Rick KlauFeb 15, 2023

today in US healthcare weirdness: a medication I last filled when I was still at Google had run out. I went to refill it, and was told by the pharmacist that my current insurance doesn't cover it, so it'll be $1800. Also, there's no generic.

Did some googling: found a coupon that lowers the cost to $800. Not great, but definitely better than $1800.

Then saw a link to the manufacturer's site. Through Walgreens and some independent pharmacies, I can get the prescription filled for $65.

Show threadDavid W. JonesFeb 17, 2023
@rklau If your insurer contracts with CVS as their pharmacy benefits manager, please be aware that CVS generally has the highest drug prices in the United States, and the worst customer service of any pharmacy benefits manager.
Show threadRick KlauFeb 17, 2023
@dancingtreefrog the whole PBM space confounds me. But this is (I think) slightly different. because my insurance doesn’t cover this medication, it’s $1800 at CVS. At the local pharmacy, they confirmed that my insurance excluded it, which meant it was $1800, but then applied the coupon, which meant my cost was $65.
Show threadDavid W. Jones
@rklau PS My opinion of the PBM space is it exists solely to extract more profit from drugs. All the PBMs are for-profit operations, except one that Anthem and Humana launched: https://jrreport.wordandbrown.com/2021/07/27/anthem-humana-drop-nearly-140-million-to-launch-new-pbm/.
Something to think about.
Anthem, Humana Drop Nearly $140 Million To Launch New PBM

Anthem and Humana have invested nearly $140 million to form a new pharmacy benefit manager, as criticism over traditional PBMs’ operations kickstarts business at startups that promise transparency. The insurers will hold a minority stake in the new joint venture, named DomaniRx, which is being championed by SS&C Technologies. The Windsor, Conn.-based fintech company owns ...

Health Care News for Insurance Brokers | J&R Report
Feb 17, 2023 at 3:40amWeb