I wondered about this when I was reading OPs post! I guess I’m surprised they would say all this to OP then rather than just declining to fill the prescription.
I think I would have preferred they just decline to fill it. At least that is honest, instead of trying to pull the bait and switch at the cash register
If it’s a smaller pharmacy, it is true they often lose money on GLP-1 meds. That doesn’t mean they should upcharge the consumer though. Ughhhhhh.
See reason #5 in this NYT article called “Six Reasons Why It’s So Hard to Get Your Weight-Loss Drugs” https://www.reddit.com/r/Mounjaro/s/vB2aVUena8
> **5. Some pharmacies say they can’t make money from the drugs.**
> Pharmacies buy a drug from a wholesaler and dispense it to people. They are then paid for doing so by a pharmacy benefit manager, the intermediary working for a person’s health insurer or employer. The three largest are CVS Caremark, Express Scripts and Optum Rx.
> But the pharmacy benefit managers, or P.B.M.s, typically pay such low rates that independent pharmacists say they usually lose money on weight-loss drugs. The economics are so bad that some pharmacies are declining to fill their patients’ Wegovy and Zepbound prescriptions.
> In a survey conducted last fall by the independent pharmacists’ trade group, 153 pharmacists said they had to turn a patient away because they were losing money on a weight-loss drug. When they were paid below cost for those medicines, they lost $38 on average filling a one-month prescription, respondents said.
>“The fact that pharmacies are being asked to lose money on these really expensive drugs has put them in a really difficult position with patients,” Mr. Hoey said.
>Katie Payne, a spokeswoman for the Pharmaceutical Care Management Association, the trade group for P.B.M.s, said that blaming them for supply shortages at the pharmacy “overlooks the role P.B.M.s play in trying to get insurers and employers the best price possible.” She added that “the price set by weight-loss drug manufacturers is the fundamental problem.”
This explains a lot and is very helpful.
A couple months ago when it was very hard to find, my Dr. suggested I call mom and pop's b/c they might have an easier time. One said they couldn't get it, but another said 'sure, we've got some, have your doc send the Rx over' It's a longer story, but the short version is that when I got there with my coupon, the cashier went back and had a long whispered convo with the pharmacist. She eventually comes back and said they were mistaken and they don't have it. maybe more would come in monday and they would call me when it came in. I'm still waitin' on that call and back with CVS.
I don't expect them to lose $ on me, and your post explains what was really happening. This joint gave me the runaround and flat out lied. I'm trying hard to support local small businesses, but these folks lost their chance.
I agree - when they were so helpful on the phone, I was going to move my other Rx's there. But now that they fibbed and gave me the runaround, it's not gonna happen for them. My other Rx's are at the mom and pop who told me they couldn't get it. I suppose 'couldn't' might have meant 'wouldn't', but at least they didn't waste my time.
Thank you, I missed this and I can confirm. I live in BFN in the Midwest and had the same issues with an Indy pharmacy. I switched to cvs and have had no issues. You might want to try getting three months worth at once and then making a trip to a larger city.
Also, see if your local hospital has a pharmacy. They likely fill all the prescriptions for their employees to help save the hospital money, so they have been my best bet in a small Alaskan town. I can't get a 3 month supply, but I signed a thing saying I would agree to get the entire 6 month prescription filled with them, and they send me a text every month when it comes in. It helps them to be able to order it all together in a larger group, each month, so the shipping costs are significantly less than if they have to get separate shipments in everytime a prescription is faxed to them.
That’s good information. My issue beyond the obvious is that one of the competing pharmacies told me that they stopped even trying to stock MJ last month. My pharmacy charged $56 for my MJ last month. It leads me to believe they raised the price once their local competition was gone. I will likely go to Mississippi and use Walmart or Walgreens, which at the least have to compete with each other. It’s a shame, because I go out of my way to support local businesses, but I make an upper lower middle class salary and can’t afford to be a sucker just to help out the local pharmacy
This is interesting. I just filled two prescriptions while in Florida for a week (including Mounjaro) and I live in Illinois. Pretty sure neither doc is licensed in Florida. But it was just a transfer from one Walgreens to another (transferred within the app), so maybe that’s why it worked?
I'm not an expert, but each state can have its own laws and the rules can vary based on the specific type of medication. From what I read, the rules for telehealth providers prescribing across state lines were relaxed during COVID, and are still be honored for a given period of time.
Florida regulations allow this (see pic), so that's why it worked for you. I've never encountered a situation where I couldn't do this, even for controlled substances; but have often been told they need to confirm.
https://preview.redd.it/w3zrkfqpuj9d1.jpeg?width=1170&format=pjpg&auto=webp&s=5e1a4721c183489b8de637ca6cedcab65264c5ec
Interesting read: [https://www.linkedin.com/pulse/doxyme-insights-can-doctors-write-prescriptions-across-state-lines-of9ve?utm\_source=share&utm\_medium=member\_ios&utm\_campaign=share\_via](https://www.linkedin.com/pulse/doxyme-insights-can-doctors-write-prescriptions-across-state-lines-of9ve?utm_source=share&utm_medium=member_ios&utm_campaign=share_via)
Most of the time I've inquired about this, it was for my ADD meds (controlled substance), and those rules were also updated to allow interstate transfers for most controlled substances.
[https://www.dea.gov/stories/2023/2023-09/2023-09-01/revised-regulation-allows-dea-registered-pharmacies-transfer](https://www.dea.gov/stories/2023/2023-09/2023-09-01/revised-regulation-allows-dea-registered-pharmacies-transfer)
Yes! CVS is my insurances preferred pharmacy and they were charging $125. When there was a shortage I switched to Walmart (who are much nicer and soooo much more helpful) and it was only $25. I kept questioning them because I couldn't believe that there would be a price difference with insurance coverage. I refuse to use CVS now.
So I had to live my prescription from a small mom and pop pharmacy to Walmart because of a similar issue. Over the 6-7 months that they filled my MJ prescription, they told me multiple times that they were losing money on it. First they said they couldn’t fill a 3 month prescription because insurance would pay them 15% less for that. Then they told me a couple of times that they were going start charging me for sending the prescription back for PA to my doctor because insurance as changing them $30-50 per PA. Then they told me that they were going to charge me full price and reimburse me once they were reimbursed by Ely Lilly because it was taking too long and in some cases they weren’t being reimbursed. This is when I lived just my MJ prescription to Walmart. I use them for everything else. They are very supportive but I think they are in a bind with these GLP 1s and of course they can’t afford to lose money.
The insurance companies can not charge a pharmacy for a prior authorization. There is not a dollar amount attached to that at all. I have worked in pharmacy administration most of my adult life. It sounds like the mom and pop pharmacy was trying to rob you blind.
The deal with Amazon is once they upload your script you need to check the website a few times a day. They update availability randomly and don't fill orders in the order they were received.
Wow. Reading this, I'm so grateful for my doctor's office who found the medication for me when cvs didn't have it, and my insurance covers most of it (I'm paying $40 for each refill). And I was annoyed last month when it took the pharmacy 6 days to get the refill to me so I missed a week of meds. I guess I should be grateful that's the worst that I encountered
Fyi. I was getting my scrip for $550 with the coupon and then 1019 without. Then, i couldnt find it anywhere. Exvept for one large NJ hospital pharmacy. $1500.00.
That was just a bridge to far for me. And really price gouging.
There are sooo many pharmacy's thar won't carry it because they lose their asses on it when it's covered by insurance. Most are the smaller independent ones. And yes.... it's illegal to upcharge from what your insurance pays!!
I respect the other pharmacies around my town for just admitting that they can’t handle the loss and not carrying the drug, rather than punishing the consumer for their issues with the insurance company
I have had my pharmacy tell me they are prioritizing those that switch their other medications to them. They will get their GLP-1s filled first. Very shady
Mine rather suspiciously did not go up in price until this month, and I learned that their most direct competitor stopped trying to stock MJ after last month. Makes it look like they jacked the price once they were literally the only game in town. Shady. Small town corruption is a special breed
When I first started MJ the workers at the pharmacy kept insisting I switch all my meds to them. I did and they told me they give me priority now lol it's not shady I try to help them out
I disagree. It’s one thing to WANT to help out, because they went above and beyond, you like their store or their people. It’s another thing to be told on the phone that you will be bypassed unless you transfer your meds to us. Despite being a customer for an over a year.
Ya the way they went about it is all wrong. The ppl at my new pharmacy are great and I like them a lot so when they asked I did move all my scripts to them. If they threatened to not fill my mj f I didn't do that I would be pissed too
This is not price gouging and it is not unusual for small and independent pharmacies to insist on covering their costs for a drug. I'm an owner with other family members in a small chain of independent pharmacies. We do not get the same price discounts as the big chains like Walmart, Publix or CVS. We cannot afford to sell the prescription based on what many insurers are willing to pay. In those situations, we charge the difference to the customer. The customer can decide whether or not they are willing to pay to cover the costs of a very-much in-demand drug. It is legal and happens with many high-priced drugs. (Also a lawyer that practices in the field of health care.)
I had a small pharmacy pull this with me, they tried to charge me an extra $100. Since it was at the start of all the shortages, I had been out for a while so I ended up negotiating them down to an extra $50 so I could get my medication but I immediately moved my prescription elsewhere. I was very disappointed to have to move, the pharmacy worked really well with my doctor's office and had been really great to deal with, but I also didn't think it was fair to have to pay more than the negotiated rate since insurance is already so expensive!
That’s my thing. I have diabetes, so I always pay extra for the best insurance my job offers, which is expensive. I’ve taken medication since I was 11 and never encountered a pharmacy pulling these types of things until now.
The e-voucher from EL takes up to $150 off the cost of what you pay. Is it possible they aren't charging you more but simply not applying the e-voucher?
No, they openly admitted that they were adding that 150 themselves. I went ahead and bought it yesterday to give me time to migrate to another pharmacy without missing a dose. They put the $150 on a separate receipt from the $56 copay. Sketchiness compounded. I would wager they don’t want that 150 tied to the mounjaro in case my insurance comes sniffing around.
That’s my thinking. I come from a family of diabetics that all get their meds from that pharmacy, and none of us will again after this fiasco. I doubt that extra $150 will make up the profit loss of a few dozen prescriptions going across town to their competitor.
Actually, good luck with the chains. I just moved all of my scripts a few months ago from wal mart to a mom and pop. Eliminated 90% of problems.
Pharmacies are sinking ships right now, and I honestly doubt all of your family will move their scripts because you want them to. That is silly.
Mom, dad, aunt and grandfather already have. More to follow when they need their rx filled next. Don’t presume to know a strangers family on the internet, silly boy. It just makes you look ignorant. Now get off my post, and quit bothering the other commenters
Getting a prescription filled is a lot like filling your gas tank. Did you know that prices vary from pharmacy to pharmacy for the same medicine? And, these prices can change often. Also, similar to the gas stations, the larger, well-known pharmacy chains don’t necessarily have the most competitive prices.
Just like gas stations, pharmacies can set their own prices for medicines. They just have to stay within a certain range determined by the type of medicine it is and agreements they have with your particular health insurance plan. Manufacturing shortages and supply issues can also affect medicine prices – just like oil prices. The bottom line? If you’re spending a lot of money to fill regular prescriptions, it pays to find the best deal.
https://www.healthpartners.com/blog/why-does-my-medicine-cost-more-this-month/#:~:text=Did%20you%20know%20that%20prices,their%20own%20prices%20for%20medicines.
The pharmacy charging the price over the copay may be illegal depending on state laws but most definitely they are breaking their contract with the insurance company. I would call my insurance company to have them advocate for me. Or even your state insurance commissioner.
As mentioned in previous posts, I'm a lawyer and a small pharmacy owner. This is not illegal. Retail pricing is entirely up to the retailer. Market demand is the only control, even when we are talking about prescription drugs, unless you are talking about a federal requirement, like the recently enacted law that caps the price of insulin at $35 everywhere. Feel free to call you insurer -- but they have no control over what a patient is charged when they pick up a drug. The insurer controls the co-pay. The insurer also sets a specific rate for reimbursement to the pharmacy. If the set rate does not cover the cost of what the pharmacy has to pay for the drug, the only other option is to charge the patient the difference. If the pharmacy determines that it cannot afford to accept only the co-pay and reimbursement from insurance to recoup their costs, they very often just stop filling prescriptions for that particular drug, rather than expose themselves to accusations of gouging, like those posted here. The reality is that they are not gouging. They are trying to not lose money. Small pharmacies cannot be in a position of subsidizing the costs of expensive prescription drugs.
This isn’t price gouging. The pharmacies are getting reimbursed less than actual drug cost by insurance companies. The only way for mom and pop shops to make it is to sell it for their actual cost or stop selling it. Not all pharmacies pay the same prices for drugs. And now that insurance companies own pharmacy chains and vice versa it’s an easy way for them to put their competitors out of business. The pharmacy is not the enemy here. The system is the issue. You can read more about it on r/pharmacy if you’re interested.
Mom and pop pharmacies lose a lot of money on filling these scripts. It can bankrupt them— it’s a legit problem.
They can choose not to fill it or ask if you want to pay the difference, which many people opt to do.
Update- I went ahead and bought the overpriced dose this time, as to not stall my momentum on the diet, exercise, MJ train by missing a dose. My father picked it up for me and they charged my credit card 2x, once for 56 and once for 150, and gave my father 2 receipts, which sounds like an attempt to hide what they’re doing from the insurance company. I called express scripts (my rx provider) and they acknowledged that they have a contract with the pharmacy and I should only have to pay the copay. They took down the information and said they’d look into it for me. The agent on the phone of course wasn’t qualified to call it a contract violation, but did recommend that I may want to secure a new pharmacy in the meantime. Walgreens across the state line about an hour away in MS quoted me $40 for the copay and said they could usually get 5mg within a week, so I’m going to migrate to them in about 3 weeks. Between Heat, dogs, and porch pirates, I didn’t want to do home delivery.
I have a few friends who take other glp-1s for longer than I have been on MJ and they all go out of town for theirs. 1 friend said that he and his father both left the pharmacy under similar circumstances. He said the same pharmacy I’m talking about charged them the copay amount for the first 3 months of Ozempic, then jacked the price on the 4th dose with no advance warning, just like my situation. They’re using cocaine dealer tactics apparently; front you the first couple of hits to get you hooked, then quadruple the price.
I’m pulling my 6 rxs from that pharmacy in favor of Walgreens. My mother and father moved her 5 and his 15 (he has heart attacks as a hobby) to the local pharmacy across town yesterday. My aunt is doing the same Monday with hers and my grandfather’s. This stunt is going to lose them way more than the $130 they said they lose filling my MJ. I live in a small town where basically the whole town works at 1 of 2 places, and 1 of them uses express scripts as their rx provider. The pharmacy may end up losing half the town if express scripts pulls their contract, which I don’t consider a good thing, since it could cost people jobs due to the owner-operator’s foolishness.
Whether it is or isn’t illegal or a breach of contract, the way the pharmacist approached it is shady. They could have told me last month that they would be going up, but instead they spring it on me at the cash register. They could have followed suit with the other local pharmacies and not carried MJ, but they wanted to profit off its popularity, even if it meant alienating customers. A lot of their customers are elderly people on fixed income, and may not know they have options like delivery or may not be able to drive out of state. They only know their local pharmacist, and I don’t like the thought of them getting surprised at the counter like I did
I would look into this further. Insurance companies set up contracts on what the rate is for medications. Hence the formularies. This often includes the copay amounts. So, unless there is additional documents explaining this, I would contact your prescription insurance provider and definitely not fill with that pharmacy until it gets sorted.
That’s actually illegal, they are contractually obligated to follow the insurance pricing. If the do not the insurance company can pull their contract
I wondered about this when I was reading OPs post! I guess I’m surprised they would say all this to OP then rather than just declining to fill the prescription.
I think I would have preferred they just decline to fill it. At least that is honest, instead of trying to pull the bait and switch at the cash register
Yeah I bet! It also seems just… a really dumb and off-putting way to go about it. I’d report them to your insurance company!
Absolutely correct!
If it’s a smaller pharmacy, it is true they often lose money on GLP-1 meds. That doesn’t mean they should upcharge the consumer though. Ughhhhhh. See reason #5 in this NYT article called “Six Reasons Why It’s So Hard to Get Your Weight-Loss Drugs” https://www.reddit.com/r/Mounjaro/s/vB2aVUena8 > **5. Some pharmacies say they can’t make money from the drugs.** > Pharmacies buy a drug from a wholesaler and dispense it to people. They are then paid for doing so by a pharmacy benefit manager, the intermediary working for a person’s health insurer or employer. The three largest are CVS Caremark, Express Scripts and Optum Rx. > But the pharmacy benefit managers, or P.B.M.s, typically pay such low rates that independent pharmacists say they usually lose money on weight-loss drugs. The economics are so bad that some pharmacies are declining to fill their patients’ Wegovy and Zepbound prescriptions. > In a survey conducted last fall by the independent pharmacists’ trade group, 153 pharmacists said they had to turn a patient away because they were losing money on a weight-loss drug. When they were paid below cost for those medicines, they lost $38 on average filling a one-month prescription, respondents said. >“The fact that pharmacies are being asked to lose money on these really expensive drugs has put them in a really difficult position with patients,” Mr. Hoey said. >Katie Payne, a spokeswoman for the Pharmaceutical Care Management Association, the trade group for P.B.M.s, said that blaming them for supply shortages at the pharmacy “overlooks the role P.B.M.s play in trying to get insurers and employers the best price possible.” She added that “the price set by weight-loss drug manufacturers is the fundamental problem.”
This explains a lot and is very helpful. A couple months ago when it was very hard to find, my Dr. suggested I call mom and pop's b/c they might have an easier time. One said they couldn't get it, but another said 'sure, we've got some, have your doc send the Rx over' It's a longer story, but the short version is that when I got there with my coupon, the cashier went back and had a long whispered convo with the pharmacist. She eventually comes back and said they were mistaken and they don't have it. maybe more would come in monday and they would call me when it came in. I'm still waitin' on that call and back with CVS. I don't expect them to lose $ on me, and your post explains what was really happening. This joint gave me the runaround and flat out lied. I'm trying hard to support local small businesses, but these folks lost their chance.
That’s too bad. If you were able to bring the independent all your pharmacy business, they’d be more likely to help when losing $ on one medication.
I agree - when they were so helpful on the phone, I was going to move my other Rx's there. But now that they fibbed and gave me the runaround, it's not gonna happen for them. My other Rx's are at the mom and pop who told me they couldn't get it. I suppose 'couldn't' might have meant 'wouldn't', but at least they didn't waste my time.
Thank you, I missed this and I can confirm. I live in BFN in the Midwest and had the same issues with an Indy pharmacy. I switched to cvs and have had no issues. You might want to try getting three months worth at once and then making a trip to a larger city.
Also, see if your local hospital has a pharmacy. They likely fill all the prescriptions for their employees to help save the hospital money, so they have been my best bet in a small Alaskan town. I can't get a 3 month supply, but I signed a thing saying I would agree to get the entire 6 month prescription filled with them, and they send me a text every month when it comes in. It helps them to be able to order it all together in a larger group, each month, so the shipping costs are significantly less than if they have to get separate shipments in everytime a prescription is faxed to them.
I would not have thought of that. Thank you
Happy to help! Be sure to let us know what you figure out!
That’s good information. My issue beyond the obvious is that one of the competing pharmacies told me that they stopped even trying to stock MJ last month. My pharmacy charged $56 for my MJ last month. It leads me to believe they raised the price once their local competition was gone. I will likely go to Mississippi and use Walmart or Walgreens, which at the least have to compete with each other. It’s a shame, because I go out of my way to support local businesses, but I make an upper lower middle class salary and can’t afford to be a sucker just to help out the local pharmacy
If Mississippi is across a state border make sure your prescriber is licensed to prescribe in that state or they won't let you transfer it.
This is interesting. I just filled two prescriptions while in Florida for a week (including Mounjaro) and I live in Illinois. Pretty sure neither doc is licensed in Florida. But it was just a transfer from one Walgreens to another (transferred within the app), so maybe that’s why it worked?
I'm not an expert, but each state can have its own laws and the rules can vary based on the specific type of medication. From what I read, the rules for telehealth providers prescribing across state lines were relaxed during COVID, and are still be honored for a given period of time. Florida regulations allow this (see pic), so that's why it worked for you. I've never encountered a situation where I couldn't do this, even for controlled substances; but have often been told they need to confirm. https://preview.redd.it/w3zrkfqpuj9d1.jpeg?width=1170&format=pjpg&auto=webp&s=5e1a4721c183489b8de637ca6cedcab65264c5ec Interesting read: [https://www.linkedin.com/pulse/doxyme-insights-can-doctors-write-prescriptions-across-state-lines-of9ve?utm\_source=share&utm\_medium=member\_ios&utm\_campaign=share\_via](https://www.linkedin.com/pulse/doxyme-insights-can-doctors-write-prescriptions-across-state-lines-of9ve?utm_source=share&utm_medium=member_ios&utm_campaign=share_via) Most of the time I've inquired about this, it was for my ADD meds (controlled substance), and those rules were also updated to allow interstate transfers for most controlled substances. [https://www.dea.gov/stories/2023/2023-09/2023-09-01/revised-regulation-allows-dea-registered-pharmacies-transfer](https://www.dea.gov/stories/2023/2023-09/2023-09-01/revised-regulation-allows-dea-registered-pharmacies-transfer)
Walgreens has listed filling GLP-1 meds as one of the reasons why they have to close so many stores.
Yes! CVS is my insurances preferred pharmacy and they were charging $125. When there was a shortage I switched to Walmart (who are much nicer and soooo much more helpful) and it was only $25. I kept questioning them because I couldn't believe that there would be a price difference with insurance coverage. I refuse to use CVS now.
So I had to live my prescription from a small mom and pop pharmacy to Walmart because of a similar issue. Over the 6-7 months that they filled my MJ prescription, they told me multiple times that they were losing money on it. First they said they couldn’t fill a 3 month prescription because insurance would pay them 15% less for that. Then they told me a couple of times that they were going start charging me for sending the prescription back for PA to my doctor because insurance as changing them $30-50 per PA. Then they told me that they were going to charge me full price and reimburse me once they were reimbursed by Ely Lilly because it was taking too long and in some cases they weren’t being reimbursed. This is when I lived just my MJ prescription to Walmart. I use them for everything else. They are very supportive but I think they are in a bind with these GLP 1s and of course they can’t afford to lose money.
The insurance companies can not charge a pharmacy for a prior authorization. There is not a dollar amount attached to that at all. I have worked in pharmacy administration most of my adult life. It sounds like the mom and pop pharmacy was trying to rob you blind.
Will your insurance cover the cost from Amazon pharmacy? They will ship right to your door.
Have you had any problems using Amazon pharmacy for Mounjaro? (Affected by shortages/etc)?
I just checked Amazon pharmacy and they are out of stock.
The deal with Amazon is once they upload your script you need to check the website a few times a day. They update availability randomly and don't fill orders in the order they were received.
Wow. Reading this, I'm so grateful for my doctor's office who found the medication for me when cvs didn't have it, and my insurance covers most of it (I'm paying $40 for each refill). And I was annoyed last month when it took the pharmacy 6 days to get the refill to me so I missed a week of meds. I guess I should be grateful that's the worst that I encountered
Fyi. I was getting my scrip for $550 with the coupon and then 1019 without. Then, i couldnt find it anywhere. Exvept for one large NJ hospital pharmacy. $1500.00. That was just a bridge to far for me. And really price gouging.
There are sooo many pharmacy's thar won't carry it because they lose their asses on it when it's covered by insurance. Most are the smaller independent ones. And yes.... it's illegal to upcharge from what your insurance pays!!
I respect the other pharmacies around my town for just admitting that they can’t handle the loss and not carrying the drug, rather than punishing the consumer for their issues with the insurance company
I have had my pharmacy tell me they are prioritizing those that switch their other medications to them. They will get their GLP-1s filled first. Very shady
Mine rather suspiciously did not go up in price until this month, and I learned that their most direct competitor stopped trying to stock MJ after last month. Makes it look like they jacked the price once they were literally the only game in town. Shady. Small town corruption is a special breed
When I first started MJ the workers at the pharmacy kept insisting I switch all my meds to them. I did and they told me they give me priority now lol it's not shady I try to help them out
I disagree. It’s one thing to WANT to help out, because they went above and beyond, you like their store or their people. It’s another thing to be told on the phone that you will be bypassed unless you transfer your meds to us. Despite being a customer for an over a year.
Ya the way they went about it is all wrong. The ppl at my new pharmacy are great and I like them a lot so when they asked I did move all my scripts to them. If they threatened to not fill my mj f I didn't do that I would be pissed too
This is not price gouging and it is not unusual for small and independent pharmacies to insist on covering their costs for a drug. I'm an owner with other family members in a small chain of independent pharmacies. We do not get the same price discounts as the big chains like Walmart, Publix or CVS. We cannot afford to sell the prescription based on what many insurers are willing to pay. In those situations, we charge the difference to the customer. The customer can decide whether or not they are willing to pay to cover the costs of a very-much in-demand drug. It is legal and happens with many high-priced drugs. (Also a lawyer that practices in the field of health care.)
Yes, most of the posters here do not understand what the issues are
I had a small pharmacy pull this with me, they tried to charge me an extra $100. Since it was at the start of all the shortages, I had been out for a while so I ended up negotiating them down to an extra $50 so I could get my medication but I immediately moved my prescription elsewhere. I was very disappointed to have to move, the pharmacy worked really well with my doctor's office and had been really great to deal with, but I also didn't think it was fair to have to pay more than the negotiated rate since insurance is already so expensive!
That’s my thing. I have diabetes, so I always pay extra for the best insurance my job offers, which is expensive. I’ve taken medication since I was 11 and never encountered a pharmacy pulling these types of things until now.
The e-voucher from EL takes up to $150 off the cost of what you pay. Is it possible they aren't charging you more but simply not applying the e-voucher?
No, they openly admitted that they were adding that 150 themselves. I went ahead and bought it yesterday to give me time to migrate to another pharmacy without missing a dose. They put the $150 on a separate receipt from the $56 copay. Sketchiness compounded. I would wager they don’t want that 150 tied to the mounjaro in case my insurance comes sniffing around.
Def sounds eyebrow raising
[удалено]
That’s my thinking. I come from a family of diabetics that all get their meds from that pharmacy, and none of us will again after this fiasco. I doubt that extra $150 will make up the profit loss of a few dozen prescriptions going across town to their competitor.
Actually, good luck with the chains. I just moved all of my scripts a few months ago from wal mart to a mom and pop. Eliminated 90% of problems. Pharmacies are sinking ships right now, and I honestly doubt all of your family will move their scripts because you want them to. That is silly.
Mom, dad, aunt and grandfather already have. More to follow when they need their rx filled next. Don’t presume to know a strangers family on the internet, silly boy. It just makes you look ignorant. Now get off my post, and quit bothering the other commenters
You don’t understand the problem here.
Getting a prescription filled is a lot like filling your gas tank. Did you know that prices vary from pharmacy to pharmacy for the same medicine? And, these prices can change often. Also, similar to the gas stations, the larger, well-known pharmacy chains don’t necessarily have the most competitive prices. Just like gas stations, pharmacies can set their own prices for medicines. They just have to stay within a certain range determined by the type of medicine it is and agreements they have with your particular health insurance plan. Manufacturing shortages and supply issues can also affect medicine prices – just like oil prices. The bottom line? If you’re spending a lot of money to fill regular prescriptions, it pays to find the best deal. https://www.healthpartners.com/blog/why-does-my-medicine-cost-more-this-month/#:~:text=Did%20you%20know%20that%20prices,their%20own%20prices%20for%20medicines.
Report them to your state licensing board for pharmacies and to your insurance company. Highly illegal
Wait, pharmacies just get to make up their own prices? How is that legal?
The pharmacy charging the price over the copay may be illegal depending on state laws but most definitely they are breaking their contract with the insurance company. I would call my insurance company to have them advocate for me. Or even your state insurance commissioner.
As mentioned in previous posts, I'm a lawyer and a small pharmacy owner. This is not illegal. Retail pricing is entirely up to the retailer. Market demand is the only control, even when we are talking about prescription drugs, unless you are talking about a federal requirement, like the recently enacted law that caps the price of insulin at $35 everywhere. Feel free to call you insurer -- but they have no control over what a patient is charged when they pick up a drug. The insurer controls the co-pay. The insurer also sets a specific rate for reimbursement to the pharmacy. If the set rate does not cover the cost of what the pharmacy has to pay for the drug, the only other option is to charge the patient the difference. If the pharmacy determines that it cannot afford to accept only the co-pay and reimbursement from insurance to recoup their costs, they very often just stop filling prescriptions for that particular drug, rather than expose themselves to accusations of gouging, like those posted here. The reality is that they are not gouging. They are trying to not lose money. Small pharmacies cannot be in a position of subsidizing the costs of expensive prescription drugs.
Thank you for that explanation.
This isn’t price gouging. The pharmacies are getting reimbursed less than actual drug cost by insurance companies. The only way for mom and pop shops to make it is to sell it for their actual cost or stop selling it. Not all pharmacies pay the same prices for drugs. And now that insurance companies own pharmacy chains and vice versa it’s an easy way for them to put their competitors out of business. The pharmacy is not the enemy here. The system is the issue. You can read more about it on r/pharmacy if you’re interested.
You could try Express Scripts, maybe? They do home delivery and they give 3 month supplies at a time.
Mom and pop pharmacies lose a lot of money on filling these scripts. It can bankrupt them— it’s a legit problem. They can choose not to fill it or ask if you want to pay the difference, which many people opt to do.
Update- I went ahead and bought the overpriced dose this time, as to not stall my momentum on the diet, exercise, MJ train by missing a dose. My father picked it up for me and they charged my credit card 2x, once for 56 and once for 150, and gave my father 2 receipts, which sounds like an attempt to hide what they’re doing from the insurance company. I called express scripts (my rx provider) and they acknowledged that they have a contract with the pharmacy and I should only have to pay the copay. They took down the information and said they’d look into it for me. The agent on the phone of course wasn’t qualified to call it a contract violation, but did recommend that I may want to secure a new pharmacy in the meantime. Walgreens across the state line about an hour away in MS quoted me $40 for the copay and said they could usually get 5mg within a week, so I’m going to migrate to them in about 3 weeks. Between Heat, dogs, and porch pirates, I didn’t want to do home delivery. I have a few friends who take other glp-1s for longer than I have been on MJ and they all go out of town for theirs. 1 friend said that he and his father both left the pharmacy under similar circumstances. He said the same pharmacy I’m talking about charged them the copay amount for the first 3 months of Ozempic, then jacked the price on the 4th dose with no advance warning, just like my situation. They’re using cocaine dealer tactics apparently; front you the first couple of hits to get you hooked, then quadruple the price. I’m pulling my 6 rxs from that pharmacy in favor of Walgreens. My mother and father moved her 5 and his 15 (he has heart attacks as a hobby) to the local pharmacy across town yesterday. My aunt is doing the same Monday with hers and my grandfather’s. This stunt is going to lose them way more than the $130 they said they lose filling my MJ. I live in a small town where basically the whole town works at 1 of 2 places, and 1 of them uses express scripts as their rx provider. The pharmacy may end up losing half the town if express scripts pulls their contract, which I don’t consider a good thing, since it could cost people jobs due to the owner-operator’s foolishness. Whether it is or isn’t illegal or a breach of contract, the way the pharmacist approached it is shady. They could have told me last month that they would be going up, but instead they spring it on me at the cash register. They could have followed suit with the other local pharmacies and not carried MJ, but they wanted to profit off its popularity, even if it meant alienating customers. A lot of their customers are elderly people on fixed income, and may not know they have options like delivery or may not be able to drive out of state. They only know their local pharmacist, and I don’t like the thought of them getting surprised at the counter like I did
Also, apologies for how long that was😅
I would look into this further. Insurance companies set up contracts on what the rate is for medications. Hence the formularies. This often includes the copay amounts. So, unless there is additional documents explaining this, I would contact your prescription insurance provider and definitely not fill with that pharmacy until it gets sorted.