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Sometimes, cash is king

By Staff | Jun 15, 2021

Count us among those who believe that good, and affordable, insurance is the path to better health.

Count us, too, among those who sometimes find sorting though the benefits provided confusing.

Case in point:

One of our team members, whose insurance package includes Medicare, supplemental insurance and a drug plan, noticed another jump in the price of a prescription drug they have been prescribed for years. A big jump.

Last year? No worries, the drug was among the many classified by the insurer as “tier 1” or “tier 2” medications. Those are many common drugs for which the drug plan calls for no deductible and are pretty cheap.

Flash forward as the pandemic rolled forward. The drug became scarce. The price jumped. And the drug plan insurer subsequently bumped the medication higher among the tiers for this year, meaning it now needed to meet a hefty deductible as well as a much, much higher price at the register.

How much?

Well, the deducible for the tier in which this drug was now classified — tier 3 — jumped from zero to $445.

And the price jumped from low double digits to about $125 out-of-pocket for a 90-day supply a few months ago to $192 this week.

The kicker? The cash price, sans insurance drug plan, is $39.47. For the same drug. For the same three-month supply. At the same pharmacy, which offered the cash option when asked why the price had jumped so much.

Now, neither the drug plan nor the pharmacy are at fault here — insurance companies and pharmacies have long negotiated drug prices and most of the time, the insured party benefits.

But there is a lesson to be learned as sometimes they do not.

According to a research letter published in the Journal of the American Medical Association back in 2018, overpayments were “common” among 9.5 million Part D prescription claims, “affecting 23% of all prescriptions, and 28% of generic prescriptions.”

Among the dozen most commonly prescribed drugs, patients overpaid by more than 33 percent, a number perhaps low as the data used was five years old.

Put another way, the price for certain drugs may actually be lower if you simply pay cash.

A few years ago, when the study was conducted, this would have been a lot harder as many insurer-pharmacy contracts contained non-disclosure provisions that prevented pharmacists from telling you your prescription might be cheaper if you didn’t use your plan.

But as of Jan. 1, 2020, as part of former President Donald Trump’s plan to provide access to lower-cost drugs, such “gag-orders” imposed by insurance companies as part of their agreements with pharmacies are forbidden.

Pharmacists can advise you as to lower-cost options.

Or you can just ask, an option that always has been available.

A couple of things.

When it comes to buying anything, from a car to appliances, from cell phones to yes, medications, it pays to be an informed consumer.

Periodically check drug prices online. Be especially diligent if it’s a new prescription or one that has jumped in price.

Your pharmacist may be able to offer some options to lower costs, and cash may be king.

Two, under Medicare provisions, you can change your drug or supplemental insurance once a year during the open enrollment period. Run your regular medications through the benefits checker available online or ask your insurance agent to help you do this. Check your deductibles as well. This way, you can get the best drug plan for your needs.

Sticker shock at the register can be enough to make you feel ill. Due diligence can be an over-the-counter cure.

— Reporter editorial