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.






