Wednesday, January 8, 2014

I Just Said No to Drugs!

I got a nasty little surprise today.

While I was in Rite-Aid spending my +Up Rewards(I am officially out of them now), I went back to the Pharmacy counter to get a prescription refilled and give them my new insurance information.
We were forced to change coverage in 2014....not because of ObummerCare or anything, because our previous coverage company was an HMO deal and doctors and services are ONLY available in the northeastern PA area.  Seeing as the Daughter has been in Louisiana since last May and #2 Son is leaving for college(only one  of the schools he is considering is in this area), half the family can't use the medical coverage and we'd had to pay out of pocket since May for Daughter's expenses(ouch)and if #2 Son goes elsewhere for college, we'd be paying OOP for his medical care too.

So Hubs changed the coverage for 2014 to one with participating doctors and coverage nationwide.

The plans we have ALWAYS had up until this new one have had prescription benefits that are NOT dependent on deductibles being satisfied first.  IE-You go to get a med refill in January and you haven't satisfied your coverage deductible, you still only pay the prescription plan price and your meds are not used to satisfy your deductible.

Until now.

So the pharmacy clerk tells me our $3K deductible hasn't been satisfied(well duh!...nobody has seen a doc or had a test or blood work done in the last 7 days)and the prescription that should cost me $20 OOP is going to be $290.

*Thunk*  That's the sound of my jaw as it hit the floor.

Obviously I did NOT get the meds refilled.
Hey!  Who needs medications anyway?

It's not one I need to take or I'll keel over least not for awhile.
I've got a similar drug I was taking they changed to this one, so I'll just get the ok to go back on that one for now as I have something like a 2 months supply of it.

Hubs is having a procedure the end of the week which we WILL have to pay OOP for and since that will probably satisfy that $3K deductible I'll wait until after that payment gets into the system to go and attempt any more drug refills.  I'm good with everything else for a couple of weeks so I'm hoping we can get this out of the way and back to paying sensible prices for meds.

If not, I'll go see if Walmart has any of my meds on their $4 list and transfer those over there which will help our bottom line.

I also have to find out if my various doctors(I have 5)take this new coverage, if the blood work lab will take this coverage, if the durable medical goods company will take this coverage and if the gastric surgery & nutrition classes will still be covered and if so, what percentages of each we will have to pay OOP.
This is going to be like a fulltime job for awhile, getting all the answers and everything sorted out!

Boy, am I going to give Hubs an earful when he gets home tonight! ;-)



  1. might try Costco to see if it's cheaper. DH's are a lot cheaper there than the other pharmacies.

    1. The nearest Costco is 70 miles from here unfortunately.

  2. This new year is not drug-friendly for you, it seems.

    If you find your drugs on the WM $4 list, will you go ahead and transfer prescription to WM to save money? People say WM pharmacy is a pain. But, I get on the electric cart, turn in whatever was not called in, and shop a bit and come back with little wait. When prescriptions are called in or I call for a refill, the wait just the time in line, no more than 20 minutes. My regular pharmacy takes longer than that.

    1. I have 1 rx already at Walmart and heck yah! I'll transfer all those puppies over if it's cheaper! lol

  3. I have all of ours at Walmart. It's just cheaper even with the insurance! Just make sure you take the ones that keep you ALIVE. I would be way to lonely without you

  4. Does your insurance have an online pharmacy option? I switched to this a couple of years back and have found it extraordinarily convenient as well as more cost effective.

  5. I hate medical bills and the cost of meds period!

  6. Some thoughts:
    -compare prices also at Target pharmacy
    -can you get a cash discount at a mom and pop, local harmacy
    -is mailorder an option
    -are there any on line or at the MD coupons/discounts available? while we were waiting for my $4000 deductible to be met, DD's meds became an issue. $150/month just for one of them. We looked on line, and sure enough, got a coupon voucher, good for a year, that brings that cost down to $50. Now that we've cleared the deductible, it's free until Sept 1, then we're back in the $50/month basket. Meanwhile, we'll enjoy the savings

    1. Thanks for the ideas CTMOM. We are checking into mail order as this med program does have that component.
      I can get a coupon good for any OOP over $5 up to $100 per refill from the manufacturer so I'd still have to pay $195 per refill. ugh
      Not hopeful that a mom and pop will give me much of a better deal but I'll try them too, thanks.

  7. Ouch. That is a big difference. I hope you find something affordable.

  8. I second the nomination for Target. I have never waited for more than 3 or 4 minutes either to drop off or pick up a prescription. I am currently without insurance and found that I, believe it or not, actually am paying less per month by paying cash than I was previously paying in co-payments! My Target pharmacist has applied all the discounts and worked some sort of magic and I couldn't be happier.

    Now my husband's story is slightly different. Last Autumn he fell into the dreaded doughnut hole! This was our first experience with that phenomenon. It was partially our fault as we didn't realize that the amount that the insurance company pays counted towards reaching the limit. Honestly I thought they were counting only our OOP expenses. Anyway after he fell into that hole we explored ordering from Canada. Meds that cost $240 a month here in the states came to $55 for 2 1/2 months by ordering from Canada. Ordering from Canada is something to keep in mind!


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  10. OH wow, that's a huge difference... I don't have meds or anything, but every so often I have to collect something from the Pharmacy and pay the $10 per med copay (I haven't even looked to see if it'd be cheaper elsewhere.. I assumed it was the same everywhere until now). Even though my deductible is $1000, it would be very hard for me to reach it, as I don't use my benefits a lot... that change would've been pretty bad for me.

  11. Ouch :( I know what it's like to have to change health insurance plans. I did a lot of research before doing so. I actually wrote about it here if you're interested:


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