Prescription Medical Discount Cards?

[Kirk]

I have long been a skeptic of the much talked about, prescription discount cards, as opposed to using insurance. We are on Medicare, have a Medigap policy, and also keep a Part D prescription plan using the list of frequent prescribed medicines to help to choose the best plan. My wife has been medicated for depression for many years with reasonably good success but her doctor recently wrote her a prescription of a new drug, after testing her with some samples that she had. The drug has worked very well so was prescribed. It is a new drug that has no generic equivalent so we were not surprised that it was expensive and had a high copay. We were not prepared for the listed price of nearly $1700 for a 90 day supply with our copay of $1005. I did some digging about it with our insurance and after some discussion, headed off to CVS to get it anyway. The young man to waited on me took one look at the bill and told me that if I could give him 5 or 10 minutes he was sure that he could save me at leat $900. After a short wait he called me back over and said that he did find some help, would $26.34 be OK for the med? When I expressed surprise he said that they have software that will do a search for the best price using discount cards. I took the meds, paid the $26.34 and left, but am still wondering how that could possibly be? I have been digging online and really find no explanation that makes any sense to me. Has anyone else used one of those cards and do you have any idea of how that can be explained? Here is what I have found so far.

How Do Prescription Cards Work?

 

[gwinger]

You could also call the drug maker and see if they have an assistance program. Most do.
Since you are on Medicare even with a part D plan, it depends on your overall income.
I did this with one drug I was using, a tier 3. I hit the Medicare DONUT hole so my out of pocket cost was high.
The form I had to fill out was long and wanted all your information, including your total income. I ended up getting a 90 day prescription at no cost to me and didn't count against the donut hole. I do have to contact them to get refills though.

 

[DutchmenSport]

You have a good pharmacist.

 

[Tulecreeper]

There is one called Good Rx. I take a prescription for a Workers Comp injury that I just pay for out-of-pocket then submit reimbursement for later as it is faster that way. Over-the-counter cost is about $120. Using the Good Rx thing it costs me about $26. Since I get reimbursed for it anyway, you would think I wouldn't care, but it usually takes WC about 5 months to give me my money back so by the time they pay me they only owe me ~$130 vice $600.

 

[rvlifer]

I have tried using some of those discount cards with limited success. The fact that there are new ones popping up all the time makes them more work to use and makes me skeptical about them.

We use wellcare in addition to my wife's medicare and medicare gap insurance. It has been surprisingly affordable and seems to work extremely well for getting reasonably priced prescriptions. We are paying less than $4 per month for it in colorado now.

My wife is on a lot of meds now. We are probably lucky all of them are covered under the discounts and i am sure that some of discount programs are great depending on what prescriptions you need.

If i was in your situation with a very expensive prescription i would definitely be shopping around for a program that got me the best price on that specific med.

Kudos to your pharmacist for finding you the best price

 

[JudyJB]

If any of you are prescribed horrible expensive cancer drugs, know that there are organizations that will pay or help you pay your copay, particularly if you have Medicare. (Note that maximum out-of-pocket on Medicare drug plans will go down to $2,000 for 2025.)

When I needed treatment for a chronic form of leukemia 6 years ago, costing about $13,000 per month for 12 months, I was given the choice of joining a research study and getting one drug free but having to stay in one spot for four months or choosing another drug (same cost) with no ramp-up period and being able to go about my merry traveling way. Medicare would pay all but $10,000 copay on second drug, while no cost on research study.

While I made up my mind, the cancer center pharmacy took some info from me and applied for a grant from a cancer organization. I was teaching college classes part time and so was at about the 5 times the poverty limit for the grant, but they quickly agreed to it.

As it ended up, I participated in the research study, but it taught me that if you are prescribed something that is horribly expensive and you cannot afford it, ask around to pharmacies, doctors, and hospitals to find programs. Also contact the manufacturer, as they do not like to get publicity about "old lady dies because she could not afford her medication from ____ drug company."

 

[John From Detroit]

My insurance has a contrct with Optum RX... they also have a "price finder" program...Not sure if it includes discount cards.. .Kroger also has a price finder... one of my meds is less at Kroger.

The prices on many drugs are extortion pure and simple..This is why it's now a political issue with Biden getting insulin capped at 35/month (Not sure how that works exactly I use ...well just one vial of insulin I use is now over 100 dollars list and I use about 2 a month) (I use 2 insulins the other is more expensive).. (Iin the 1980s I could snag a vile of "R" for 10 bucks) and he's gotten 3 of my other meds reduced.


I recall one 35 dollar med that overnight became 750 I suspect it cost about 14 bucks to make

That kind of mark up 14 to 35... Well that was the standard industrial markup 60 years
14 to 750... Well the owner of that company is in prison for fraud (Differnet issue) but that is where they belong when they mark up like that.

 

[UTTransplant]

For one of Kevin’s cholesterol drugs, he gets a better price with GoodRX than with our own (pretty good) Medicare prescription drug plan. I haven’t used it since my regular meds are all at a minimal cost anyway, but it saves him a considerable cost each 3 months since it isn’t on the preferred list with the drug plan.

 

[rvlifer]

My insurance has a contrct with Optum RX... they also have a "price finder" program...Not sure if it includes discount cards.. .Kroger also has a price finder... one of my meds is less at Kroger.

The prices on many drugs are extortion pure and simple..This is why it's now a political issue with Biden getting insulin capped at 35/month (Not sure how that works exactly I use ...well just one vial of insulin I use is now over 100 dollars list and I use about 2 a month) (I use 2 insulins the other is more expensive).. (Iin the 1980s I could snag a vile of "R" for 10 bucks) and he's gotten 3 of my other meds reduced.


I recall one 35 dollar med that overnight became 750 I suspect it cost about 14 bucks to make

That kind of mark up 14 to 35... Well that was the standard industrial markup 60 years
14 to 750... Well the owner of that company is in prison for fraud (Differnet issue) but that is where they belong when they mark up like that.

Hopefully they get insulin costs under control soon. There is no reason why it should cost what it does given that the discoverers sold the patent for $1 intending insulin to be very inexpensive. In colorado insulin copays are capped at $100 per month no matter how much or what type you need. Hopefully other states adopt something similar.

You would think the govt could contract with manufacturers to produce some versions that arent paten protected to give at least some users a decent alternative

 

[Professor David]

To answer your question using the GoodRx example:
Using the GoodRx website and smartphone app, you (or your pharmacy...my pharmacy does the same thing by checking around since they want to keep my business) can search for the cost of prescriptions by choosing your location and selecting which medication you need. The system will then show you the cost comparison at different pharmacies near you, as well as provide coupons to give you more discounts. GoodRx offers information about other ways to save, such as asking your healthcare provider about savings tips or looking for alternative medications.
GoodRx can be used whether or not you have insurance, but you can't use GoodRx and insurance together. You can choose whichever gives you a better deal.
GoodRx makes money by selling its technology, running ads, and receiving referral fees.

I also have a med that is a lot cheaper with GoodRx compared to Medicare part D and Wellcare medicine supplement.

BTW...the Inflation Reduction Act reduces the max Medicare part D drug payment per year from 8K to 2K. That is a huge yearly reduction!!

 

[Professor David]

Hopefully they get insulin costs under control soon. There is no reason why it should cost what it does given that the discoverers sold the patent for $1 intending insulin to be very inexpensive. In colorado insulin copays are capped at $100 per month no matter how much or what type you need. Hopefully other states adopt something similar.

You would think the govt could contract with manufacturers to produce some versions that arent paten protected to give at least some users a decent alternative

For those over 65...Under the Inflation Reduction Act, out-of-pocket costs for insulin in Medicare are now capped at $35 per monthly prescription for Part D, as of January 1, 2023, with asimilar cap taking effect in Part B on July 1, 2023. Medicare beneficiaries who use insulin would have saved $734 million in Part D and $27 million in Part B if these caps had been in effect in 2020.

For those under 65 there is private insurance, other insurance forms for example current and ex military, and the ACA for a reduction of insulin costs.

 

[John From Detroit]

Hopefully they get insulin costs under control soon. There is no reason why it should cost what it does given that the discoverers sold the patent for $1 intending insulin to be very inexpensive. In colorado insulin copays are capped at $100 per month no matter how much or what type you need. Hopefully other states adopt something similar.

That is why the companies developed the "Lab grown"insulin (Which by the way is more dangerous) and replaced the safer animal source with it... The lab grown is NOT covered by the Banting/Best license which disallows price gouging... With the lab grown stuff they can price gouge.

 

[Professor David]

That is why the companies developed the "Lab grown"insulin (Which by the way is more dangerous) and replaced the safer animal source with it... The lab grown is NOT covered by the Banting/Best license which disallows price gouging... With the lab grown stuff they can price gouge.

This is incorrect. Several comparison clinical trials have been run. See one example here: 'Human' insulin versus animal insulin in people with diabetes mellitus - PMC

I actually worked with the people at a university (UCSF) that developed the technology used to produce human insulin (which you call the "lab grown" insulin. Genetech got its start using this technology to produce human insulin. Don't get caught up on how the protein is produced. We can't harvest proteins from humans for obvious reasons except those non-invasively collected such as proteins from blood. The animal or Bovine insulin refers to a form of insulin that is derived from cows and has three amino acid differences from human insulin, making it more likely (at least potentially) to cause immune reactions when administered. Plus, the Bovine form is more expensive to produce than the human insulin that people have used since the early 1980's. That's over 40+ years of clinical use!

In 1923, Frederick Banting, Charles Best, and James Collip were awarded a U.S. patent for insulin and the process to make it by isolating Bovine insulin used clinically until the 1980s, which has nothing to do with price gouging.

 

[SeilerBird]

"We were not prepared for the listed price of nearly $1700 for a 90 day supply..."

You are lucky. I was given a prescription for Trelegy for my emphysema. It was $47 a month for the first two years and then suddenly it jumps to $2000 per month. There is no generic. I am forced to buy Trelegy from a pharmacy in India and it is only $170 a month Same exact inhaler just priced outrageously in the US only.

 

[Kirk]

I was given a prescription for Trelegy for my emphysema.

I suggest that you at least try Good Rx as I just did and found this pricing. At nearly $700 it isn't cheap but it sure beats $2000!

In poking about, I tried plugging the 90 day supply of the drug mentioned above into the sites of Good Rx and also Single Care and they both came up with the very same price at CVS, just a couple of dollars more than I paid about 10 days ago. In reading about them, the customer just puts the name of the drug and the prescription amount and dosage and the site then gives you a coupon to use, in place of the insurance. I just looked at the claim record(EOB) on our Part D insurance (Well Care) and the drug in question is not listed among the claims. In a nutshell, rather than us paying $1000 and Well Care paying another $600, they used the discount coupon and no insurance by which I paid $26.34 and the insurance was not involved in the transaction.

Here is a link to the best, most understandable of the articles that I have found to explain how the discount cards work and how the card issuer makes a profit.

 

[SeilerBird]

I am getting it a lot cheaper from India.

 

[John From Detroit]

In 1923, Frederick Banting, Charles Best, and James Collip were awarded a U.S. patent for insulin and the process to make it by isolating Bovine insulin used clinically until the 1980s, which has nothing to do with price gouging.

You are right the process does not... The LICENSE did... Since for Bovine/animal source you needed a license.. But with Lab produced. they got a new patent..

So what was 10 bucks is now in 1990 (When it had to compete with Bovine and Porcine) now costs (MSRP as of about 5 minutes ago) $162.50

Tell me again it is not price gouging.

 

[rvlifer]

"The US is a global outlier on money spent on the drug, representing only 15 percent of the global insulin market and generating almost half of the pharmaceutical industry’s insulin revenue."

The absurdly high cost of insulin, explained

Why Americans ration a drug discovered in the 1920s.

www.vox.com

I like the UK system. The govt sets the max price and those that cant meet it are SOL

 

[Professor David]

You are right the process does not... The LICENSE did... Since for Bovine/animal source you needed a license.. But with Lab produced. they got a new patent..

So what was 10 bucks is now in 1990 (When it had to compete with Bovine and Porcine) now costs (MSRP as of about 5 minutes ago) $162.50

Tell me again it is not price gouging.

My comments had nothing to do with price gouging. Price gouging = BAD.

Again, your facts were incorrect about bovine vs human insulin and the basic facts of each patent. I was actually there personally watching for the human insulin technology development and subsequent patient fight.

Frederick Banting, Charles Best, and James Collip essentially gave the patent to the U of Toronto (for $1 dollar). The U of Toronto then licensed the patent to manufactures. U of Toronto made millions from the bovine insulin patient before it expired as patent do after a specific number of years. Since the patient has run out....drug manufactures can produce as much of the bovine insulin as they want without paying U of Toronto a licensing fee since the patient ran out. The problem is there isn't much of a market for it since the human insulin is much, much better clinically. Of course a new patent was granted to produce the human insulin. The new technology developed was ground breaking. This patent story is quite interesting since Genentech got the patent but the UCSF should have filed the patent earlier but did not. There was a long patient legal fight.

There is a lot of BS out there. If you really want to know the facts see:

The discovery of insulin revisited: lessons for the modern era - PMC

2021 to 2022 marks the one hundredth anniversary of ground-breaking research in Toronto that changed the course of what was, then, a universally fatal disease: type 1 diabetes. Some would argue that insulin’s discovery by Banting, Best, Macleod, and ...

pmc.ncbi.nlm.nih.gov

BTW...if you are still with me...Human insulin is preferred over bovine insulin for several reasons, including:
Lower immunogenicity
Human insulin is less likely to cause an immune reaction than bovine insulin. Bovine insulin differs from human insulin at three amino acid positions, making it more likely to cause an immune reaction.
Fewer skin reactions
Subcutaneous injections of human insulin are associated with fewer skin reactions than animal insulins.
Faster absorption
Human insulin is absorbed more rapidly from the injection site than animal insulins.
Superior purity
Recombinant human insulin is considered to be of higher purity and pharmaceutical quality than animal or semisynthetic insulin.
In addition, no cows are killed to produce the human insulin.

 

[Professor David]

"The US is a global outlier on money spent on the drug, representing only 15 percent of the global insulin market and generating almost half of the pharmaceutical industry’s insulin revenue."

The absurdly high cost of insulin, explained

Why Americans ration a drug discovered in the 1920s.

www.vox.com

I like the UK system. The govt sets the max price and those that cant meet it are SOL

The Vox article you cite is mostly BS. Again see this article for the actual facts:

The discovery of insulin revisited: lessons for the modern era - PMC

2021 to 2022 marks the one hundredth anniversary of ground-breaking research in Toronto that changed the course of what was, then, a universally fatal disease: type 1 diabetes. Some would argue that insulin’s discovery by Banting, Best, Macleod, and ...

pmc.ncbi.nlm.nih.gov