|Shopping for 30-day supply of generic Lipitor (atorvastatin)|
|Average Discounted Retail Prices by Pharmacy|
With more people having insurance plans with very high deductibles or poor drug coverage, more patients are paying for drugs out-of-pocket, and so they need to be cost-conscious about where they shop. Based on Consumer Reports' latest survey of drug prices, where you shop can make a big difference in your wallet. In fact, even for those with insurance co-pays, simply paying for the drug out-of-pocket could be cheaper than the co-pay itself. Check out the Consumer Reports link above for additional pharmacy price comparisons for the generics of Actos, Celebrex, Cymbalta, and Plavix for 2018.
How can big-box stores like Costco sell drugs so much less expensively than a CVS or Rite Aid? For one thing, they handle the Pharmacy Benefit Manager functions (PBM) internally, so they can negotiate prices and pass on those savings to the consumer. Costco and Walmart count on gaining new customers and additional sales by luring customers into the store with great deals on prescriptions. Traditional drug stores like Rite Aid and CVS have a different business model; their profit center is the pharmacy, and while they may offer more customer service perks, their mark-up on prescription drugs drives the profits.
When an uninformed consumer buys a prescription at a pharmacy, it can have unfair consequences. A patient pays the co-pay (not knowing that the cash price could be cheaper), and the Pharmacy Benefit Manager (PBM) for the insurance company can keep the difference between the copay and the cash price of the drug. According to some analysts, the insurance company doesn't care one way or the other. Because the cost of the drug is covered by the patient, they don't have to do any reimbursements. See Pharmacy Times for a discussion of this practice and when pharmacists should advise the consumer to pay cash. Consumer Reports recommends always asking your pharmacy about generic substitutions, discounts that might be available, and about whether getting a 90 day prescription would be a cheaper option.
There are more pieces to the drug pricing mystery."Blink Health" generic discount web site, for instance, offers a price of $0 for a one month supply of our example generic drug atorvastatin (Lipitor) without an explanation of how they can offer such a discount. It is clear that the patient (especially the under-insured patient) who doesn't have the time, energy, or knowledge to do a lot of research legwork, is often the loser financially in the pharmacy pricing scenarios that exist today.
In April, right on the heels of the publication of the 2018 Consumer Reports pharmacy prices comparison, CVS announced that it was going to be launching a new tool (Rx Savings Finder) to help its pharmacists find coupons, discounts, and the best prices for customers. But will this tool save the pharmacist's time and the patient's money, or will it be a burdensome addition to pharmacist's already hectic workload, and still result in the patient paying more than they would at a competing pharmacy that offers low prices to start with? It could be that the market will decide that pricing the drugs transparently at the get-go is a better business practice for customer and pharmacist alike. Only time will tell, but in the meantime consumers need to be vigilant about exploring their drug purchasing options.
- Insight from industry analyst Adam Fein: Why Retail Pharmacies Still Overcharge
- Court document recently unsealed: a whistleblower accused CVS and its PBM, CVS Caremark, of overcharging Medicare for drugs. CMS rules state that"payments are required to be based on the actual cost of a drug, meaning the drug price received by the pharmacy."