Our PDP (Prescription Drug Program) Silver Scripts … part of CVS Health … that we have used since Jan 1, 2006… IMO.. is starting to “play games” with how medications are classified in the various pricing “TIERS”.
Apparently with the 2016 formulary and tiers.. there was a lot of upward shifting of most generic medications in the pricing tiers.
Because Barb is on a lot of medications, the copays that I get hit with at the pharmacy counter can at times exceed $1000.00. I have become jaded to the $$$ that exchange hands at the pharmacy counter. We are fortunate to be in the 8% of families where the disease and/or cost of treating the disease doesn’t have a adverse financial impact on our family.
To be honest, I have never really paid much attention to the EOM (Explanation of Benefits) that they send out monthly/quarterly. Until this year… I had put them aside and one day recently I started going thru them… before putting them in the shredder and noticed that about 75% of the meds for both of us… WE PAID A LOT and SILVER SCRIPTS PAID NOTHING on a lot of the Rxs that we had filled.
I starting going thru LINE BY LINE… and found one generic medication that we both take and Barb was charged $80 for a 90 days supply and I was charged $12 for a 90 days supply.. WTF ?? Looking at it.. Barb was given TABLETS and I was given CAPSULES… same generic medication, same strength… I called up Silver Scripts and they told me that CAPSULES were CHEAPER than TABLETS… WRONG !!! commercial production of capsules is a semi-automated process… tablets is a fully automated process… Come to find out that the capsules are a TIER ONE drug (preferred generics) and the tablets are a TIER THREE (Brand name & non-preferred generics). So someone who has trouble swallowing LARGE capsules would have to pay abt $300/yr more to get small swallowable tablets.
So I went to www.goodrx.com and checked retail prices.. and GUESS WHAT… capsules are abt 50% MORE EXPENSIVE than tablets..
I got a new Rx from my doc this week.. another generic… and a 30 days supply was $33… This medication is a combination of two existing generics… so back to Silver Scripts formulary.. and another generic that is in TIER 3… and they PAID NOTHING…
Digging a little deeper… each of the two medications in this medication… individually are TIER ONE … and if the doc had written TWO PRESCRIPTIONS… one for each.. my cost would have been $6 and back to www.goodrx.com .. I could have purchased the medication I paid a $33 copay for…. $10 retail/cash..
There is an estimate 4+ million Medicare folks enrolled in Silver Scripts.. making them the second or third largest Medicare Part D PDP.
Paying them a monthly premium gets us what… paying more than cash paying customers are paying for the same medication… paying up to SIX TIMES the price for the same medication depending if my doctor writes for tablets or capsules ?
Just this past week.. Silver Scripts parent company CVS HEALTH… reported a 20% INCREASE in revenue… for first quarter of 2016… I wonder where all those extra dollars came from… how about from the pockets of Medicare folks ? Many who have trouble making ends meet and often have to decide between paying for food and medicine…
Other Medicare Part D PDP programs may be doing the same thing to others on Medicare… I don’t know… but if you have a Part D medicare program.. maybe it would be in your best interest to check out what you are paying and what they are paying… maybe some should call their Congressman..and suggest that there be an investigation of such tactics.
Filed under: General Problems
Preditors are CVS, Walgreens and the other chain Pharmacy’s. If anyone has the option to use privately owned, or Mom & Pop Pharmacy’s do it. Those that are listed on the stock exchange don’t give a shit about the people who use their pharmacy, they are Party Stores that fill prescriptions. Boycott them if you have another option.
THE MOM & POPS HAVE A NEW PROBLEM. MEDICARE HAS BEGUN TO DECREASE THE REIMBURSEMENT TO ALL RX FACILITIES TO LESS THAN WHAT THE PHARMACY PAYS FOR THE DRUGS FROM THE MANUFACTURER. IT IS ILLEGAL TO PASS ON THE INCREASED COST TO CUSTOMERS. THE BIG BOX STORES ABSORB THE LOSS, FIGURING YOU WILL SHOP AROUND AND BUY A FEW THINGS; THE LITTLE GUYS ARE GOING TO GO OUT OF BUSINESS (AGAIN). I USE ONE IN SW FLORIDA AND THEY TOLD ME ABOUT IT TODAY. UNBELIEVABLE HOW MUCH AN INDUSTRY CAN BE SO SCREWED UP. IT COULDN’T GET MUCH WORSE WITHOUT A CHEVY CHASE/DAN AKROID MOVIE BEING MADE LISTED UNDER NON-FICTION. (RIP FUNNY MEN).
Politicians, bureaucrats, and PBM’s are playing games – and winning while patients lose.