Fighting outrageous generic drug prices at the Dr.'s office

[MineralMan]

I had my annual extended Medicare wellness visit with my primary care doctor at the multi-specialty clinic I use today. I complained to him about the drastic price increase of generic atorvastatin, one of the meds he has prescribed. Even with GoodRX discounts, the price for it was out of line. It went up several hundred percent last year.

He told me that he had heard that complaint from other patients, and switched me to lovastatin generic, which he said was much lower in price.

I just picked up my three 90-day prescriptions a few minutes ago and sure enough, the new med was less than 1/3 the cost of the previous one. I asked the pharmacists about that and he said that lots and lots of people had switched after the big price increase last year.

I don't have Medicare Part D, because the monthly premium is much higher than the cost of my meds. I have a GoodRX discount card, which kicks the prices down to about the same copay as a Part D policy would be. The pharmacy treats it just like insurance coverage. I have no connection to GoodRX.com, but it's worth looking at as a way to maybe lower your drug costs.

Anyhow, if you've experienced a large price increase for one or more of your prescriptions, start with GoodRX to see if you can bring the price down. If not, talk to your physician and see if a different med would be as effective but cheaper. My PCP knew the relative prices of the prescriptions. Maybe yours does, too.

BTW, my doctor says I'm still alive and doing pretty well for an old geezer. "See you in a year!"
3

[SheilaT]

1. If you don't currently have Medicare Part D,

and eventually do sign up for it, you will pay a premium to do so.

I have an Advantage Plan through Humana, which includes Part D. I don't pay anything extra for it. Through their plan the three meds I take, all generic versions, are free to me, no copay at all, and they are mailed to me.

You might want to see if anyone offers an Advantage plan where you are that would work for you.

[MineralMan]

2. I'll have to wait until the next open enrollment period.

I considered it this year, but the additional cost to me over my regular supplement made no sense, based on my cost for the prescriptions I take.

Next year, it will cost more for me to sign up for Part D. I will recalculate, based on my health at the time and my list of prescriptions and make a fresh decision at the time.

I will never sign up for an Medicare Advantage plan, though. I strongly prefer the (cost) supplements, and have seen others' experiences with Advantage plans.

Thanks for your suggestion, though. Everyone's decisions are made based on different factors. What is right for one person isn't necessarily so for others.

[SheilaT]

5. Here's my Advantage Plan experience.

Humana apparently collects the $104.90 (I think that's the amount) that Medicare takes for Part B, and they also cover Part D with that money.

I have a zero copay for an office visit, and a $50 copay for a specialist and $75 for Emergency room. Haven't been to a specialist or ER. Plus, no copay for my meds. My PCP is in their network.

This may be the best coverage I've ever had.

The biggest problem of course is that what coverage you can get depends on where you live. Which is too bad, because if a plan as great as mine were available everywhere, if people really had plenty of choices -- until we finally get a true Universal Health Care/Single Payer -- we'd all be better off.

[MineralMan]

7. Advantage plans tend to work OK for normal medical stuff.

It's when you get into costly problems that they aren't so great. You may find that they're less excited about those specialist visits, advanced diagnostic tests, etc. My parents had extreme problems with an Advantage plan when they needed joint replacements. They ended up having to wait until the next year, when they signed up for a more typical supplemental policy and paid their own Part B by deduction. After that, they never spent another penny on care. Two knee replacements and a hip replacement, plus a prolonged hospital stay for my father after a cranial hematoma that almost killed him. They were never billed a penny. No co-pays. No nothing.

Advantage plans are OK, as long as your health is relatively good. But they are "managed care" programs, and that management is often hesitant about costly treatments and procedures. I hope you won't need anything like that. If you do, you may find that you have a less satisfactory experience.

[SheilaT]

9. Does your plan cover specialist visits?

Just curious, and again, I know that different plans are available in different parts of the country.

[leftyladyfrommo]

15. I have Humana Advantage

And it covers specialists. Those visits have a little higher copay but it's not bad - like $45 or something. My copay for a regular visit is $10 this year. Last year it was $5. So much better than the $150 I had to pay when I had a high deductible plan.

[SheilaT]

19. I'm waiting for someone to let me know

what their copay is for specialists in a non Advantage plan.

A good friend of mine also has a Humana plan, I want to say it's a Fee For Service plan. Not sure I have the name right. I do know she has a copay for all office visits, and I think a higher specialist copay than I do. However, she's not restricted to a network, and I believe she sees a specialist or two that aren't in a network. And I know she pays sixty something dollars a month above and beyond the Medicare amount.

On my plan, my deductible is $0, and supposedly there's a $360/year prescription deductible, but as I've said, I get my three generic prescriptions with no copay.

[Yo_Mama]

16. The problem is when a real medical problem emerges. Then they can suck big time.

Those plans want people like you. People with very low medical costs. They deliberately make it a good deal for you and a terrible deal for a person who had a stroke - so the ill people don't stay in their network and they can make money.

[KamaAina]

3. Is Shkreli involved?

[MineralMan]

4. Nope. Generic pharmaceutical companies have

begun to jack up their prices, though, to astronomical levels for popular generics. I'm not sure why that is, but it is a phenomenon that seems to have started last year in earnest.

Even basic antibiotics that have been almost free for years are now being sold at prices that rival patented brand name antibiotics. It is becoming a serious problem and is hurting people, even if they don't know about it. Their health insurance plans may be charging the same old co-pays for these drugs, and then raising their premiums to cover it later.

It's an insidious thing that smacks of collusion and conspiracy by generic drug manufacturers, many of which are actually owned by major pharma companies.

As this practice becomes known, perhaps we can get some action from our lawmakers. Right now, they aren't hearing much about it. Here's a story about what's happening:

https://www.bostonglobe.com/business/2015/11/06/generic-drug-price-increases-alarm-insurers-providers-and-consumers/H3iA9CSxAUylnCdGjLNKVN/story.html

[sharp_stick]

6. There's a few reasons that they're doing it

basically it boils down to, because they can.

It used to be that generics were cheaper because they not only didn't have to do any research to invent and test the drug there were at least 3 companies all making the same thing.

Now the generic market is a lot tighter and in many cases a generic company is the only one manufacturing a certain drug. Lots of consolidation. It's too expensive and a pain in the ass for one of the other generic companies to enter the market fresh so they are free to jack the price through the roof.

[MineralMan]

8. Yes, that's part of it. Also, major generic manufacturers are

increasingly being bought up by major pharma companies. They then use their own predatory pricing strategies to increase revenues.

Things are about to get real, though. The insurance companies are starting to react negatively to all of this, and may have the clout to force a pull-back from this crap.

Where there is only one manufacturer for a generic or two, it's easy for them to jack up the prices. That may open up the market to new manufacturers, though, despite the high cost of getting approval to make a generic.

It's a growing concern in health care, though, all around.

Sadly, Medicare isn't allowed to negotiate with drug makers, proprietary or generic, on pricing. Thanks to the Republicans for that bullshit.

[dixiegrrrrl]

17. One of my generics went from 10.00 to 54.00 for a refill.

Interestingly, I can get it for 10.00 at Wal-Mart but not at my usual local -harmacy.
So, sadly, that med is gonna have use Wal-Mart, cause i cannot afford to pay much more.
Tried al "similar to" drug but it had uncomfortable side effects.

[dembotoz]

10. it pays to shop around..for me i found costco to be by far the cheapest

cheaper than running thru my insurance....

[B Calm]

11. I am on 3 prescriptions and my Humana D coverage is $18.00 a month.

[Nye Bevan]

12. Canadian pharmacies are one possibility....

http://www.onlinecanadianpharmacy.com/drugdetail.aspx?DrugName=Lipitor&ps=Atorvastatin

[MineralMan]

13. Yes, but deliveries are spotty at times.

Customs can still intercept them if they want to. Normally, they don't, but they can.

My current prescription for lovastatin is cheaper than the Canadian prices for atorvastatin, in any case. Frankly it doesn't really matter which statin drug I'm taking, so it doesn't matter to me. You can also find even lower prices in Mexico, but again, the shipping issue is still a problem at times for some people, and reviews of both Canadian and Mexican pharmacies are mixed, with plenty of reports of non-delivery or late deliveries.

Too much hassle, really.

[Jim Beard]

14. It isn't a hassel if you buy inhailers.

I can buy the Advair from Canada at the same price I pay with Part D......... So, why should I go thru the hassle of buying from Canada? Because it will keep me from going into the doughnut hole so I ca buy my other two 2 inhalers with Part D that are not offered in Canada. I got into the doughnut hole last year, did without one of the 3 inhalers for 60 days.

Another Part D.... My mother is 89 and has Part D. My much younger sister helps her with her finances so she isn't aware of old folks prices. One day I was visiting and she ask me to look at her bank statements and I noticed several insurance payments and finally got them figure out as to what was what.

She was paying $150 for PART D a month This is what happens to old folks who do not check or are not able to check each year. I am going into my second year with with the same plan but I will probably switch next year.

I have the top of the line supplement to part B. I have never paid one dime to any provider. Its expensive for me at $189 a month and it will go up over the years because they can base it on age. I go in the hole on it but with my medical conditions, I don't want to be forced into Medicaid. My mothers Medicare Supplement is very, very close to $500 a month but when she had a heart valve replaced last year, she didn't have to pay for anything. Its the same 89 year old same mentioned above and she was walking around the next day. It was one of the several valves but a valve no less. She feels much better and can MORE than before.

[Nevernose]

18. The newest drugs aren't always the best, either

The docs hear about them from sales reps or at conferences and then start prescribing them. Often, though, the new drug is only slightly better than the previous generation, if at all.

OTOH, I take Viibryd, which is pricey, but is the only SSRI I can tolerate without major side effects and that also works (but this was a last resort, only tried after a dozen cheaper combinations).

[Jim Beard]

20. They always have that one drug that is not covered.

I could have reduced my premium by half but one of my more expensive in my formulary was placed in teir 3. The death spiral. Not much less that full price.

[uppityperson]

21. My current insurance oddly won't cover some generics, only name brand. My pharmacist is a

really good guy who searches out work arounds for his customers to give to their doctors.