Secret Pharmacy Pricing

Last week I talked about portals and why it’s so important to set up your portals. I’m going to tack onto that just a little bit and talk about pharmacy pricing.

Fun fact, did you know that every pharmacy pays the same price for the medications they received from the manufacturer?

So why do they all charge different amounts?

Well, it’s just like any other retail business, they have markups.

For example, for the same medication, for let’s say cash price, just to make this simple right now, you called Walgreens, or CVS or HEB, and asked them how much it was, for your blood pressure medication, you’re going to get three different prices. And that’s because of how they choose to mark up the medication.

When it comes to insurance, it’s really important to use a pharmacy that again is in-network, and you can find that information in your portal and refer to last week’s blog. When you look at your portal, find out the recommended pharmacy.

Some of them have Maylands, where you can save even more if you want to do that. Not required, but they do encourage it because there’s a savings. But if you use your pharmacy and stay in-network, you’re going to pay less out of pocket. I don’t care that you’re used to going to CVS and now your insurance uses Walgreens, if you don’t go to Walgreens, you’re going to pay more for your prescription at CVS if they will cover it at all. A lot of times you can go out of network, but you’re paying about 50% more if you do that. I know it’s a pain if you’ve already used one pharmacy, and now you have to switch all your prescriptions over. But again, it comes down to pricing, and you can call and check and see what the pricing is on your meds.

If you’re taking all generics, it may not be as bad. And you could continue with your same pharmacy. HEB has a great program, just like good RX does. The good thing about HEB is that they usually are a pretty close match good RX, and you don’t need coupons.

But I tell all my clients, I don’t care what insurance you have, you should check your medications on good RX, to see what the cash pricing is. Because you may be overpaying with your copay for your medication. Some plans have a $30 copay for generics. That’s insane.

Most generics are not even that much. So use good RX instead.

Did you know? You’re not required to use your insurance. The insurance company will want you to use your insurance because then they don’t have a record of your usage, while the pharmacy does. If you’re taking medication, that doesn’t work, they need to switch you to something else, which is now more expensive. You decide you want to use your insurance but they may say that you need to use this other med first, while you did, you just used GoodRx. So it comes down to the pharmacy submitting that documentation to your insurance company to get the authorization for them to pay for it. So don’t let that fool you. Request the pharmacy submit the documentation so that you decide whether you will or won’t use insurance for that medication.

You can choose anywhere you want to go. The pharmacy has proof of usage that they can submit, or you can submit it to the insurance company yourself to get approval. So just keep that in mind if you’re doing what they call “step therapy” with a doctor who is trying a particular medication first, and then maybe will have to switch you to another if it doesn’t work.

You CAN choose whether you want to go ahead and use your insurance so they have a record of it, or switch it on the back end. Use good RX if it’s very expensive and then just provide documentation showing you did do the step therapy.

If you need any assistance when it comes to health insurance or even understanding pharmacy pricing, please feel free to reach out to me.

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Austin, Texas

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