I’m pretty sure you’ll only see that if you’re using a GoodRx coupon to avoid your health insurer’s captive PBM price gouging.
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Depends which drugs you need. If you use a variety of generic non-branded drugs, it can get pretty cheap.
However, if you require recently developed brand name drugs, then you are stuck.
Diabetes drugs are classic examples. Amazon Pharmacy has the older brand names (Humalog/Novalog, Lantus/Basaglar, etc) and generics cheap. Recently developed brand name drugs (think the weight loss versions for diabetes) are $$$.
All 3 drugs I take are generic non-branded drugs. Yet if use my Aetna Part D drug plan to buy one of them it’s $1,060/yr. A GoodRx coupon allows me to buy the same drug for $353/yr. You need to be careful when dealing with your health insurance company’s captive PBM. That extra $700 would have gone directly to excessive Executive Compensation.
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I have AARP’s United Healthcare HMO Medicare Advantage including drugs. When I got on Jardiance, the copay was $1000/yr. And I found myself in the donut hole. Copay is $47/mo (below donut hole, $150/mo in donut hole) but they charge $600/mo toward the donut hole. Also found that they charged $1000 toward donut hole for generics with zero copay.
Keep a close eye on your donut hole charges. They are a ripoff set to put you in the donut hole as soon as possible.
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@pauleckler I do not know how the donut hole works with an advantage plan.
Do you have Part D when you have an advantage plan?
This is how Part D with traditional Medicare works.
What is the donut hole discount for 2023?
25%
Once you and your insurance plan have spent a total of $4,660 in 2023, you will move into the Medicare donut hole. In 2023, you pay 25% of the cost of your prescriptions, both brand-name and generic, once you reach the Medicare donut hole.
Is the Medicare donut hole going away in 2023?
In 2023, you’ll enter the donut hole when your spending + your plan’s spending reaches $4,660. And you leave the donut hole — and enter the catastrophic coverage level – when your spending + manufacturer discounts reach $7,400. Both of these amounts are higher than they were in 2022, and generally increase each year.Jan 10, 2023
Check my math result but 25% of the donut hole would be about $700.
In 2025, Part D maximum out-of-pocket will be $2,000 per year no matter what drugs you take. But of course, all the drugs you take must be sent through your insurer’s PBM to count towards the $2,000 cap. And there’s no limit to what your insurer’s PBM can charge for a generic drug. You might pay $2,000 for drugs you could have purchased with a GoodRx coupon for $600 to $700.
If you’re taking a name brand drug that costs $1,000/month, it’s a no-brainer to run it through your Part D insurance card. But 90% of the prescriptions written for senior citizens are for generics. If people are not comparison shopping with GoodRx or Mark Cuban’s Cost Plus Drugs, there’s a tremendous opportunity for the health insurer to price gouge you.
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So you can have an advantage plan and Part D? I did not know that.
Most Medicare Advantage Plans include drug coverage. But if yours doesn’t, then you can also sign up for a Part D drug plan.
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I did not know that…that some MA plans don’t include drug coverage or that it’s possible to have the two (MA plus Part D) concurrently. I’m glad you’re willing to do the donkey work looking at all these plans because I stop at the mention of MA!
I could see scenarios whereby the insurance industry manages even more “skim” for seniors than for the same person when they were part of the workforce and with a group health plan.
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For Jardiance the $1000 copay is $47 Per month before donut hole and $150/mo in the donut hole. The $600/mo charge toward the donut hole means you hit the donut hole at abt 6 mo. And at one year the top of the donut hole.
So your next prescription takes you to the above donut hole price. United Healthcare has worked it out precisely.
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Yep, Repatha has done that to me. Mind you, it’s also dropped my LDL-C down to the low 30s so cheap’d be nice…but effective is better.
Mind you, we’re off to England tomorrow and we’ll be getting together with cronies there and no doubt having our usual reciprocal updates on the state of play with the NHS and US Healthcare. Can you believe, they were under the impression that once you reached 65 everything was free…just like there. Hard to know whether to laff or cry!
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In 2022, I looked at the various options for 2023. Most were either free (or nearly so) if I used Express Script’s mail order delivery (90 pills at a time). If not free, it was $4+/90-day prescription. So, no sweat. The “expensive” stuff was either $10+/mo for local delivery (monthly) or I could use their 90-day service and pay $10+/90-day prescription. I like the local delivery (hand delivered to my door) and it is worth it to me to KNOW when I will get it–and how. FedEx has been pretty good thus far (2023 deliveries), so am debating which way to go for 2024. There was a drug shortage for one drug the first six month of the year, so it made sense to move that one to Express Scripts delivery. They have better leverage on the mfr than a local pharmacy because the local place could not find the drug anywhere. However, there have been no really bad snow storms in 2023, so can’t say how well FedEx would do in such an event. Luckily for them < g >, I tend to order 1-2 weeks in advance. So bad weather does not really pose a problem. Issues in the mfg/distribution chain I can’t handle because they are sometimes caused by problems beyond the reasonable range of expectations (i.e. plane crash, ship sinking, etc). I have bought via mail order from Canada with few problems (other than price being 2x-5x higher than buying in the US).
The GoodRx coupon allowed me to buy a year’s supply of the drug in one fill at the Safeway pharmacy near my home. I keep at least a 6 to 12 month supply of the drugs I take in inventory. You never know when the FDA might shut down a factory for quality control problems.
Of course, all the stuff I take is in tablet form. If you’re taking something like an injectable drug or liquid eye drops with a shorter shelf life, you probably can’t do that.
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Part D will not allow more than 90-days at a time. This has been going on for some time now (pre-dates Part D) and Part D merely accelerated the decline of pharmacies selling to this market.
I used to buy a year’s supply at one time because it was easy and cheap ($30 or less for a year+). My doctor agreed it was a good idea and wrote the prescription for 400 at a time.
Another key point: If buying overseas (personally carrying or via mail order) US Customs will stop and impound personal imports of more than a 90-day supply of drugs that are US prescription-required medication(s). So you can’t get larger quantities via import (even with a doctor’s written Rx). I ordered one mail order drug from Canada (with written Rx). US Customs held it (plus other shipments from the same Canadian origin, a valid Canadian pharmacy–not the same drug, sent via US Mail for delivery) for roughly 3-4 MONTHS before it was finally released and delivered (via US Mail). Interestingly, a replacement shipment was promptly delivered about six weeks into the “held by US Customs” notification.
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If you’re paying cash, US generic drugs are usually cheaper than foreign ones. It’s only in name brand drugs where we’re “paying 5 times the price of other countries”. There’s little reason to go outside the US to buy generics – just use the GoodRx coupon.
When I first started taking my $353/year “expensive generic” 20+ years ago, a year’s supply was about $10,000. I was usually paying cash to get it from Canada (90-day supply) at about half the price since that was cheaper than using my health insurance. Sure, a few times it was flagged at customs and sent back to the pharmacy in Canada, but they’d just resend it, and it would get through on the 2nd pass.
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