I just picked up some prescription eyedrops from the pharmacy. I don't have any vision insurance, so this was an all-cash transaction.
The clerk at Walgreens told me it would cost $365. Hoo boy. But if I joined their club it would only cost $104 plus $20 for the first year's fee. Great! Sign me up.
But think about this. At $104 Walgreens is still making a profit, so let's figure this stuff costs them around $70 or so. That means the list price is more than a 400% markup from their wholesale price.
That seems like an awful big penalty for not having insurance, doesn't it?
Shady.
It is an obscene price to pay for not having insurance. We could take care of this through legislation, but no, legislators are mostly bought and paid for by big insurance and big pharma.
It is obscene. Which makes it kind of puzzling that Kevin's post sounds like he's just discovering this now. It's been this way for decades.
Look at any medical bill you get... there's the price the hospital charges the unwashed masses, then there's the "write down wink wink" price that insurance companies are actually willing to pay, the rest of which the hospital just drops. Pay out of pocket, you don't get the "write down wink wink" option.
You know, getting on Medicaid is not frictionless. In a lot of red states and many blueish ones, there are layers of friction to discourage all but the most desperate from getting on the Medicaid rolls.
Trump allowed for work requirements which a couple of states went for. Otherwise under the ACA only a simple income test is required for eligibility. I've known several people who had to go on Medicaid in ACA-affirming states and none of them reported any real difficulty. Heck in 2018 I was out of work for five months and still had a very small income from a non-work source plus unemployment. I signed up on my state ACA portal for an exchange policy-- and they called me to tell me I was Medicaid eligible since unemployment payments do not count as income since they are not permanent. They signed me up right over the phone.
Genercs, everybody. Generics. They exist for most prescription drugs that have been around for a few years, and the cost is a fraction of the non-generic. And press your doc to make sure he/she really needs to prescribe the latest and greatest version of whatever it is. The cute little scam is that drug makers make a small change in the formula to, for instance, make a 2x a day drug a once-a-day one, and then they can charge the outrageous prices they're accustomed to and there's no generic yet. Most docs, sadly, pay virtually no attention to these issues, assuming insurance will pay for whatever it is, whether you actually need the latest and greatest or not.
My doc is one of the rare ones who *does* pay attention to this stuff. I take 5 different prescriptions these days, all of them generics and all of them very low cost. I'd have to declare bankruptcy if I had to buy the non-generic versions of these things.
Feh.
👍👍👍👍👍
It's even worse. The insurance companies try to incentivize patients to use cheaper prescription drugs by charging a higher copay, but the drug companies merely kick a payment equal to the copay directly back to the customer (remember all those adds that say "contact us if the copay is a problem"). The copay is small compared to the drug companies’ margin, so they can easily afford to kick it back to the customer.
My insurance company kicked me off a generic medicine at $90 per month and offered the name-brand medicine at a deeply-discounted price of $300 per month. There must be kickbacks involved. I'm now paying the goodrx.com price cash, about $35 per month.
Vision insurance is not health insurance. When added up, the amount spent on premiums and deductibles/post-allowance expenses for frames/lenses vs. the non-insurance cost for things like eye exams, glasses, and contacts - it's not all that different. I think it saved me about $50/yr as I paid $230-250/yr and the cost of the annual exam was about $60 and I got a $140 allowance for frames/lenses. Everything else was on me. Same thing usually goes for dental insurance.
The Walgreens "club discount" compared to their non-club discount is unscrupulous, however.
And the really unscrupulous part of all of this is that vision and dental should just be part of regular health insurance. They're still medicine and still important for your overall health.
the powers that be should be informed that mouths and eyes are parts of the human anatomy. seriously.
Overall medical costs are driven by a relatively few people who require extensive care - the costs can be spread over all policyholders, most of whom will have modest expenses. Vision and dental costs, by contrast are driven by many people who require relatively low-cost, but recurring care. So medical insurance is classical risk-pooling, while vision and dental insurance is mostly cost-leveling. I believe many developed-world universal medical coverage systems exclude vision and dental care. MfA would be an outlier.
Doesn’t matter. If you don’t attend to routine teeth or eye issues, you eventually develop “real” medical issues with the 98% of the body that real medical insurance does cover. What’s the point of that tho?
For what it’s worth, there are a lot of body parts that people go to the doctor regularly for, not just teeth and eyes. For example, vaginas need regular checkups. Yet somehow we don’t separate vaginas out for their own coverage. (Although I guess we do if they have a baby in them that the owner doesn’t want, when it comes to publicly funded medical insurance.)
It matters for the financing - universal care reduces costs by including more healthy individuals in the pool. Enlarging the pool for dental care doesn’t bring economies of scale; as you say, routine care is important to prevent, e.g. periodontal disease, so we really want to encourage everyone to use the benefit. Vision care costs would likely bring some modest savings. Until some politico stirs up resentment among perfect-vision voters against ‘four-eyed freeloaders’.
Dental and vision plans aren't "insurance" -- they're basically discount buyers' clubs, or cost-sharing plans. You can't "insure" against vision or dental care the way you can regular health care. 99% of people require both. So what you're really getting is what Kevin purchased at Walgreens: a membership in a discount club.
That seems like an awful big penalty for not having insurance, doesn't it?/i
Yes, it seems like crime.
Something happened. See what happened? Too much italics.
How to fix it, how to fix it.
oh...I thought it was my eyes...
Eyetalics. It's a thing.
Lol!
One day you'll be able to buy whole seasons of tv shows in the form of eyedrops.
End tags.
Oligarchs of medical stuff
Ha, it's not just medical Rx. I purchased a baby gift, on line for $56. Shipping was about $10. There was an error in the order so the company gave me a refund of $20!!! What the heck was the actual cost of the gift???
Buy through Amazon. Most everything ships for free. And the returns are pretty painless too. And yes, Amazon is the giant taking over the world. Why is that? The prices, quick delivery, easy returns.
Never. Subscribing to a newspaper owned by Bezos is bad enough, but his treatment of employees & small sellers on his platform would be enough reason to avoid Amazon
Seeing his delivery trucks on my street more than once a day, remembering how eager localities were to spend money to bring Amazon in despite the effect in the area, while he spends a fortune to launch his Blue Origin crafts, is disgusting.
I would think that prescription eye drops would be covered by prescription drug insurance, not vision insurance. Probably depends on the plan.
Anyway the answer to all these problems is single payer national health insurance along the lines of Sanders' Medicare for All plan. (Which is not really a good name as it would be incredibly better than existing Medicare.) As I recall the bill would eliminate all co-pays on prescription drugs unless you insist on a non-generic when a generic is available. Co-pay costs are limited to $300/yr. The government has to set the costs it will pay for drugs in line with other major countries.
Yeah with Medicare now they only cover the most expensive population, simply adding all the younger healthier people to it is going to lower the per person cost.
Except that the younger population is already paying into Medicare.
I had to get a prescription filled in January and I forgot that my prescription plan had changed as of the 1st so when the pharmacist initially rang it up it was $375, which reminded me of that so I gave him my new card and then he re-ran it and it was $27 like I expected.
Protip: if it is something that has a generic equivalent, go to Costco. They are so much cheaper for prescriptions that it is usually worth the membership fee.
One of mine is $12 there, was about $300 at a CVS. The other is $22 vs. I think around $180.
Unfortunately, there's zero consistency on drug prices across retailers. What costs $25 at your local pharmacy may cost $10 across town, or $35. Luckily, the pharmacy I use, which is part of a supermarket in the nearest big town, has low prices across the board, I've discovered. But early on, when my doc's office called in a prescription to a different pharmacy, I ended up pitching a fit in the place when I learned what they wanted to charge me.
Costco should be more inexpensive, but I wouldn't count on it without checking!
Nonsense, in the US we have a "free market" and a requirement of free markets is perfect information, therefore, we all must know what every retailer is charging for a drug, what the retailer is paying for it, and what it costs for the manufacturer to produce it. But for some reason, all this information is completely secret. Go figure.
Yes, Costco is often the best. Walgreens is usually the worst.
GoodRx.com is a good place to compare prices, and get coupons.
Here's another vote for GoodRx.com! I have a long-term prescriptiom that goes for upwards of $80 and of course, my drug policy won't cover it, but with a GoodRx coupon, I got the 'script filled for $14.75 yesterday.
The American drug market is like capitalism run wild with no police on the beat. And, so far, it's been Too Big To Fight.
It isn't capitalism, it is robbery with the government holding the gun in the form of patent protection. For some people, like diabetics, it is literally "your money or your life".
Given my user name guess what I'm going to say? Here is Canada I have prescription coverage but I'm sure something like eye drops would be less than the Walgreen;s Club price because durg prices are regulated. Half the time it's not worth claiming for these kind of prescriptions because we do have deductibles and the're just not that expensive. I lived in Scotland until 2020 and all prescriptions were free there. It really is an American problem.
Yep, it sure is. It's disgraceful!
Drug prices are only based on what they think they can get. Similar to medical procedures. And beds that always seem to be 50-60-70% off!!! This weekend only!!! Save hundreds!!!
Marginal costs for production of small molecule drugs are trivial. However, costs to entire a market can be very high. Ripe for quasi-monopolistic behavior.
On the delivery end--how many independent pharmacies to you see in your neighborhood?
In the middle---pharmacy and drug management firms.
And to cover the layer cake, insurance companies. ....
By the way, is that discounted price the standard discount you'd get with the program or was there a one time sing up bonus? Also, did you check the price online with something like GoodRx? What's that price range?
I recently had a hospital stay for some tests (blood tests, chest fluid tests and a CT scan), over the course of 18 hours. Probably ~20-30 lab tests in all.
The list price / uninsured cost: $39,000.
After BC/BS insurer discount: $5000
My responsibility after insurance coverage: $500
So, since BC/BS is probably the biggest insurer in this town, so the vast majority of UPMC's patients are paying only 12% of list.
And you can be sure that they are still making a profit!
If it’s Rhopressa I have 2 unopened bottles I would be happy to send you..
Generally speaking, ACTUAL healthcare prices -- for everything: hospitals, doctors, drugs, everything -- are VASTLY different from "list" prices, because providers negotiate discounts with middlemen (like pharma benefits managers) and payers (insurance companies) and those discounts can be MASSIVE. This is one reason large drug chains and large retailers can offer "buyers clubs." The discounts are so huge that in accounting statements they sometimes are treated as adjustments to revenue, eg revenue before discounts and revenue after discounts, rather than as costs like advertising or promotions or whatever else. And this applies across the board, eg a procedure that "lists" for $20,000 may actually cost an insurer only $7,500.
List prices for healthcare are basically in Monopoly money. Anyone who pays them is getting ripped off to a level that's effectively criminal.
You have to understand that, Obamacare notwithstanding, our system is still fucked up.
The problem is that we insist on keeping private insurers in the game and largely let them do what they want with private health care providers. Both of them have an incentive to post list prices that bear no relation to actual costs. That's why, say, an MRI can cost $1000 at one hospital and $5000 at the one down the road.
The existence of private insurance is the reason for the fake pricing. When they negotiate a price with an insurer, the provider has room to go down, maybe a lot, without losing money. Similarly, the insurer can point at the size of the discount they got when touting their benefit to patients. Everybody wins!
Except, of course, if you have no insurance. Then you pay list and get totally screwed. You are an N of 1 and have no negotiating power.
The system is built for private insurers to dicker with private providers, and if you don't fit that mold, how sad for you.
The United States of Rent-Seeking.
+10
Never miss a revenue stream and never give into the whinging.
Must I?
/s
Walgreens: $30/pill
Costco: $0.58/pill w/GoodRx
Insane
A shout-out to Mark Cuban. https://costplusdrugs.com/ doesn't have everything and isn't always the cheapest, but it's worth checking.
There is also this odd thing the pharmaceutical companies do if you are on a long term medicine with high co-pay and have insurance. They offer you a discount plan, kind of like a frequent user discount. The one my wife is on for her quarterly medication is called "co-pay assistance". It comes from the drug company, it subsidizes our co-pay. It feels like every other shopper rewards program where you get a discount from a retailer for return visits. But from a drug company it feels wrong. Sure, I may go to CVS over Walgreens because I have discount coupons, but for a drug, this seems so odd. They could just lower the price or accept the insurance payment.
One article - https://creakyjoints.org/advocacy/understanding-copay-assistance-programs/
Why would you need "vision insurance" to get a drug prescription filled?? I use prescription eye drops, and my regular drug plan gives me a fairly good discount. (Mind you, these are not $300 eye drops.)
I'm protesting by giving up rushin' around -- which isn't at all the same thing, but it's something I'd like to do anyway that I can claim is taking a brave moral stand, which makes me feel good about myself. And isn't that what's really important?
What was in the eye drops that wasn't medical?
Check out goodrx.com. There are other similar sites. Type in the name of your medicine and the dosage, and they will tell you a cash price, often much less than what the insurance companies negotiate with the Pharmacy Benefits Managers.
Moreover, you get the prices at several local establishments, so you can select based on price AND location.
Sounds like Walgreen's REAL game here was to get you to sign up for their plan. I would suspect that NOBODY actually pays the $365 after the clerk "helpfully" points out that if you join the plan, you can save hundreds of dollars today. So it is a bit of a red herring there.
That said, the opacity of the pricing in the healthcare market in the USA is appalling. I suspect that most of us get some of our health care without really knowing for sure how much it is going to cost until they present the bill.
I am extremely happy to live in a country where I pay higher taxes but in return have all of this taken care of for me. Simply not having to worry about what MIGHT happen healthwise is worth a lot.
I've often thought that one way to improve the system a bit is to require health care providers (including doctors, dentists, hospitals, pharmacies, ambulances, home-care nurses, opticians, medical devices vendors, etc.) to charge uninsured patients no more than the lowest price that they are willing to accept from an insurance company.
I've long thought this, and not just with pharma, but with every provider. I am insured, and every time I get an explanation of benefits, I am struck by how much the insurer negotiates down a price, and then how much or little of that I get charged. Seriously? My insurer can bring a basic doctor's office visit down from $300 to $75 and then (in-network) I don't have to pay anything? Or (out of network) only $30. The flu shot that got whittled down from $110 to $25 to nothing?
And here's the next thing: the clinic I visit DOESN'T SERVE UNINSURED PATIENTS! I know because they thought I was one. So who gets charged that uninsured rate? Why is it even posted?
But God forbid if I was uninsured and they were willing to serve me. Suddenly just basic health is out of my reach, even for very simple stuff.
It's complicated. And the big question is: Who benefits? What interest is served by complication? By huge debts? By bankruptcy?