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Personal Finance Topics / Retirement Investing
No. of Recommendations: 4
Just checked my 2025 options on Medicare.gov.
For 2024, I pay a premium of $3.30/month ($39.60/yr) and get 2 of the drugs I take for “free”. The 3rd would cost me $1240/yr if I use the insurance. I pay cash and get a year’s supply for $360 using a Good Rx coupon. So for 2024, premium + drugs cost me $400 for the year.
For 2025, there are 12 plans available in my zip code.
In 11 of the 12 plans the premium + annual drug cost price ranged from $900/yr to $2100 per year.
The last one was a $0 month premium with 2 “free” drugs and a $15 co-pay for a 90-day supply ($60/yr) for the drug I was buying for $350/yr with the Good Rx coupon.
So for 2025, my premium + drug cost will be $60/year down from $400 in 2024.
It’s apparent to me that they’re funding the $2,000 out-of pocket limit by ramping up the price gouging on generics. Make sure you’re checking generic drug prices against Good Rx or Mark Cuban’s Cost Plus Drugs. Less than 10% of Medicare beneficiaries will bump up against the $2,000 out-of-pocket limit. It may make sense to pay cash if you’re annual drug costs are below that using a Good Rx coupon.
intercst
No. of Recommendations: 1
The 3rd would cost me $1240/yr if I use the insurance. I pay cash and get a year’s supply for $360 using a Good Rx coupon.
An obvious question is: what is a pharmacy's incentive for this kind of discount? Does the pharmacy itself have that much profit on the $1240? I would have expected the drug company to have the majority of the profit.
Good information, thanks
No. of Recommendations: 2
An obvious question is: what is a pharmacy's incentive for this kind of discount?
This has puzzled me, too. Our Humana medicare plan gets us most of our mail order drugs for $0 or trivial amount.
For an immediate prescription we use goodrx to see what they have for a local pharmacy. Walgreens or Sam's Club or Kroger or Walmart. Some of the time the Goodrx price is cheaper than the Humana plan "local pharmacy" price. One in particular was $95 on the plan or $12 on Goodrx.
The lady at Walmart happily runs a compare to see which way gives us the cheapest price. I have NO IDEA how they would get the difference. They already have the drug in stock, they already paid for it. Do they get a reimbursement from Humana or GoodRX? Where to _they_ get the money?
We had one where Kroger w/Goodrx was the cheapest for a 3 month supply. The next time we went they told us that the previous Goodrx price was no longer and the new price was a LOT higher. So we went to Walmart.
We just recently got another RX card in the mail, unsolicited. "OptumPerks"
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Man oh man.
I just compared B12 (Cyanocobalamin), Optum vs. Goodrx.
Walmart $21.12 vs. $43.98
But.......we have noticed that sometimes Goodrx has a discounted low price on the first time you fill a RX and higher when you refill.
No. of Recommendations: 0
If your med is available through Cost Plus drugs, I have found that to be the cheapest pharmacy by far. They use True Pill, I believe, and then do a small markup. However, I do not believe they have any influence over the actual manufacturers. They just control their markup after.
No. of Recommendations: 2
<< An obvious question is: what is a pharmacy's incentive for this kind of discount? >>
Crazy large margins versus the wholesale price of the drug.
In the case of the $1240/yr insurance company price, Mark Cuban's Cost Plus Drug Company disclosed a $425 wholesale price. There are 6 or 7 generic manufacturers for the drug -- competition keeps wholesale prices down.
CVS/Caremark is my insurer's captive PBM. Their annual sales volume is probably 100 times larger than Mark Cuban's operation. I'm sure they're paying a lot less than his $425 wholesale price. Good Rx is a much smaller player and they're still making money charging me $360 for a year's supply.
The insurance company price of $1240 is simple price gouging. They know that very few people are going to price shop on Good Rx, so they can get away with charging it.
intercst
