quote:

Originally posted by tigereye313:

quote:

Originally posted by ador:
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).

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.

quote:

Originally posted by rocket72:
That's crazy that a peptide like tirzepatide has been placed under a stranglehold by one entity like this. Would be funnier if there was a workaround on the grey market. Lol

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quote:

Originally posted by jhe888:

That is the reason for the difference. The PPO has a deal with the pharmacy for those prices, which can vary between mail-order and local stores.

This is frustrating, as we don't see the underlying contracts for the provision of the drug, but it isn't really Walgreen's fault - they are saddled with the contract terms. Our insurance system is fucked up for so many reasons, and this is an example. My insurer may have a totally different pricing contract with the same pharmacy.

And yes, that drug is hard to get. So much demand.

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