What are your struggles with pharmacies as caregivers of seniors?

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According to a recent study, people are not aware of their options when they're faced with buying a new medicine. They don't know another pharmacy might have the exact same medicine for a cheaper price and no one shares this reliable information.
Another pain point, is when you are not aware of your insurance coverage until you're at the pharmacy and you should decide if you want to buy it or not.
Now imagine if you are doing all these things for your mom, dad or any other senior relative or friend. How do you manage these things? What are your experiences? What do you think can be improved?
What has bothered you or made you happy?
Please tell me more about your experience and include any suggestions that you might have.

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Gosh I love the internet!

I was musing on the difficulties of rational drug pricing, and thought "I wonder if..." and sure enough - ta-dah! - very interesting article from March this year:

https://www.forbes.com/sites/arleneweintraub/2018/03/30/the-call-for-drug-price-transparency-is-growing-louder-but-will-it-matter/#75721d643267

We are by no means alone in fuming over this subject.

And to satisfy the site administrators - it will take many, many terms in office for any government to get any sort of handle on this, which means it's way beyond party political scope.
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Persons who do not live in the US, or persons who don't have Medicare themselves and are dealing with it for an older loved one seem to have a hard time comprehending the basics. I don't blame you! The basics are SCREWY. But they do work consistently.

To illustrate a point, I looked up my purchases of a particular drug in 2017. I purchased it 9 times. The retail cost of the drug was $899 that year. (Retail is a price only non-insured persons pay.)

# All at the same drug store (Walgreens)
# All under Medicare and the same supplemental insurance -- no changes throughout the year
# All for the same quantity
# All for the IDENTICAL drug (an injectable diabetes drug in prefilled pens)

Do you think I paid the same each time? Ha! Here are the payment amounts in chronological order:

$196
$314
$314
$338
$42
$42
$42
$42
$42

I was probably in the donut hole for the highest charges and the lowest charges were after I'd spent so much on drugs I was eligible for catastrophic coverage.

These variations were NOT the doing of the pharmacy. They were strictly a result of the medicare and insurance policies.

If I had coincidentally changed pharmacies after that large cost, I might have thought (as kbuser did) that I was getting a MUCH lower price ($42) because that pharmacy had a better price. No. It was because I was due a lower price according to my policy, and I would have gotten it from ANY pharmacy within network at that point.

Country Mouse, maybe different generic drugs charge very differently where you are, but I don't think you will find that true in the US. Unless a doctor insists otherwise, all medicare prescriptions are filled generically if they can be. (My injection pen is not available generically.)

Sayena, pharmacies are generally not the stumbling block. Cock-eyed insurance policies and medicare are the cause of most confusion, and pharmacies can not be expected to fix that.
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Countrymouse Oct 11, 2018
Sob! Sniff! Aaaarrggh...

So... you're paying a percentage of the $88888888888, and the %age varies according to cover terms? Until you reach a capped maximum, and then it drops to a concessionary rate? - catastrophic, indeed! I'll say!!!

We have to pay £8.80 per prescription unless exempt. At a quick glance, there are a dozen categories of exemption so that in effect you only pay if you're between 16 and 60, not in full time education, not pregnant, not particularly low income, not ill with a disease such as cancer or diabetes, and not chronically ill. And contraception is free - or was last time I looked, which admittedly was more years ago than I care to reckon up.

And yet we squeal like wet piglets every time the price goes up (I do too, I admit) and complain bitterly that we can't get the exciting new drug in the strawberry flavour. I'm going to copy your very clear explanation to anyone I hear whining in future.
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After reading your profile, I assume this is for a master's class.

1. Most doctors have free samples or coupons available for patients with no ins. or high copays. You can also contact the pharmaceutical companies for the discounts.

2. The problem for caregivers is not necessarily the pharmacy. It is the time associated with picking up prescriptions, setting them up...then redoing all of the work when something happens and a prescription is added or increased mid-month/cycle. It would be nice for insurances to just have them set up and delivered.

3. The insurance companies trying to cut costs so they send out letters trying to set up appointments to "discuss" medications with insurance company doctors or nurses so they can convice a person to take a cheaper alternative. It is exploitative and irresponsible.
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jeannegibbs Oct 11, 2018
Tacy, my doctors have given me those coupons. Turns out they cannot be used by people with insurance, EVEN IF their insurance does not cover that drug. If you have insurance and the drug is not on your insurance company's formulary, your only alternative is to pay out of pocket for the entire cost.
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Here in NJ Walgreens is a Medicaid pharmacy. As such, they handle the 90 day instead of going thru express scripts. Loved that fact when Mom had State PADD and nephew is on Medicaid. I have never had problems with them. I would question why the big difference in price.
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sayena94 Oct 11, 2018
I remember a couple of months ago, my friend's niece had a liver failure. She needed a device and she went to just a Walgreens branch to get it and send it to Dubai. She paid $900 for it because it was critical, but soon after everything was handled she found out that they've sold it two times more expensive than somewhere else.
She went there with a receipt and they paid her half of the money.
It was a tough experience, but it made me not trust them a little bit.
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I was using Walgreens pharmacy for my mom's carbidopa levadopa. She does have Medicare and Humana supplemental. I was paying a little over $100 for a 3 month supply. I found Smith pharmacy, a small local one, and the exact same prescription was $13. I don't understand how Walgreens can charge so much more, especially since it went through insurance at both pharmacies.
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jeannegibbs Oct 11, 2018
Insurance coverage does not vary by pharmacy, unless one pharmacy is within the plan network and the other one is not.

BUT the same medication will cost widely differing amounts depending on the stage the insured is in. It will cost one amount until the deductible is paid, another amount after that, an entirely different and higher amount during the "donut hole" crazy period, and a much lower amount after you come out the other side of the hole, if you do.

Walgreen and Smith cannot charge different amounts for the same medicine IF they are both in the Humana network. But you certainly can be charged different amounts for the same medication depending where you are in the Medicare cock-eyed "stages."

If you look into this a little further I suspect, kbuser, that you will find that Walgreen would have charged $13 for that prescription at that time also (unless Walgreen does not have a contract with Humana.)

I've totally given up predicting what to expect to pay for a prescription from one time to the next.

When I had Walgreens, prices varied for each visit. Now that I have to use another pharmacy, prices vary for each visit. It is the insurance and medicare policies that cause this, not the pharmacies.
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I was interested in this topic because I thought there might be tips about how to make sure your px has been filled correctly, always check before you leave the store or the hospital, never assume, always make sure it's the right patient's name on the label, develop a relationship with your local pharmacist so that s/he can give you a heads up on possible interactions, etc etc etc. Let's hear it for good community-minded pharmacists, and more power to their white-coated elbows!

What hadn't crossed my NHS-cosseted mind was the sheer Byzantine h*ll you all have to go through every time your insurer takes against a particular pharma company, or the limitless opportunities for fleecing people who are ill and in real need.

The thought of having to be a canny consumer at the same time as you yourself are ill, or stressed out with responsibilities for someone else - it just makes me put my head on my desk and groan.

Assuming that defamation laws will get you into serious trouble if you name and shame the worst offenders, couldn't you at least name and celebrate health insurers and pharmacy chains who provide clear information and good value services?
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jeannegibbs Oct 10, 2018
CM, every insurance company I have ever used or heard my sisters talk about using does the same stuff with their "formularies." As far as I know, there are no good guys to single out.

I was extremely satisfied with the pharmacy chain I used for several years, but they didn't get awarded a contract from my insurer this year, so I had to switch. The new one has a rinky-dink website, is not open on Sundays, has limited hours the other days, has no drive-through, etc. etc. I hate it. I can see why it would have outbid the excellent chain for the business. You get what you pay for, I guess. BUT the pharmacists are helpful and friendly. I've never had bad experiences with pharmacists from any drug store. They have all been amazing. Sometimes I think they are the unsung heroes in the health care system.

A for-profit healthcare model is simply going to be not in the best interests of the consumer no matter how you tweek it.
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If you are paying for medications out of pocket, then pharmacy shopping makes sense. Maybe you wind up getting 3 of the drugs from one place, and 2 from somewhere else that has a better price.

But if you have drug insurance it probably is a waste of time to price shop. The insurance company has negotiated the price any pharmacy who accepts that insurance can charge you. Your price will be the same no matter where you buy. In that case shop for convenient location, speedy drive-through, pleasant and helpful clerks, etc.

Each insurance company has a list of drugs and the "tier" the drug is in in their coverage. This is called their formulary. Each year I get a booklet of the formulary from my insurance company. It is also available online. If I am prescribed a new drug, I can look it up in the formulary and see that it is considered a tier 4 drug and my cost is going to be a 45% co-pay. Yikes! I could ask my doctor if there are any tier 1 drugs that might be as effective, because then my co-pay is $0.

My insurance evaluates which drugs are in its preferred tier from time to time. I hate it when they change from one brand of insulin to another. Then I have to get my physician to change my prescription to the one that is in the favorable tier!

If your loved ones have no drug coverage, you don't have to worry about formularies, and you can compare prices at different sources, but non-insured people pay at the highest level. In a way they subsidize the lower costs for insured people.

(Health care costs in the US are royally screwed up, in case you haven't noticed. Pharmacies cannot do anything about that.)
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First, insurance companies usually have certain pharmacies they have contracts with and you have to use them to get a good price. Some work with mail order (90 days) after the med has been established as maintenance. That is the cheapest way to go. Not all Seniors have the ability to shop around. They stay with one Pharmacy because they have meds delivered because they no longer drive or not able to get out and about.

I agree, that our elderly do not understand their insurances. Its not cut and dry. And very hard for them to get their mind around. Walmart used to have a list of drugs that they would discount. If a person is low income, there are state programs that help with Drugs. Mom had PADD with the state.
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