I don't understand the extreme disparities between pharmacies for the same medication.

Factual Questions
1

Ok, I take a “cocktail” of three medications that I have to take twice a day, in order to prevent migraine. One of these drugs is a beta-blocker, nadolol. Typically, according to the Rite Aid I’ve been using for years, the manufacturer’s cost of this medication, for a month’s supply, without insurance, is close to $500! For a beta-blocker?!

Anyway, for the most part, my insurance covers most of that cost, until I hit a “doughnut hole” dollar amount, in which they then only cover 50% of the drug’s cost. So, again, according to Rite Aid, this meant I was paying like $243/month at the worst times. Well, in addition to the other medications I was taking (not just the migraine meds), the cost of this beta-blocker soon became a pretty big financial strain on me.

So, in what I should have done a long time ago, I started shopping around the various pharmacies. The only thing that prevented me from doing so earlier is that I thought, while I may get some sort of discount somewhere else, the hassle of switching pharmacies just wasn’t worth it. I mean, the manufacturer’s price was the manufacturer’s price, right? How much difference could there be between different pharmacies?

Well that answer turned out to completely fucking astound me. And I still don’t completely understand it myself. I found a CVS pharmacy, a bit farther away from me than my Rite Aid, that could fill my nadolol prescription, with my insurance card, for 12 freaking dollars! I shit you not. At first I thought there must have been some sort of miscommunication so I repeated all of the relevant details, and sure enough, $12 for a month of my beta-blocker.

Now my question is, how is this possible? And who is making all this money here? If I had been going to CVS for this pharmacy for the past year, it would have cost me one hundred dollars less than one month for the product from Rite Aid. And Rite Aid claims it’s not them making the profit but the manufacturer? Is that just bs? Or do certain drug manufacturers have deals with certain pharmacies, which allows such incredible disparity?

2

The brand name drug is Corgard, while the generic version is nadolol. There are usually massive price differences between the brand names and the generic versions. Was Rite Aide selling the brand name?

3

No. Never, not once.

ETA: These price differences are for the exact same medicine.

4

No idea. The biggest differential I’ve found is for lidocaine patches, which cost some of my patients $256 a month and others $2.

Seriously…it’s fucked up.

ETA: This is why asking your doctor to prescribe you “the cheaper option” doesn’t work well. Between radically different pharmacy pricing and radically different drug program benefits, he has no better clue than you or I do. The only way to find out is to call a dozen pharmacies. Or use goodrx.com They seriously rock.

5

I pharmacy shop for clients once in a while. Usually just between CVS and Walgreens. I’ve had them quote me slightly different prices, but nothing that disparate unless it’s Name Brand vs. Generic.

Out of curiosity, I would want to call Rite Aid and ask them a couple questions: what’s the cash price without insurance, and will they match CVS. I don’t know, something’s not right there. That drug has been generic for a long time.

Mind, there are four different manufacturers approved to make this drug, so one really could be charging a bunch more than another and if the buyers at Rite Aid aren’t paying attention I suppose they could be getting shafted and passing it on to you.

I’m also curious about the “doughnut hole” as I’m not sure what that means. Is it possible you’ll get partway through the year with a new pharmacy, hit the hole again and have to pay more like at the last pharmacy?

6

Firstly, I mentioned in my OP what the for-cash price of the nadolol is, according to Rite Aid and they told me (I don’t remember the exact number at the moment) something like $487. I also have a printed out sheet that has that info for all my other meds. And it’s always been the generic version that I’ve taken.

And my insurance is just Medicare Part D. The company that handles it has a doughnut hole that is reached once they spend a certain amount of money covering prescriptions throughout the year. Once that amount is reached, only 50% of the cost of the medicine is covered, until the end of the year. The amount is fairly high but with just one or two expensive meds, you can reach that level pretty quickly.

7

And I must admit to a pretty idiotic mistake. The $12 was just for the partial script I needed for the remainder of the month. However, the question in my OP remains relevant, as the entire cost for a month is still only $40. I just want to know where all this money is going.

8

At any rate, as I said there are four different manufacturers approved to make nadolol. If Rite-aid is buying from Mylan, and CVS from Sandoz, that could be the difference.

9

OP: have you checked http://www.medicare.gov where you can compare different insurers for the set of drugs you are using? (Press the button for Find Health and Drug Plans). You may be much better off with a different insurer.

10

Thanks! I’ll look into the info provided in both of these posts. :slight_smile:

11

Pharmacy A buys 100,000 of a drug Pharmacy B buys 50,000. Pharmacy A has a better contract with your insurance company than Pharmacy B.

12

Pharmacies make contracts with different insurance companies. This is why you might get a letter from your company saying they no longer cover, say Lunesta, and you should talk to your doctor about a similar drug. They will cover Lunesta for the rest of the year, but if you don’t find a drug that you can use that they do cover (zolpidem, Rozerem, etc.) you should either shop around for a new insurance company, or your doctor must write a letter explaining why Lunesta is the only drug you can take for your condition, and then they will continue to cover it for you for another year. One assumes that if they are bombarded with letters, they may drop another drug, and try to renegotiate for Lunesta.

Usually, insurance types try to cover types of patients, especially the part D Medicare. One covers lots of geriatric meds, and other things that are going to come up with geriatric patients, from Viagara to high diabetes meds. Another covers lots of psych meds, and will tend to cover migraine and insomnia meds as well. Another covers things commonly prescribed for chronic conditions in children.

Normally, they will negotiate all drugs with one pharmacy, but if they have different coverage packages like a “depression” package, a “pain” package, a “general” package that has lots of low-level pain meds, anti-biotics, allergy meds, a few very common psych meds like Prozac and Wellbutrin, antabuse, that stop-smoking drug, etc., they may have deals with different pharmacies, so you may find that the one that has the best prices on you sleep med, your headache med and your antidepressant, will have an exorbitant co-pay on the yeast infection pill you need. You have to call around to get a better price.

13

This was one of my intial suspicions.

14

According to goodrx.com, my (optional) rx that I refused because it costs $100 has a manufacturer’s discount card that should drop it to $15.

Anyone have experience signing up with one of these, directly from the manufacturer? I have one for another script that my doctor gave me…I assume this will effectively be the same.

15

I did the manufacturer’s financial support program for my Enbrel for a couple years. Enbrel is one of those super expensive drugs (around $3000 for a 1-month supply) and my copay was around $50. The support program made it free to me for 6 months and then after that I had to pay $25 copay. So it was very nice.

I let it expire when they couldn’t pay the online pharmacy’s bill promptly enough that they kept billing me for the whole cost. I never had to pay it, but it was just a hassle. Those prescription plans have an amazing amount of bureaucracy that all but eliminates any convenience of online/mail order refills.

16

Usually they’re pretty easy. Fill out the form, provide proof of income, have the doctor fill out and sign her part of the form, and fax or mail it in. The forms are usually available on the manufacturer’s website.

The most common restrictions are based on your insurance and your income.

17

Ok. I signed up. It didn’t even ask for the doctor’s information. I did have to click a box that said I have other insurance. I assume the game is that insurance still pays enough to make it worth the manufacturer selling it to me.

I’ve printed the card, and will go to Publix after lunch to see if they like it.

Thanks!

18

Update: Card accepted. $15 later, I have pills. Much better than the $100, just to find out if they even help me.

19

There can also be huge disparities within the same pharmacy, for a single medication. I have to inject U-500 insuliin (5X normal potency) twice a day. I have paid as little as $19 for two vials, and as much as $550 for one vial (a vial lasts 30 days). These are not the full price, but my copay, so the disparity is probably from my insurance company. But it makes it impossible to comparison shop.

20

Woo-hoo! :smiley: