Again with the pharmaceutical shopping game...

[DandyDon]

Buying pharmaceuticals seems to be a bigger racket than funeral sales, or at least similar. People in need are generally stressed to buy quickly, etc.

This is the Anoro Ellipta inhaler my PA wants me to use every day. Unlike Flomax or Mobic, I cannot tell that it makes any difference, but then I have a dozen daily meds I take on faith that the medical professionals prescribing know a lot more than I do and are probably giving me good advice. So I buy and use it, as long as I can keep the costs down.

The retail price is like $212/month and up in drugstores, even with GoodRX, SingleCare, Amazon, etc and not covered by my Medicare drug plan, so I've been getting it for $28/month from a Canadian pharmacy - a middleman for overseas manufacturers skirting rules by buying in "for sale in Turkey only" packages and shipping. It's made by the same reputable manufacturers that sell many drugs to Big Pharm in the US, licensed by the patent owner, all the same except for the 90% price difference.

My PA told me about a new deal with the local drugstore that got it down to $25/month - cool!

Then it went up to $44/month!

And my old Canadian supplier now wants $85/month - what?!

So I found a new one to try at $25/month, except I got my old supplier to price match.

It's always something with medicine costs! I am getting pretty good at shopping.

 

[kinoons]

The major reason for the high cost is that drug is brand name only - there is no generic. It’s a combination of an anticholinergic and a long acting beta agonist.

Each individual class of medication could be had on its own, potentially as a generic. The big limiting factor is I believe the generics are only available to use in a nebulizer; they are not available as a generic as an inhaler. But if cost is a limiting factor that is something your PA could explore.

Another game pharma will frequently play is DC the current drug and then release a “new” drug that is a different combination or different dosing to renew the patent so they can keep charging the high number to insurance who must cover atleast one drug in each class. Or add a third. Or combo together two that were in separate pills, but now in one pill. The list goes on.

 

[DandyDon]

The major reason for the high cost is that drug is brand name only - there is no generic.

Yeah, but I am getting the same brand for $25/month instead of $200 & up.

But if cost is a limiting factor that is something your PA could explore.

It's not with my shopping.

 

[kinoons]

Yeah, but I am getting the same brand for $25/month instead of $200 & up.

It's not with my shopping.

$200 and up is what the (insurance) market will bear, so thats what they will charge when there is no competition.

You said yourself the cost was going up and you have to keep shopping around. I hope that continues to work. I gave you an alternative if that isn’t the case in the future.

 

[lionfish-eater]

$200 and up is what the (insurance) market will bear, so thats what they will charge when there is no competition.

You said yourself the cost was going up and you have to keep shopping around. I hope that continues to work. I gave you an alternative if that isn’t the case in the future.

$200 and up is what the companies bills Medicare, who is forced to pay full list price.
The insurance companies negotiate a substantially reduced rate. I have a friend in the PBM business

 

[DandyDon]

$200 and up is what the companies bills Medicare, who is forced to pay full list price.

Medicare does not pay for meds out of the hospital setting, not in the least. There are two choices...

What we call Part D is an optional insurance plan a Medicare recipient can purchase from an insurance company, also called a PMB, and I did opt for a cheaper one that covers most of my meds but excludes some.

Or there is Medicare Advantage which many spammers try to get me to switch to every year, but I reject because of the limitations. Those include PMB coverage but it's provided by a company.

 

[lionfish-eater]

Medicare does not pay for meds out of the hospital setting, not in the least. There are two choices...

What we call Part D is an optional insurance plan a Medicare recipient can purchase from an insurance company, also called a PMB, and I did opt for a cheaper one that covers most of my meds but excludes some.

Or there is Medicare Advantage which many spammers try to get me to switch to every year, but I reject because of the limitations. Those include PMB coverage but it's provided by a company.

Sorry I meant MedicAid, which does pay for millions of Americans, many who are overmedicated.

 

[DandyDon]

Sorry I meant MedicAid, which does pay for millions of Americans, many who are overmedicated.

Ok, that's a totally different game.

 

[kinoons]

Medicare does not pay for meds out of the hospital setting, not in the least. There are two choices...

What we call Part D is an optional insurance plan a Medicare recipient can purchase from an insurance company, also called a PMB, and I did opt for a cheaper one that covers most of my meds but excludes some.

Or there is Medicare Advantage which many spammers try to get me to switch to every year, but I reject because of the limitations. Those include PMB coverage but it's provided by a company.

The PBM and the insurance company are not the same - the PBM is a middle man between the retail pharmacy and insurance. The original intent was for the PBM to keep cost down. Now they are just there as an added cost.

Of course this means that insurance companies have all bought or started their own PBM to keep that money. Another prime example of what’s wrong with US healthcare.

A not very short but very good explanation.

 

[DandyDon]

The PBM and the insurance company are not the same - the PBM is a middle man between the retail pharmacy and insurance. The original intent was for the PBM to keep cost down. Now they are just there as an added cost.

Ok, yeah, that figures. And your Youtube makes an excellent case. I feel even better about avoiding them all on my big-ticket items.