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I just don't get how the same exact medication, using the same Rx insurance can be charged with different co-pays by the same pharmacy (local pharmacy vs. mail order). So here is my issue. I am diabetic. I was prescribed Monjauro by my Endocrinologist a year ago. Filling this medication got very frustrating lately. I have Blue Cross FEP (PPO plan). I filled them using CVS Mail Order pharmacy in the past. Three month supply (3 boxes) was sent at least 3 different refills, with a Co-Pay of $40 for 3 boxes. Then CVS started denying my refills via CVS Mail Order saying this medication is "Out of Stock" and cannot be refilled. I called and asked what is my other choice as far as refills. I was told I can try calling a LOCAL CVS pharmacy as they "may have" some supplies. I went ahead and called around. Sure enough, they have some locally. BUT.... they will only fill my RX once a month (1 box), and the copay is $87.50 PER box. Huh? How come the CVS mail order used to fill them 3-month supply (3 boxes) at $40 co-pay? This is the same company. CVS pharmacy (Mail Order vs. Local pharmacy). Does anyone have any idea how pharmacy operate? Why the CVS Mail Order cannot get the medication, but the local CVS can? And now, I am being forced to pay more in co-pay. I went to Cosco and filled the Rx there. Same thing. Monthly fill ONLY. The co-pay is $50 per box (with a MANUFACTURER Coupon). Early this year, I used to pay $40 for 3-month supply. Now it is $150 for 3-month supply for the SAME exact medication, using the SAME exact Rx insurance, for the SAME plan year (2024). _______________________ P228 - West German | ||
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Firearms Enthusiast |
Have looked at Goodrx pricing. I found many drugs available through GRX to be cheaper than using my insurance plan. Using Goodrx unfortunately didn't go towards my insurances deductible but i used it anyway. | |||
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| Member |
Kroger Rx as well. This drug is one of the newer drugs "used" for weight loss as well as diabetes. Demand is huge, the supply cannot keep up. Were I in your position (and I am diabetic) I would speak to my endocrinologist to see if a drug less in demand would be helpful. It's likely to get worse-Biden just recommended these types of drugs be provided free to anyone in the US who is "obese." Obese now means 50 pounds over the recommended weight. If approved, demand will skyrocket. | |||
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| Save today, so you can buy tomorrow |
I agree. This medication is being abused lately causing shortage. I have been diabetic for over 10 years now. I was on TRULICITY last year. Along with Long Acting Insulin and some oral meds. Then Blue Cross decided end of plan year 2023 NOT to cover TRULICITY for 2024. That is what I was switched to MONJAURO. Now I have to deal with this again. I have appointment next week with my Endocrinologist. Will have to discuss this shortage issue with him. At least Blue Cross is covering it for now. But the increase in cost is just upsetting.
_______________________ P228 - West German | |||
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| Member |
It is a racket that's all. One of my drugs is 400 per month.Not a drug you can stop without severe consequences. The prices for some of the other meds differ greatly between pharmacies.If you lived in the UK and over 65 the goverment paid for your drugs. Of course not all drugs are on the UK formulary. THe price gouging has many reasons. We have the PBM, the manufacturer and the pharmacy who actually makes very little. | |||
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| Dances With Tornados |
Ask your Doc if they can help you get a discount, or even possibly free from the drug manufacturer. You'll have to apply, but I know folks who have been able to get help to pay for, or provide for, drugs such as Eliquis. Or just go to the drug website. For example this is from Monjauro: " Are you eligible for the Mounjaro Savings Card? If you are eligible, you may pay as little as $25 for a 1-month or 3-month prescription of Mounjaro.* See how to get a Mounjaro Savings Card below. *For eligible commercially insured patients with Mounjaro coverage. Governmental beneficiaries excluded. See eligibility requirements. Terms and conditions apply. One month is defined as 28 days and 4 pens. Three months is defined as 84 days and up to 12 pens. "Please click “Get Savings Card” button below and answer the attestation questions to confirm eligibility. If you are not eligible, pricinginfo.lilly.com/mounjaro has information on other types of affordability solutions." LINK TO MONJAURO WEBSITE INFO For Eliquis LINK TO ELIQUIS DISCOUNT For the originating Poster of this thread, google this: WHO ARE PHARMACY BENEFIT MANAGERS AND WHY ARE THEY BAD? Peruse a few of the linked stories. Good luck and best wishes. Drug prices are often obscene. . | |||
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Spread the Disease |
1000% My insulin cost doubled through Walgreens and their reason was that I was "always paying that price" and "nothing changed". WTF? My insurance company was zero help with the situation, too. ________________________________________ -- Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past me I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain. -- | |||
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| Member |
My wife has made a habit of searching for coupons before filling a prescription . Most of the time she saves money over using our insurance . | |||
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Peripheral Visionary |
That's based on the insurance contract your chosen pharmacy has with your PPO. Your pharmacy isn't setting the price, the PBM (pharmacy benefit manager) that services your PPO is. Often times the mail-order contract price is lower. As far as Mounjaro and other glp1's, yes local pharmacies are limiting RX duration due to extremely high demand and extremely limited supply. I really feel for diabetic patients like yourself that are having difficulty accessing medications that others are using for weight loss.   | |||
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| Member |
Not the same situation but I picked up a Rx yesterday and noticed as I was walking out that I got 76 pills instead of 90. Went back and found out they were trying to synchronize my Rxs to get them to the same day. Co-pay of $60 stayed the same regardless of amount dispensed I guess. Not much of an explanation from the pharmacist. Got 90 and told them to not worry about the synchronicity. | |||
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| Member |
Infuriating. I got told a 90 day ‘script got changed to 75 days, but that I shouldn’t worry about it. I told them the change meant five co-pays a year instead of four and that meant an extra $100 out of my pocket. I refused the ‘script and had my doctor write a new one for 90 days | |||
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Member |
A few months ago I was picking up some meds, nothing crazy. I do have an HSA which helps with paying. She adds a few things up then says $300+. I say, that seems awful high, never even broke $40 before. The assistant nearby says, I’ll run it for him. She came back at about $33, what a difference. Medical billing can easily give a headache of confusion. | |||
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אַרְיֵה |
Picked up couple of med refills for my wife at Publix pharmacy yesterday. Clerk rang them up at almost $70. That was way more than I have paid for them in the past, so I started looking at GoodRx on my phone. Found the first one at less than half the price, was looking for the second, clerk got pissy and said "Sir, there are people waiting behind you." I responded, "They wouldn't be waiting if you had not grossly over-charged me. There's another register, why don't you take care of them there, while I check the second med?" At this point, the pharmacist intervened, took over the register from the clerk, hit a couple buttons, rang up the former $70 sale at just $30, and apologized for the clerk -- he said that she was still in training and had a few things to learn. The expression on his face indicated that he was not overly happy with the new clerk assigned to him by HR. DEI hire, maybe? Does Publix do that? הרחפת שלי מלאה בצלופחים | |||
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| Member |
I take Trulicity and for the past few years, I can only get 1 month at a time. People are using these meds for weight loss. Anyway, New Year resolutions are coming and Summer shortly, these meds will be in shorter supply at least until Spring. That’s when the new body is ready for the summer. | |||
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| Member |
My dogs medicine was $620 for three months at Walgreens and $173 for 3 months at Costco. That’s no insurance to add to who charges what. I really need to find out how much Costco charges for my RX. The store is so nuts everytime I go in really hate to go there anymore than I have to. | |||
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| Member |
The Vet knows where the best price exists. | |||
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Member |
Check Mark Cuban's Pharmacy. My meds are cheaper with cash and not getting insurance copay involved -.---.----.. -.---.----.. -.---.----.. It seems to me that any law that is not enforced and can't be enforced weakens all other laws. | |||
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