Hello everyone, I'm a pharmacist at a three-letter pharmacy and have been hemming and hawing about posting some tips in here for a while now. I can't sleep so figured this would be as good a time as any!
As many people have suggested on here previously, GoodRx is a good program you can get discount cards on and it will show you how much the price should be at various pharmacies. While it's not always accurate and usually won't save as much as actual insurance, it almost always saves SOMETHING, and therefore is a great tool for people without insurance. Best part is they have an app, so you can download and price shop right when you get the scripts.
Not sure about others, but the chain that I work at has its own version of insurance called the Prescription Savings Club. It is $20 and lasts for a full year. There is a list of eligible medications on the website or you can call your local store to have them look up prices to see if it is beneficial for you. If you are on simple things like lisinopril, metformin, etc. this is a REALLY good deal as the prices are cheap and the discount is even higher if you get a 90 day supply. In addition, this card gets you additional benefits such as 10% off store brand items and in-store clinic visits (where applicable). I notice in the rules for the sub not to mention deals. Please let me know if this applies and I will remove this portion. I felt that it was appropriate to include as I do not receive any kind of incentive to discuss this.
Another thing that I see happening pretty often is people paying $11.99. This is a price you will see if the medication is cheaper than this amount, but insurance doesn't cover it. It's called the "minimum dispensing fee" and I do everything I can to avoid it. A majority of the time you will see this because of OTC medications, which many insurances (especially Medicare Part D (MPD) and Medicaid) won't cover. This price is very avoidable. Here's a couple of ways around it:
*1. Vitamind D and Iron - MPD won't cover these, but a majority of the time Medicaid will. If you have both, our system requires that you click "Bill secondary" whenever the primary (MPD) rejects it. Unfortunately, a lot of technicians don't realize this is an option or forget in the bustle of the shift. If you have Medicaid and have been paying for these, on your next fill mention the Bill secondary option and see if it goes through. If so, have your pharmacist put a note in your profile reminding future technicians to do this. In addition, Medicaid only covers a specific NDC (manufacturer number) of iron (which is escaping my mind at the moment) so it will need to be that manufacturer in the system to be accepted.
*1a. ALSO, you can be reimbursed for anything like the above that has not been processed correctly. If this is happening to you, you can have your pharmacy send you a list of what you have paid for a specific time period and contact the insurance for reimbursement.
*2. I've seen every now and then medical devices, such as insulin syringes and testing supplies, be billed incorrectly. If you have regular medicare (not MPD), these should be billed through that. Also, nebulizing solution can be billed through medicare depending on the diagnosis. Insulin can be billed through medicare if being used in an insulin pump (medical device). Insurance is one of the most difficult things to meander when it comes to medications, so please bear with the process when working with your pharmacy to figure out how everything is covered.
*3. Final OTC recommendation. I mentioned in point 1 about certain OTC's not being covered. If they are not covered and the discount cards aren't working for you, there are more options. If the prescriber has included refills on the rx, I will usually increase the amount dispensed until it gets you over the $11.99 point. If there aren't enough refills for it, I will send a refill request. Not everyone does this, so pay attention to the Rx.
Also, while having the rx with the directions on it is helpful, you can avoid this fee by simply buying the bottle. It's an OTC product after all and there isn't a requirement that you buy it as an Rx. What I will do for patients if I have time is to look on our ordering website for the cheapest, therapeutically equivalent version of an OTC med and order it for them. Usually our system tries to do this automatically, but it isn't perfect and will go off of order history instead of cheapest available sometimes. It may need to be added into the store system to be sold, but once that happens, you will then be paying what you would if it were a product in our store instead of the minimum dispensing fee.
I hope this has been somewhat helpful. There are probably more things that I will post later that I can't think of right now. Please let me know if I need to clarify anything and hopefully my peeps over in /r/pharmacy can correct any times I misspoke.
September 14, 2017 at 06:05AM
