Crazy Prescription Prices!! - Its Insane...

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
metsfan302
Posts: 687
Joined: Fri Oct 09, 2015 9:44 pm
Location: Dewey Beach, Delaware

Crazy Prescription Prices!! - Its Insane...

Post by metsfan302 » Wed Nov 25, 2015 12:05 pm

I just got prescribed a new inhaler for my copd / breathing - Advair

Its wild the prices big pharma charges insurances/ consumers. I understand there is alot of research, science, yatta yatta but wow!

This new Inhaler Retail Price is - $505.99 for 1 inhaler that's 120 puffs - $4.21 per puff!!!

Yes the insurance covers it and my co-pay's only $3. They have no prob paying for this but wont cover an attended sleep study rejected once again but the sleep dr is appealing it.
Image

So every month they are paying for this inhaler basically what it cost for a new AirSense 10 Autoset (almost)
https://www.cpap.com/productpage/resmed ... idair.html

_________________
Machine: DreamStation BiPAP® Pro Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Prior - ResMed AirCurve ASV User
This is my Orig Post "The start of my venture to find proper therapy" - http://www.cpaptalk.com/viewtopic.php?f ... &sk=t&sd=a

User avatar
ChicagoGranny
Posts: 14409
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: Crazy Prescription Prices!! - Its Insane...

Post by ChicagoGranny » Wed Nov 25, 2015 12:10 pm

metsfan302 wrote:They have no prob paying for this
That's not how insurance works. Your insurance company has a contract with the pharmacy and doesn't pay that much for the inhaler.

No one pays retail.
Last edited by ChicagoGranny on Wed Nov 25, 2015 12:16 pm, edited 1 time in total.

User avatar
metsfan302
Posts: 687
Joined: Fri Oct 09, 2015 9:44 pm
Location: Dewey Beach, Delaware

Re: Crazy Prescription Prices!! - Its Insane...

Post by metsfan302 » Wed Nov 25, 2015 12:12 pm

except if I did not have insurance I would i assume?

_________________
Machine: DreamStation BiPAP® Pro Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Prior - ResMed AirCurve ASV User
This is my Orig Post "The start of my venture to find proper therapy" - http://www.cpaptalk.com/viewtopic.php?f ... &sk=t&sd=a

User avatar
ChicagoGranny
Posts: 14409
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: Crazy Prescription Prices!! - Its Insane...

Post by ChicagoGranny » Wed Nov 25, 2015 12:15 pm

metsfan302 wrote:except if I did not have insurance I would i assume?
No, you would not pay it. You could not afford it.

Your doctor should work with you on substitutes. http://www.livingwithasthma.net/3-alter ... or-asthma/

User avatar
chunkyfrog
Posts: 34377
Joined: Mon Jul 12, 2010 5:10 pm
Location: Nebraska--I am sworn to keep the secret of this paradise.

Re: Crazy Prescription Prices!! - Its Insane...

Post by chunkyfrog » Wed Nov 25, 2015 2:44 pm

I suspect that the insurance company may have some kind of (nudge, nudge) "agreement" with the drug company.
Just because such collusion is illegal is not always a deterrent.

_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Airsense 10 Autoset for Her

Janknitz
Posts: 8410
Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: Crazy Prescription Prices!! - Its Insane...

Post by Janknitz » Wed Nov 25, 2015 2:53 pm

chunkyfrog wrote:I suspect that the insurance company may have some kind of (nudge, nudge) "agreement" with the drug company.
Just because such collusion is illegal is not always a deterrent.
It's not even illegal collusion. The insurers are free to negotiate volume discounts, and I guarantee you they don't pay anywhere near the retail price. Just like CPAP equipment. Our insurers aren't paying the retail prices for CPAP equipment and supplies, they pay a negotiated rate.

It's the GOVERNMENT which isn't allow to negotiate on behalf of the people. Stupid, stupid, stupid.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

User avatar
chunkyfrog
Posts: 34377
Joined: Mon Jul 12, 2010 5:10 pm
Location: Nebraska--I am sworn to keep the secret of this paradise.

Re: Crazy Prescription Prices!! - Its Insane...

Post by chunkyfrog » Wed Nov 25, 2015 3:34 pm

Jan, you clarify this muddle for me, somewhat.
I do know that Medicare may pay doctors between 40-60% of the "normal" price, or even lower,
And hospitals may only get around 10% {based on my benefit statements}. Sweet negotiating! --or lying!
All MC drugs are Part D, taking the gov. out of the equation, (and your fully latched congressperson,
--suckling like mad at the Big Pharma nipple); so my insurer is free to lie as much as they please.
I don't believe for a minute that Humana pays as much as they say they do.
One could only hope that some day the deception will be illegal.

_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Airsense 10 Autoset for Her

Janknitz
Posts: 8410
Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: Crazy Prescription Prices!! - Its Insane...

Post by Janknitz » Wed Nov 25, 2015 3:41 pm

It's not any different than "fantasy billing" for CPAP's. It's what the DME wishes, in it's wildest dreams it could get for a CPAP machine (and sometimes does get if a poor, uninsured sucker walks into their lairs).

Same with drugs, doctor's charges, and hospitalizations.

I love to laugh when big wigs say we need to be better medical consumers and pay attention to costs. HOW???? The prices are pure fiction!
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

User avatar
LSAT
Posts: 13229
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin

Re: Crazy Prescription Prices!! - Its Insane...

Post by LSAT » Wed Nov 25, 2015 5:19 pm

metsfan302 wrote:I just got prescribed a new inhaler for my copd / breathing - Advair

Its wild the prices big pharma charges insurances/ consumers. I understand there is alot of research, science, yatta yatta but wow!

This new Inhaler Retail Price is - $505.99 for 1 inhaler that's 120 puffs - $4.21 per puff!!!

Yes the insurance covers it and my co-pay's only $3. They have no prob paying for this but wont cover an attended sleep study rejected once again but the sleep dr is appealing it.
Image

So every month they are paying for this inhaler basically what it cost for a new AirSense 10 Autoset (almost)
https://www.cpap.com/productpage/resmed ... idair.html
Just for kicks I checked Costco's no insurance price on this item.....$340
By the way...in case you are not aware...You do not have to be a member to use the Costco Pharmacy.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion)
Additional Comments: Back up is S9 Autoset...... Buckwheat hull pillow
Last edited by LSAT on Wed Nov 25, 2015 6:30 pm, edited 1 time in total.

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: Crazy Prescription Prices!! - Its Insane...

Post by Wulfman... » Wed Nov 25, 2015 5:28 pm

Janknitz wrote:
chunkyfrog wrote:I suspect that the insurance company may have some kind of (nudge, nudge) "agreement" with the drug company.
Just because such collusion is illegal is not always a deterrent.
It's not even illegal collusion. The insurers are free to negotiate volume discounts, and I guarantee you they don't pay anywhere near the retail price. Just like CPAP equipment. Our insurers aren't paying the retail prices for CPAP equipment and supplies, they pay a negotiated rate.

It's the GOVERNMENT which isn't allow to negotiate on behalf of the people. Stupid, stupid, stupid.
In my opinion, this all started the snowball rolling downhill in the mid-1960s when the government got involved in and created Medicare and regulating medical costs/prices. Over the decades it's gotten progressively worse.

Now we have an insurance and medical care nightmare.......created by........ ______________________ (fill in the blank)
Be careful what you wish for.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
Olivia
Posts: 73
Joined: Sat Sep 14, 2013 8:56 pm
Location: San Francisco Bay Area

Re: Crazy Prescription Prices!! - Its Insane...

Post by Olivia » Wed Nov 25, 2015 10:26 pm

You could get it from Canada for $40 or try Costco if you have no insurance.

yaconsult
Posts: 1099
Joined: Fri Nov 14, 2014 10:43 pm
Location: "Silicon Valley", CA

Re: Crazy Prescription Prices!! - Its Insane...

Post by yaconsult » Thu Nov 26, 2015 3:06 am

I always suggest that if people need to buy medications without insurance that they check GoodRx to find the best prices:
http://www.goodrx.com/advair-diskus?dru ... air+diskus

Here's the story on GoodRX - started by a couple of early Facebook employees:
http://techcrunch.com/2012/02/18/goodrx ... ion-drugs/

This is a very legit site that costs nothing. You can access it on your home computer or using their phone apps. It keeps track of lowest prices and gives you codes you can print out to get the reduced prices. Like many medical things, the "list prices" pharmacies charge are often outrageous. But if you have the right discount codes, you get a much better price.

When I have been off insurance, I used GoodRX to compare if I got better prices at walmart, costco, target, etc. The other nice thing is that you can see how the price changes with different quantities. Often, by buying a larger quantity, you can pay less per pill. I made a spreadsheet to calculate the per pill price for different quantities and found that the highest price was usually for a 30 day supply. And doctors are usually happy to write the prescription for the amount you want to buy. You can also often save money by buying pills that are double the dosage you need and then cutting or breaking them in half.

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: January 2015 Sleep Study Results: Apnea/Hypopnea Index (AHI): 80.2, Sleepyhead

Sonnyboy
Posts: 637
Joined: Sun Nov 23, 2014 8:56 am

Re: Crazy Prescription Prices!! - Its Insane...

Post by Sonnyboy » Thu Nov 26, 2015 8:09 am

yaconsult wrote:I always suggest that if people need to buy medications without insurance that they check GoodRx to find the best prices:
http://www.goodrx.com/advair-diskus?dru ... air+diskus

Here's the story on GoodRX - started by a couple of early Facebook employees:
http://techcrunch.com/2012/02/18/goodrx ... ion-drugs/

This is a very legit site that costs nothing. You can access it on your home computer or using their phone apps. It keeps track of lowest prices and gives you codes you can print out to get the reduced prices. Like many medical things, the "list prices" pharmacies charge are often outrageous. But if you have the right discount codes, you get a much better price.

When I have been off insurance, I used GoodRX to compare if I got better prices at walmart, costco, target, etc. The other nice thing is that you can see how the price changes with different quantities. Often, by buying a larger quantity, you can pay less per pill. I made a spreadsheet to calculate the per pill price for different quantities and found that the highest price was usually for a 30 day supply. And doctors are usually happy to write the prescription for the amount you want to buy. You can also often save money by buying pills that are double the dosage you need and then cutting or breaking them in half.
How does this work if you have Medicare Part D?
Can I use GoodRx for one or 2 medications and then my Medicare Part D plan for the rest?

_________________
Mask

RobertS975
Posts: 209
Joined: Tue Feb 11, 2014 6:03 pm
Location: MA

Re: Crazy Prescription Prices!! - Its Insane...

Post by RobertS975 » Thu Nov 26, 2015 9:30 am

http://www.bloomberg.com/news/articles/ ... ric-advair

Generic Advair is close!

But as has been said, the list price of $500+ is NOT what your company had to pay... no even close!

User avatar
metsfan302
Posts: 687
Joined: Fri Oct 09, 2015 9:44 pm
Location: Dewey Beach, Delaware

Re: Crazy Prescription Prices!! - Its Insane...

Post by metsfan302 » Thu Nov 26, 2015 11:22 am

But if I did not have insurance i would have to pay that

_________________
Machine: DreamStation BiPAP® Pro Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Prior - ResMed AirCurve ASV User
This is my Orig Post "The start of my venture to find proper therapy" - http://www.cpaptalk.com/viewtopic.php?f ... &sk=t&sd=a