Why do we care what you pay for your medications? That’s pretty straightforward: we have seen patients skipping their medications or reducing their dose in order to save money. This puts their health at risk and in some cases is a very serious danger. The more we can ensure that you can afford your medications, the better you will stay with the prescribed therapy and the more you will stay well.
Most people (except those using Medicare D) don’t have any role in choosing the prescription insurance part of their health plan. Their employers’ benefit administrators sometimes focus more on the medical benefit than the prescription benefit because the medical benefit can mean large dollar figures for each event. But stop and consider: if you visit the doctor only once or twice a year, for routine office visits, the catastrophic part of your insurance doesn’t kick in. Yet you may be using a handful of different medications that you fill every month. Those medications may be what keep you healthy and well and they are not to be discounted as unimportant. If you don’t take your medicine, no amount of sitting talking to a doctor is going to fix you. The doctor picks the right one but it’s up to you to take it to stay well. You need medications to be affordable but also easily available and you need to be able to resolve problems such as dose changes quickly and correctly. Here’s how your prescription insurance works.
Your employer (or other benefit provider) contracts with an insurance plan and that plan typically contracts withanother company to manage the prescription benefit: this company is a Pharmacy Benefit Manager or PBM. We work with these companies every day at the pharmacy, but most members of the public aren’t even aware that they exist. They have names like Catalyst, Medco, Caremark, and so on. When you call your health plan, you don’t talk to anyone in those companies but that’s who we have to wrestle with when your prescription claim is rejected or delayed.
Your health plan has some control of the drug coverage: they often dictate a formulary of drugs they will cover, and they determine many (but not all) of the details. The hire the PBM to administer it all. If you think about it as insulation, it begins to look very cozy for everyone but you and us: the employer hires someone who hires someone else who hires someone else to receive the prescription drug claim. The last someone else (the PBM) still doesn’t have to face up to you when there are roadblocks: they leave that to our pharmacy staff.
Ok, enough background. When I get time, I’ll write up a description of the details, so check back in future.
For now, scroll down to the bottom section or click Generic Substitution for a little more info….
Medicare’s drug coverage program is administered by private companies under contract with the government. You can join no sooner than 3 months before your 65th birthday and up to 3 months afterward. Beyond that, you can always join Medicare D, but there is a chance you will be assessed a penalty for delaying. The penalty is proportionate to the number and costs of the drugs you use. [Click here] for more details on Medicare D.
They can take a somewhat manipulative tone but remember: you always have the choice of where to fill your medications. They may “ask” you to fill them with their pharmacy, but this is no different from us “asking” you to fill them here. It’s because that company wants your business, just as we do. We are a fully independent Decorah business owned and operated here. The mail order center location? You’ll have to take a guess based on the accent of their “next available representative”. One thing’s certain: nothing you send to a mail order service is going to help your regional Iowa community. Every dollar you spend at a mail order pharmacy is a dollar that has left Winneshiek county forever.
It is important to realize that the special cost savings offered by mail order pharmacies are NOT available to real pharmacies. These are deals worked out within the insurance company or pharmacy benefit manager and they do not permit us to sign on to the same deal. This is not what we consider fair competition and the only way to address it is for members who use the insurance to demand a change.
We consider it wrong and unsafe to force patients to choose between reducing their costs and protecting their health by using a local healthcare source like our pharmacy.
Bottom Line: Does mail order pharmacy save you money? Sometimes. Sometimes not.
More to come on safety problems with mail-order pharmacy and other concerns….
MAX Card: Separate from the $5 generics program, we also have a MaxCare discount card that will shave a few dollars off of most prescriptions and can help this those not covered by the $5 list. The discount is larger for some drugs than for others but doesn’t provide any advantage over an existing insurance copay. Note that if your prescription plan has a deductible, you can only work it down by submitting the claim to them. If we were to use a discount card or savings club, it might cost you less but you would get no credit toward your deductible, so it would just work against you in the end.
COUPONS: We occasionally have coupons for brand drugs that will save a patient quite a few dollars. Coupons are also available at many drug company websites, so be sure to look online to see if you can find some. Some doctor’s offices have coupons they can provide too. Caution: many/ most drug coupons are excluded from use by patients enrolled in any government sponsored drug coverage. So if you are on Medicare D or on Medicaid, those coupons may not be available for your use. Just have to read the fine print.
Patient Assistance: We have several resources to help you find patient assistance programs which could cover part or all of the cost of some expensive brand medications. Often run by the drug companies themselves, these can mean very big savings for those who qualify. Eligibility usually depends on family income and the absence of other insurance coverage for the drug. Some patient assistance programs are designed for lower income uninsured patients and are operated separate from the drug companies. If you have a hardship in paying for your medications, please ask us to provide you with some of these resources.
A good website for seeking these programs and similar resources is NeedyMeds.org. I would suggest you start there. You can search by medication name and it’s very easy to get started. Before someone asks: We have not tried the discount card they offer there, but we’d be glad to. I don’t know if it will be much better than the Max card we have here. Possible, but I don’t know.
You’ve heard of the $4 generics program that some big box pharmacies offer. Well, this is similar.
This is a Healthmart program for people without insurance or whose insurance forces them toward mail-order or excessive copays.
It works only for drugs on the list (same list as the one They use for their $4 generics program) and it provides a 30 day supply for $5 right here at Donlon Healthmart. 90 days supply for $14. Keep in mind that the list dictates how many pills is considered a 30 or 90 day supply.
Check the list to see if your medications are included: HMS 12-05-2012
The program is a club, so you must sign up. There is an annual fee of $11.95 but we can cover that for uninsured patients whose income places them in true need: please ask to discuss it with one of our pharmacists.
Each sign-up covers all members of the patient’s household as well, so one card will work for everybody.
High costs play a role in many interrupted therapies which can result in compromises to your health.
If we can help find ways to keep your medications affordable, then you’ll be able to stay with the program your doctor has outlined and you’ll stay well. There are a few important things to know: