I have noticed in the cost of insulin question thread, there is a huge difference in cost between user self pay or paying via insurance with a copay… I am checking into this now, I did get my levimere from walgreens via insurance, they billed 250.00 per vial, I paid 30.00 copay.
I just checked target this weekend and cost for same thing via self pay is 115.00!! what is going on here and do all insurance companies just stand by and pay the inflated price.
HERE IS THE QUESTION: DOES ANYONE KNOW WHY THIS HAPPENS?
I think it has to do with the individual deal each retailer works out with the insurance companies. Also, some places (like Walmart) heavily subsidize the cost of some insulins, often via deals directly with the manufactuerers. I think this is how Walmart is able to provide R and N insulins at $25/vial (no insurance). The same insulin is something like $70 or $80 per vial at CVS if you buy it without insurance.
I am currently paying about $95 (my copay after insurance) for every 3 vials of Humalog I get. If I need more in a pinch, I have a standing Rx at CVS, but my insurance won’t cover it, and then it costs $169 PER VIAL. I have not shopped this around, but I probably should, because I am sure I can get it cheaper.
Don’t forget, just because Walgreens billed your insurance $250 doesn’t mean that is what your insurance actually paid. My supply company charges about $95 per box of test strips but my insurance pays about $33 per box. Most insurance companies have set prices that they pay.
It has always been my understanding that the insurance company dictates what the “full” price is to be displayed on the form from the drugstore in order to show their “insured” how much money they saved them by using their plan. Theoretically 3 people could walk into a drugstore for the same prescription with 3 different insurance plans and each walk out with a different “full price” and how much their insurance saved them with their co-pay.
My insurance has an online pharmacy (90 days supply) which saves me a months copay, but I did have to pick up a bottle of Lantus recently (broke one) which my insurance covered with a copay and it was marked a “full price” of about 120 dollars, saving me 80 dollars!!
I call it “funny money”. You might think the drugstore stuff is bad, but look at your lab test bill sometime.
e.g. “Full list on the insurance paperwork” price of an A1C test is $70 according to my lab. My insurance company pays $5.68. I do not really believe I could walk in off the street without insurance and pay $5.68 for the test. At the same time I know that $70 can’t be a “real price” except in terms of “anyone unlucky enough to not have insurance has to pay this.” But that doesn’t mean “real price”.
It would seem to me that they could have “some” cost control by issuing " the insured prepaid cards to pay for the script in person. anyone’s thoughts on this?
