You are I’m sure WELL FED UP with hearing how I feel about phone calls so let’s just take it that you already know, and I refer to it only because I want to make sure I get extra credit for making a phone call this morning that saved us $68. One of Edward’s medications is a compounded medicine, meaning a special compounding (i.e., custom-medicine-making) pharmacy has to make it specially for him. I know from getting a compounded prescription for one of our cats that a lot of the price of a compounded medication is the cost of having something custom-made; so for example, with the cat’s medicine, a one-month supply was $40, but a two-month supply was only $52 because the medicine itself wasn’t all that expensive, and it was the custom nature of the product that drove the price up.
Anyway, our insurance will pay for Edward’s compounded medicine for a $50 copay. But before I realized they would do so, I was paying cash for this medication—and it was $58, which included a $5 shipping charge. (We have since then found a pharmacy we can drive to.) So this morning I geared up the courage to call the pharmacy and ask if we could fill it WITHOUT insurance, and get a three-month supply: it is almost always insurance companies that limit patients to a one-month supply at a time, not doctors or pharmacies. And the answer was yes we could do that, and it would cost $82. So, I can get it filled in three separate one-month supplies, driving half an hour to the pharmacy each time, and pay a total of $150 with insurance, or I can get it filled once and pay $82 without insurance. SCORE.
I am telling you this in part to celebrate a small victory, but also because it’s only because (that is awkward to have those two becauses like that, but let’s just move on for now) I’ve worked as a pharmacy technician AND gotten a cat’s medicine specially made that I knew to try this, and you might not have done EITHER of those things. Before I worked in a pharmacy, I didn’t know it was the insurance company limiting patients to a one-month supply of medicine at a time. So I am telling you, in case you can benefit from this as well: with almost all prescriptions (certain narcotics are different, and certain doctors may have their own policies), if you are willing/able to pay cash, you have TONS more flexibility. You can get all of your refills at once, for example. You don’t have to get prior authorizations: that’s your insurance company too, and not the doctor or pharmacy. If your insurance company says that you may only have ten of the thirty pills your doctor prescribed, they are only saying that is all they will PAY for: you may still have those other pills, if you pay cash. (“Cash” here includes credit/checks. I don’t know why it’s always referred to as “paying cash” when it’s self-pay instead of insurance.)
Of course with some prescriptions, the price of the pills means this won’t help you one tiny bit. If the month’s supply is $600 without insurance, and a $30 co-pay with it, there is no advantage to paying the $600 to avoid the hassle of getting a prior authorization, or paying $1800 cash to get your three refills all at once. If the pills your insurance company will only let you have ten of cost $20 each, it’s slim comfort to know you COULD have the other twenty if you paid $400. But it is good to keep in mind as a possible option for some cases where it might help, especially since I have found there are some pharmacy employees who enjoy explaining such things and/or telling customers their options and/or looking up cash prices, and there are even more pharmacy employees who don’t and don’t and don’t, and in fact don’t seem to understand it themselves. I had a co-worker who would say “You’ll have to call your insurance company, ma’am” to almost ANY issue/question brought up by a customer, when it was something that could be explained/fixed by us in about ten seconds. I think the pharmacy/doctor/insurance triad is a very confusing one, and that it could be made a lot clearer.
This to me is the exact thing wrong with healthcare. Why oh why would the insurance company not WANT to pay only $82? *head desk*
Yay for you! That is an excellent reason to brave the phone!!!
I remember running into the doctor vs insurance thing when I had morning sickness. And my doctor said “take x z0fr@n a day” and the insurance company would only pay for what amounted to x – 3 a day and yet each pill cost something ridiculous. $90 sticks in my head but maybe that was the cost of the 3 extra pills per day rather than each individual pill. I had a kind a wonderful pharmacist who explained everything to me but I still cried in the middle of a Walgreens. Madness! Utter barfy madness!
This. My migraine meds at Walgreens (insurance-mandated) cost $50 for four pills (my co-pay). I go across the street to the grocery pharmacy and pay cash, and get four pills for $3.81. Madness!
I hope I will not need this information, but if there are…ahem…changes to the Affordable Care Act, and they stop covering my pill, I will have this information helpfully tucked away.
I have the app “Goodrx” which tells you the lowest cash pay place for your meds that is local. I find it very helpful, and maybe you guys will too. It’s a free app.
I wish there were a short online class to take that would explain all this, perhaps one for each major healthcare plan, or perhaps just a general one for “check your healthcare plan for its benefits and here is the rest of the information.” It would be so interesting and useful.
Huh. This is interesting to me on so many levels but the main one is that insurance places limit people often to only one month’s pills at a time. Does your doctor give you a prescription good for one year but then you go to the pharmacy every month to get the pills? Is this true for birth control too? Because holy cats, this seems like a lot of pharmacy trips. I’m from Canada and things work a bit differently here. I used to get 12 packages of birth control pills at a time. My doctor prescribes my meds in 6 month intervals (and would do more, but she needs to see a blood test every six months and that’s her way of ensuring I’m compliant).
Because it’s a system I’m not used to nor have any experience with, the American health insurance system seems so so very confusing and I don’t seem to have the brain power to be able to understand all of the complexities. I have loads of sympathy for all of you.
Yes, that’s right: the doctor writes a prescription for a year’s worth of birth control pills, written usually as a prescription for one pack with 11 refills. Then every month you have to remember to call in the refill and go pick it up. And then if other people in the family also have monthly prescriptions, they never seem to line up, so it’s like this week for this prescription, and next week two more!
There are ways you can get 3 months’ worth at a time by mail order. It’s not something I’ve tried yet, since there’s a pharmacy in Target and I’m there every week anyway.
So the reason for this, in case it isnt’ clear, is this: if you get three months worth and pay twenty bucks they don’t get as much covered as if you have to pay twenty bucks every month.
That is maybe super obvious but until I had to actually do it, it wasn’t so obvious. Sorry if this is pedantic, I don’t mean to be!
I’m not sure if it applies in all situations, but I think even if you can get multiple months’ worth at a time, you have to pay a co-pay for each one. That is, if people came to the pharmacy and got a 2-month supply because they were going to be traveling, they could get an insurance override to allow them to get more than one month at a time, but they still had to pay two co-pays.
I’m Canadian and my supplementary drug insurance will only pay for 3 months worth of birth control pills at a time. Since I take them every day though with no weeks off (which is AMAZING: clear skin, no mess, no migraines due to hormonal fluctuations, no anemia – it’s not the solution for everyone but man is it ever right for me!), 3 months for me is 4 packs, and I have to go through a song-and-dance at the pharmacy every time I renew so they don’t charge me extra for the 4th.
A lot of Canadian insurance companies will limit you to a certain amount at any given time. My experience has been that it usually maxes out about 90 days. You can get special dispensation for longer periods though, I think.
My big prescription aha moment was that although your insurance company would prefer for you to take the generic version (cheaper!) you can request your doctor put “no generic” on your prescription. Many drug companies (in Canada, anyways) will give doctors discount cards that will cover the difference between the generic and the name brand. I had some issues with generic birth control that were solved with the name brand.
$68 savings? Worth the phone call, I’d say! That’d go straight to my Startling Expenses. ;)
As a person with mild phone phobia who ALSO made some calls today, I am focused on the telephonic aspect of your victory here- making a special request of a professional! One that could be scoffed at and/or denied! Well done. *clap clap clap*
*phone-phobic high-five!*
Don’t know if this will help anyone else but my mum always used to start calls of this nature (she was not phone phobic but I am and I find it helps me) with, “I’m wondering if you can help me…”
It works almost like magic- people love being helpful and it seems to sort of get them on your team from the beginning of the call. t also helps me with a weird panic I have about not knowing how to start things.
Or if they have a cranky reply you can hang up right away and try again another day (however long it takes to work up the courage again!)
Completely off topic, but I hope you will be doing a calendar post this year! I looked up when you posted the roundups in years past and it looks like I’m a bit early getting excited and will have to be patient. But, I hope you know that I do so look forward to those!
I will! It’s one of my favorite posts of the year.
Hi Swistle. This may be unique to my health care plan, but here goes. My insurance plan does not seem to have the one month at a time limit even though doctor prescribes more months issue. I do believe I have gone in person to pick up 3 months worth at a time. I will say the one time I have had a problem is when my prescription is huge (for a med I’m taking now, I take 5 pills a day, so times that three months = a lot of pills). So when I went in asking for a 3 month supply, they would refill it, just not that day and I had to come back because they didn’t have enough on hand to turn over that day.
But my health insurance also lets me have 3 (or more, I just do it by three so I don’t totally forget about it) refills at a time by mail order. I just do that because now I don’t even have to go to the pharmacy (and my prescriptions have gotten out of sync so I’m ordering one and then 3 weeks later having to order another). My insurance also lets me order refills online, and I just do that about a week before I run out and I get them in time.
Sorry this wasn’t a helpful tip on how to get your plan to let you do it by mail order for 3 months, just a reassurance that mail order 3 months supply is helpful at saving time. Perhaps that will encourage you to look into on your end and keep this uncomfortable phone call train rolling a little easier?
Omg, phone calls AND math. You should have warned me.