What is a pharmacy "discount", and why would the uninsured price be 2.6× market value?
This is in Massachusetts; I have Cigna, with a deductible that's been met at this point.
I was issued a prescription for Omeprazole by a doctor; when I went to CVS to pick this prescription up, I presented my insurance, and it was going to cost $64, or a unit price of ~$2.67/pill. The pharmacist herself thought this price was far too high: she pointed out to me that Omeprazole is OTC, and that if I turned around to the shelf in the store, I could just buy it there, for a unit price of $0.80/pill; well under half! (II'm going to call this price the "FMV" of the drug, since it is what you'd pay if you just bought it yourself, no questions asked.)
She re-ran the prescription, this time without applying my insurance. The price remained $64. Given that this is still far above CVS's own price, the pharmacist herself was still perplexed. She consulted with a co-worker, and applied a "discount" or … something. It seems like she applied "Make a Wish Discount Card", which brought the price to about $0.55/unit, or slightly better than store price.
Cigna, in my discussions with them, also noted that they think I can just simply ask for a "GoodRx" discount, and simultaneously represented that Cigna has and does not have a relationship with GoodRx, but insisted that somehow those magic words would get me a discount from the absurd price, to FMV, I guess.
What happened here? Why should the uninsured price be different from if I just grabbed it off the shelf? What is GoodRx, and how can they possibly stay in business if they offer discounts on drugs? What happened here — did I inadvertently barter the price down? I'm used to American healthcare attempting highway robbery of its patients, but … TF? Do I really have to double-check not only that I'm not getting uninsured prices, but prices that are inexplicably several times higher than FMV?
(I asked Cigna about this, and got back generally useless responses. While perhaps they might market the plan during Open Enrollment season as "oh yeah it'll cover prescriptions!" the actual plan text states,
Your Cigna Advantage Prescription Drug List includes a full range of drugs including all those required under applicable health care laws. Some of the more expensive drugs are excluded when there are less expensive alternatives. To check which drugs are included in your plan, please log on to myCigna.com.
And of course if you "check which drugs are included" … this one is not.
When asked about the price, all I got was non sequitur from Cigna. "Well, sometimes it is more expensive depending on the store" — there's only one store here. The same CVS has it on the shelf for $0.80/u, and if naturally rung up in a pharmacy with Cigna's insurance, or even without¹, jumps to $2.67/u.
¹it makes some sense that the insurance doesn't affect pricing, as the drug isn't covered)
submitted by /u/deathanatos
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