Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

For those being forced into Mail order pharmacy refills

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--- Quote from: bocker3 on August 30, 2013, 04:21:06 PM ---The price "charged" by a pharmacy and the price actually "paid" by the insurer is very often completely different.  Usually a provider charges a standard charge, but will only be paid for the negotiated price.

I pay a much lower copay for the mail order pharmacy.  Logically, this tells me that my insurance company has a better negotiated price, else why would they force me to pay less and for them to pay more??  Especially when I know my company is xylophonist, so Etna negotiates the prices, but my employer pays the bill.  trust me when I say that this company would not be willing to pay more than then need to pay.


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I understand the negotiated price thing but your point is moot when the insurance company owns the pharmacy (common but not universal). They profit in 2 pockets. If one pocket makes less, the other pocket makes more.

--- Quote from: bocker3 on August 30, 2013, 04:24:48 PM ---My insurer is Etna, my Milder pharmacy is Caremark -- owned by CVS.  So, this isn't a universal truth.  I try and stay away from the big conspiracy idea..... And, as I just pointed out -- the "retail price" rarely matches what an insurance company pays -- they get discounts when negotiated based on volume of business they can send that way.  That is where the savings come from.


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I'm not sure if you are required to get your melds through Caremark but it strikes me funny that since Caremark is owned by CVS that they wouldn't let you buy your melds at any CVS store. The "volume" concept doesn't seem to have any logic in this case.
I can't imagine that large pharmacy chains like CVS, Walgreen's, Walmart, etc. can't compete due to "lack of volume" as compared to mail order pharmacies.
It just doesn't add up.
They all (insurance companies, pharmacies, hospitals, etc) make it all so mysterious by not being open with what they charge. Another good reason to get the many insurance companies out of healthcare. The government could easily negotiate the best prices from the drug companies and pass the savings down to everyone. The same thing could be said about many other parts of the healthcare system.
Each sector of healthcare in this country is driven by profits before concern about patients being able to afford care.
IMHO, every sector of our healthcare system "conspires" with the folks in Washington.

Here is a little ditty about mail order pharmacies that should curl anyone's toes.

And this. - 23k

Oh, and I was mistaken. Curascript is owned by the giant PBM ExpressScript.
Consumer choice has gone by the wayside. (except in a few states)

I also live in NY and I take 18 different medications, I use optum RX and in the beginning I was not happy with them, every time my doctors faxed prescriptions optum never found the so the had to be re faxed 3-4 times but now I think it's ok, you get refill when you have 1 month of medication on hand, so there is no risk to run out.

I take 4 Meds from a local pharmacy and I can't get refill before I'm done with the month on hand. I have more problem with the local pharmacy but since 2 of the Meds are controlled drugs and I get a new script every month I have to take them locally.


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