What do US insurance companies pay for prescriptions

Discussion in 'Politics, Religion, Social Issues' started by senseless, Dec 30, 2013.

  1. macrumors 65816

    senseless

    Joined:
    Apr 23, 2008
    Location:
    Pennsylvania, USA
    #1
    Do health insurance companies get special prices for drugs that are filled under their plans? If you have a high deductible health policy that hasn't been met, do you still get to pay that discounted "insurance rate" or are you stuck with regular retail pricing?
     
  2. macrumors 603

    thekev

    Joined:
    Aug 5, 2010
    #2
    Well you wouldn't get them at co-pay, but I would call around. Depending on the drug, prices can vary considerably between pharmacies, especially among big chains.
     
  3. macrumors 6502a

    jnpy!$4g3cwk

    Joined:
    Feb 11, 2010
    #3
    In my world, people with an HDHP pay retail. I don't know what happens when the deductible finally kicks in. Probably the insurance company starts getting its discount. :mad:

    In other news, in my experience, service providers either do not know, or, refuse to state, what the up-front cost of a treatment is. Several times, in fact, I have been told that I am the only person in the universe who has ever even asked :rolleyes:

    So, one of the basic premises of the HDHP+HSA is that because it is mostly out of pocket, the customer is likely to be able to drive a harder bargain or make a more reasoned choice about a treatment. But, if the customer can't pry that information out of the service providers, there is no price basis for comparison.
     
  4. macrumors 603

    Tomorrow

    Joined:
    Mar 2, 2008
    Location:
    Always a day away
    #4
    In my experience, the amount paid by insurance can be all over the map.

    I bought a prescription yesterday from Walmart for $4, no insurance claim needed. I've had plans pay for nearly the whole thing before, and I've had plans pay a few bucks - literally, a $22 prescription cost me $17 and change.
     
  5. macrumors Penryn

    rdowns

    Joined:
    Jul 11, 2003
    #5
    The whole system is ****ed up. I take 3 meds. They cost me $15, $20 and $30 per month co-pay. Recently joined Walgreens prescription club for $20. Now I get a 90 day supply of one for $8 and a 90 days supply of another for $11, no insurance claims needed. Yes, a 90 day supply cheaper than if I were to use my insurance. I still pay a $20 co-pay per month for he other.
     
  6. macrumors G5

    yg17

    Joined:
    Aug 1, 2004
    Location:
    St. Louis, MO
    #6
    I have a HDHP and the two meds I take are each around $7 for a 90 day supply.

    The costs haven't been terrible. A visit to my doctor is roughly $50 (annual physical is free). Blood work for a recent visit cost me $80 which seems expensive, but it's all pretax money from my HSA. It's an alright plan if you're healthy and don't see the doctor much (which applies to me) but if I got sick and hospitalized, I'm on the hook for a couple thousand at least.

    I do know I pay a discounted rate for everything - probably the rate my insurance company would pay if they had to. I still have the bill from that lab work on my desk. The original cost was $208.59, there's an insurance discount of $126.63, leaving me with a bill for $81.96. I can only guess someone with no insurance would have to pay the entire $208.

    I still like the plan I used to have where I just had a flat copay for doctors, specialists, ER, etc, but my employer got rid of them in favor of the HDHP.
     
  7. macrumors demi-god

    Hugh

    Joined:
    Feb 9, 2003
    Location:
    Erie, PA
    #7
    I'm on Medicare part D, and I get a statement each month what each script costs them. I'm not sure the prices are real or not, or it's because I'm on part D. :/

    Hugh
     
  8. thread starter macrumors 65816

    senseless

    Joined:
    Apr 23, 2008
    Location:
    Pennsylvania, USA
    #8
    I got 2 prices for a prescription and there was a $100 difference with my insurance, even having to pay full out of pocket for it. So, I guess the insurance rate is passed on to me after all. I was surprised at how expensive it was.
     
  9. macrumors 68020

    Macky-Mac

    Joined:
    May 18, 2004
    #9
    My insurance carrier has negotiated rates for many different services including prescriptions. A pharmacy that accepts my insurance plan will charge me the negotiated rate while they'll change other customers other rates for the same meds....it doesn't matter if I'm paying all of the charge or if the insurance company is paying some of it.
     
  10. macrumors 604

    Jessica Lares

    Joined:
    Oct 31, 2009
    Location:
    Near Dallas, Texas, USA
    #10
    Our insurance won't cover generics :rolleyes:, but I don't think the prescriptions are apart of our deductible as it's $1,000.
     
  11. macrumors 68020

    Macky-Mac

    Joined:
    May 18, 2004
    #11
    a lot of insurance policies, mine included, also have a deductible for drugs that's totally separate from the deductible that covers the usual costs and services we tend to think about
     
  12. macrumors 6502a

    Joined:
    Mar 6, 2009
    #12
    I still find Asia and the Middle East best for over the counter prescription medicine. Cheap and you can pretty much buy what you want. Herein California the majority of the pharmacies sell generic medication and both generic and non-generic are a rip-off compared to prices one gets in Asia.
     

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