The Rx Coupon Game

Posted by seasuite @seasuite, Jan 25 9:19am

While it's not quite The Squid Game, sometimes it seems equally corrupt. Prior to PCa, I don't recall ever paying for prescription drugs. Any drugs that my Drs. prescribed were covered by the company's insurance plan fully. After moving to Medicare and Medicare Part D a year ago, I had some rude awakenings. The first was Orgovyx, which is a one-off that I won't delve into but, suffice it to say, that I got boned.

Then came prescriptions for Cialis, Viagra and recently, Testosterone Gel. Walgreen's told me that the Gel cost was $1600 for a small sprayer. Then, my Plan D insurance said, 'good news, it's covered' and the price dropped to $165. I then Googled 'Testosterone Gel COUPON' and, lo and behold, the pricing was $45-50. I'd learned about coupons, like GoodRx here on the MCC site and now always check for them.

Does anyone understand how the coupon system works and why it makes it so there is zero reason to have Medicare Plan D??

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retireditguy | @retireditguy | Jan 25 10:19am

You ask a good question. I'm no expert on this topic, but here's a few thoughts. My wife and I are on medicare. I can get generic tadalafil through Goodrx or just at Costco for about $13 for 30 5mg tablets. However, Costco wants about $66 if you don't have a Costco membership. My pharmacy plan wants a lot more. But (last time I looked), for a couple of my wife's med's our Part D plan gives us the best rate. So I suspect it's just a dynamic and ever changing landscape and you never know where you'll get the best price. But I'm keeping my Part D plan since this seems to keep changing and you never know where it'll be in 6 months, or even now for some drug you might get prescribed next week. Plus if you drop Part D, there's a big permanent penalty if you need to get back on it later. Also, over time I've noticed that the Goodrx offers change for a given drug. So I think some of them might participate with Goodrx to get customers, and then raise their prices later. So I kind of use Goodrx when it makes sense, but I can't count on a specific pharmacy having a great price when I get a new prescription. So living in a large metro area I can shop pharmacies. But if I was in a rural setting with less pharmacies around, Goodrx might not work as well for me. Another option I've heard of but haven't tried yet is Mark Cuban's Cost Plus Drugs online pharmacy. I didn't answer your question, but rather just shared a few related thoughts on the chaotic world of drug pricing. Best wishes.

northoftheborder | @northoftheborder | Jan 25 1:45pm

Here in Ontario, presciption drugs cost a small fraction of what they do in the U.S., but we don't have universal pharmacare yet, so that's the one area that's still tricky to navigate.

- if you're under 25 or 65+, all prescription drugs in the provincial formulary are covered (except for a tiny pharmacy dispensing fee)

- if you're in hospital, on social assistance, or receiving home care, your drugs are also covered

- if you're age 25–64 and none of the above applies, there's a good chance you'll have private health insurance through your's or your spouse's work (that's how I cover my Erleada and Lixiana)

- if you don't have private insurance and need expensive meds, most of the pharma companies have patient-access programmes that will provide cancer meds for free (that's how I cover my Orgovyx)

- if all else fails, there is a last-resort programme called the "Trillium Drug Benefit" that will cover your family's meds with a maximum co-pay of about 4% of your family taxable income

I expect it would be cheaper just to have a single drug benefit for everyone and reduce the bureaucracy overhead — and they are working towards that — but for now, this is the one area where I need to stay on top of things; for all other areas of healthcare, I just flash my OHIP card at the check-in desk and that's it (I don't have to think about payment, any more than if I were taking a book out of the library).

jcf58 | @jcf58 | Jan 26 8:35am

I have part D but have yet to use it. That could change though if I ever need a high price drug. Out of pocket per year is now limited to $2000/year.
I use Costco. They check my part D cost and the Costco cost and offer me the best price. I pay $17 for 60 Cialis. I also check GoodRx on any new Rx, but Costco has been great.

garylr | @garylr | Jan 26 9:53am

Just tremendous variation from one person's situation to another - which I guess is part of what makes this so frustrating. My wife and I are both retired and on Medicare. My former employer pays for a Medicare Advantage plan through Humana that covers both of us. When I was about to go on ADT with Orgovyx, my RO warned me that some of his patients were paying up to $1200/month for the drug, but also said there might be some strings he could pull to reduce my out-of-pocket cost. Turned out, it wasn't a big deal - my Humana plan covers the Orgovyx with a $75/month co-pay - pretty manageable.

Wish it could just be simpler for everyone.