yeah, I knew this was the case for several years ... ever since some pharmacies (like the ones inside of Walmart and Target -- before they were bought out by other companies) offered $4 generics that they advertised... However they'd charge you a higher amount of the insurance "co-pay"... I was able to get the lower price when I questioned this.. but they certainly didn't volunteer it.

[PepperPotts]

Pricing of prescription drugs pisses me off regularly.  I hate the lack of transparency.  In what other retail situation would it be normal to have no idea how much a product costs until you're at the cash register?  I check prices regularly on the GoodRx app and use that in lieu of insurance if it makes sense to, but even then, sometimes the price is still a bit higher than it's supposed to be.  I use Blue Cross/Blue Shield pharmacy tool to see what they'll charge vs the Good Rx coupon (which doesn't count toward your deductible), or for a branded drug there may be a manufacturer's coupon.  Costco used to have an online price list, but they took it off their website.  I hate playing games at the pharmacy.  It's high time for an overhaul of their business practices. Cost of drugs is one matter, but pricing games are ridiculous.

[mosprott]

Now that we're on a bare-bones ACA plan, it's awfully good to know that prescription costs might be somewhat more elastic...

[Davids]

Dumb question but is the term pay cash actually with cash or could I use my credit card.

[Paul der Krake]

Dumb question but is the term pay cash actually with cash or could I use my credit card.

It means "not going through insurance". Plastic is fine.

[rantk81]

Even if you find out the "cash price" is cheaper than going through insurance --

You then have to go through trying to make the sucky-decision/prediction of:  "Will I be hitting my out-of-pocket-max this year or not?"

1) If you think you will be hitting OOPMAX, then go ahead and use insurance anyway for the 'script.

2) If you don't think you'll be hitting OOPMAX, then you'll probably save money by just paying cash and not going through insurance.  (Of course, if you do this, then the amount you pay for the 'script won't be counting toward your insurance deductible or OOPMAX for the year.)

*probably* -- depending on how big the dollar difference is, and how your co-insurance amounts are if you've met you deductible.

[HermanCain]

I discovered that it's soetimes cheaper to pay cash than it is to use insurance.  I didn't know that pharmacists couldn't tell you if it's cheaper unless you ask.

https://www.nytimes.com/2018/02/24/us/politics/pharmacy-benefit-managers-gag-clauses.html

The disparity between cash vs what insurance companies pay for many medicines is also not required to be public. Total black box. Really makes it hard to assess the value of insurance policies.

[Sibley]

Not only do different insurance companies get different discounts, but so do different policies by the same company. It's really messed up.

Good to know about the cash price - I've found out this weekend that I'll probably have a ton of costs for asthma meds this year. Will be sure to ask.

[FiftyIsTheNewTwenty]

I always ask.  Our pharmacy is Walmart, they've always given us an answer, and every med we use is way more expensive without insurance.  After doing the math I've made sure to have the insurance.

[ThatGuy]

My insurance only allows 30 day scripts and my co-pay is $20.  I've learned that a lot of times I'm better off getting a 90 day script and paying cash.  Like most things, if you buy in quantity it's cheaper. The GoodRx app is very handy for checking out prices but it doesn't appear to list all pharmacies, maybe just the major players.

[the_fixer]

It would be nice if the system were setup to look at the cost and charge at that rate not to exceed the co-pay.

For example say I go in and have insurance the medication is $10 cash my co-pay is $20, it would seem that it should be billed through the insurance at the $10 rate as a co-pay.

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[Rosy]

My insurance only allows 30 day scripts and my co-pay is $20.  I've learned that a lot of times I'm better off getting a 90 day script and paying cash.  Like most things, if you buy in quantity it's cheaper. The GoodRx app is very handy for checking out prices but it doesn't appear to list all pharmacies, maybe just the major players.

Wow - I didn't realize that was possible. Thanks for pointing that out!
I ran into a similar situation, but just sent the kid to pick it up and thought I was locked into 30 day scripts on that med for good. Which was insane, since they were eye drops and if you spilled some you were SOL, they were that closely measured.
I solved it by talking to my eye doctor and after repeated tests, the pressure had normalized and I no longer needed the meds at all. Sometimes the eye pressure goes up after an operation but normalizes later.
Had I not questioned my doctor I'd still be paying $40 a month for a med that is uncomfortable to use and no longer needed.

I also didn't pay attention and notice that my insurer has a deal with CVS for cheaper prescriptions while I was still going to Walgreens and paying more out of pocket. Pitiful!

[frugalnacho]

Even if you find out the "cash price" is cheaper than going through insurance --

You then have to go through trying to make the sucky-decision/prediction of:  "Will I be hitting my out-of-pocket-max this year or not?"

1) If you think you will be hitting OOPMAX, then go ahead and use insurance anyway for the 'script.

2) If you don't think you'll be hitting OOPMAX, then you'll probably save money by just paying cash and not going through insurance.  (Of course, if you do this, then the amount you pay for the 'script won't be counting toward your insurance deductible or OOPMAX for the year.)

*probably* -- depending on how big the dollar difference is, and how your co-insurance amounts are if you've met you deductible.

I thought cash payments could be submitted to your insurance and count towards your deductible and OOPM (at least up to the extent that insurance would have paid - ie you pay $10k cash for a dr visit that insurance company negotiated to $50, then they will only allow $50 towards your deductible/OOPM.  This situation is the opposite though, a $10 cash rx that the insurance company negotiated to $20 will only count as $10 towards your deductible/OOPM when you submit receipts)?

Can anyone clarify this?  I know I've read (I believe on this forum) that you can pay the cash price for dr visits and submit it to your insurance to count towards your deductible, but I've not ready anything about rx.