FC2 has the flu. She was prescribed Tamiflu which has a generic (Oseltamivir) available.
We dutifully filled the prescription for $71.11 an hour ago at our local CVS, the preferred pharmacy of my insurance company/employer. I believe the technical term for the preferred pharmacy/manager is the Pharmacy Benefit Manager (link).
Since we were using a generics at preferred pharmacy, I assumed that I was making the optimal decision.
In making the above assumption, it turns out I made an ass out of myself. A simple google query took me to this beautiful website: GoodRx.com, which offered the same drug for $39.99. They have an app if you prefer those to websites (though it seems that “apps” are the same thing as websites viewed on a phone).
Because I assumed, I overpaid by 78% (=71.11/39.99-1) at the same damn pharmacy!!!!.
On the surface, the GoodRx website seemed too-good-to-be-true. However, my litmus test for pretty much anything in life is whether the Bogleheads approve. 2 minutes on the forum convinced me that the Bogleheads overwhelmingly approve: https://www.google.com/search?sitesearch=bogleheads.org&q=goodrx.
The only remaining question is whether using GoodRx would preclude the prescription going towards my deductible. If the GoodRx expense counts towards the deductible, it’s an absolute no-brianer to use them. If not, then it becomes an interesting math problem (see nerd-fest section below). It seems the Bogleheads had mixed experiences on this one, so a call to your PBM would probably resolve that uncertainty.
While I haven’t used them before, GoodRx seems like a pretty incredible deal. Since the Bogleheads have vouched for them, I’m 99.9% sure it’s legit. I’m amazed/embarrased that I hadn’t heard of it before and will likely use them over my existing insurance going forward (with caveats explained in the nerd-fest analysis below).
It’ll be most valuable for those of us with high deductible health plans, particularly if you’re not expecting to hit the deductible/out of pocket max. If you’re planning on blowing through your deductible/OOP max, then the savings are moot since the marginal cost of healthcare is small past your deductible (20% in my case) or 0% past your out of pocket (OOP) max.
Thanks to Rob’s suggestion in the comments, I called up CVS and they said I could stop by for a refund. So I did. I am now a happy GoodRx customer. The only remaining uncertainty is whether it’ll count towards the deductible/OOP max. It’ll probably take a few weeks for the dust to settle to learn how my PBM (CVS) handles this.
It looks like my online CVS Caremark account has updated the price from $71.11 to $39.99, so it appears to me that I got the best of both worlds: better price and it counts towards deductible.
Upon further inspection, the CVS Caremark account indicates that $0 went towards my deductible. In the event that I hit my deductible this year, having used GoodRx will turn out to be less than ideal. In the event that I don’t hit my deductible, GoodRx will have saved us some decent money.
Assuming someone made it to this point in the article, I have a couple of questions for anyone who has used GoodRx. 1.) How was your experience? 2.) How large has been the cost savings? 3.) Did your GoodRx payments count towards your deductible (and is the answer to this dependent on where you fill the prescription)?
Nerd-Fest Probabilistic Analysis Computing the Magnitude of my “Mistake”
I did the following for my own benefit to help in my future decision making. It will be of zero interest to 99.9% of you.
The below attempts to answer the magnitude of today’s “mistake”. It’s a fun problem to think through because so much depends on the underlying assumptions. I’m fascianted by healthcare economics because 1.) it’s a fascianting math problem, 2.) healthcare constitutes a huge fraction of the typical family’s budget, 3.) the financial magnitude of optimal vs poor decisions are quite large, and 4.) it’s fascianting to see how different assumptions influence the “right” answer under uncertainty.
In the event that the GoodRx payment goes towards my deductible:
- If we don’t hit my deductible this year (which is my probably-unrealistic goal), I’ll bear the full $31 (=$71-$40) financial burden of my mistake.
- If we hit our deductible but not our out of pocket (OOP) max, this mistake will end up costing me 20%(my coinsurance after deductible)*$31 overpayment=$6.20.
- If we blow through OOP max, this mistake will cost me $0.
In the event that the GoodRx payment does not go towards my deductible:
- First bullet point above is unchanged
- If we hit our deductible but not our out of pocket (OOP) max, this mistake will end up costing me $71*20%(my coinsurance after deductible)-$40 = negative $26, meaning I’m $26 better off in this scenario! Why? Because 20% of $71 << 100% of $40.
- If we blow through OOP max, this mistake will benefit me by $40 (=$71*0%*(zero financial burden after hitting oop max) – $40 = negative $40). 0% of $71 <<< 100% of $40.
The true cost of my “mistake” is computed as:
Probability of this payment counting towards deductible * ($31*prob of not hitting deductible + $6*prob of hitting deductible but not OOP max + $0*prob of exceeding OOP max)
Probability of this payment not counting towards deductible * ($31*prob of not hitting deductible – $26*prob of hitting deductible but not OOP max – $40*prob of exceeding OOP max)
Which simplifies to:
$31*prob of not hitting deductible + $6*(prob of hitting deductible but not OOP max*prob of payment counting towards deductible) – $26*(prob of hitting deductible but not OOP max*prob of payment not counting towards deductible) – $40*prob of exceeding OOP max * prob of this payment not counting towards deductible
- I have a 50% chance of not reaching deductible
- A 5% chance of hitting deductible but not OOP max
- A 45% chance of hitting OOP max
- A 50% chance the expense would count towards deducible
Plugging in the paramaters above
Total expected cost of my “mistake” = $31*50%+$6*5%*50%-$26*5%*50%-$40*50% = NEGATIVE $5, meaning my “mistake” today makes me $5 better off, on average. Woot.
However, if I change the parameters to:
- I have a 80% chance of not reaching deductible
- A 5% chance of hitting deductible but not OOP max
- A 15% chance of hitting OOP max
- A 90% chance the expense would count towards deducible
Total expected cost of my “mistake” = $31*80%+$6*5%*90%-$26*5%*10%-$40*10% = $20.94, meaning the mistake is going to cost me $20.94, on average. Bummer.
Given that my family of 7 consumes healthcare like drinking water, perhaps the “decision” I unknowingly made today will turn out to inconsequential since there is a decent chance we’ll blow past our deductible/OOP max again this year. Nonetheless, if I could rewind the clock a couple of hours, I probably would have paid with GoodRx and hoped that the payment counted towards the deductible.
38 thoughts on “Prescription Rant”
Nothing but good experiences with GoodRx. Nothing but bad experiences with my Medicare Part D (Rx) insurance companies. It’s worth a try to go back to CVS and tell them you used the wrong payment method. They may undo your transaction and let you use GoodRx as your payment. I made the same mistake at Costco and they would have made good on the GoodRx price if I had gone back soon enough.
Thanks so much for the feedback!!!!
Just got back from CVS, $31 richer (depending on probability, that is). Thanks again for the help!!!!
Here’s a bonus comment which doesn’t answer your above questions, but provides information that may come in handy later…
We had to fill an ophthalmic prescription for our golden retriever. The Vet told us it would need to be filled at our pharmacy.
So we went to CVS and provided the “patient” name (our dog).
Pharmacist: “Has Carly filled a scrip here before?”
Ah, not to my knowledge.
And our dog is not on our family’s high deductible health plan, thus no prescription benefits.
The pharmacist quoted ~ $55 retail for eye drops for the pooch. He was kind to quote it before filling.
I asked that he hold off.
I stepped back from the counter, texted my better half who quickly found the prescription eye drop price in GoodRx, and texted the GoodRx e-coupon back to me. After the pharmacist helped the next human in line, I stepped up again with the GoodRx scrip on my phone, handed my phone to him and asked that he fill it for our four-legged patient.
GoodRx price: $13.26.
I hit that bid.
Given our lack of health insurance for the dog, you don’t have to go through the probability cost gymnastics on this one…
Great advice on the pet meds! I really appreciate it!
For our OC (only child), we have had great luck going to the pharm company website to get coupons for her ADHD meds, which are out-of-this-world expensive because she can’t/won’t swallow pills. She is currently on a patch that would normally cost $120/month but the pharm. company offers a 1 year only coupon that allows us to get it for $20/month. Because we don’t use the patch on weekends and during the summer, that ‘year’ will last us longer so by the time the coupon runs out, hopefully she will be swallowing pills. Same dealio when she was first diagnosed at 6YO and we had to use a liquid. The couple cut the price in half.
One of our kids was just diagnosed with ADHD as well. She’s on meds that are working but I’m unsure of the cost b/c we got them “free” at the end of last year. Thanks to your note, I’ll double check the manufacturer’s website for coupons before filling the next prescription.
4/7 of us have athsma, which is quite the financial obligation. Luckily, we’d already discovered manufacturer coupons for some of the athsma meds that has halped consideraby.
I found GoodRx a few years ago. Went to fill a prescription at Wal-Mart for my youngest (an antibiotic cream). First they quoted $90, got there it was $210 (with insurance!). I complained, the pharmacist told me if the doctor ordered an “ointment” it was about 1/3 the price. I asked what is the difference, and he said nothing but what the doctor wrote! At about that point the cashier asked me if I had checked GoodRx. Asked her “what is that”, so she takes out her phone and says “you rich people don’t know how to do anything” – but then pulled up the app and it was $60. The woman behind me, says “here, use mine”. We have a High Deductible plan and max out the HSA, we never hit the deductible, so I don’t even bother to file.
Thanks for another datapoint Dean. I’m amazed I’d never heard of it before!
Thanks for the tip as I have never heard of this service. It would be nice if Bogleheads made a wiki or had a thread that collected all of these money saving websites.
Happy to help. I think the forum is dedicated towards saving money, so I’m not sure how they’d implement what you’re proposing. But I agree that I shouldn’t have found out about this by accident.
I have a ton of patients who use it and it’s great. (I’m a family doctor)My understanding is that if the pharmacy runs it through goodrx, it will not count toward your deductible, but you could always test it out on a less consequential prescription or ask the pharmacist when you run it (who may or may not know.
When I saw your article I thought your rant was going to be about how poorly effective tamiflu is compared to its cost… It shaves off about 12 hrs off of the illness in most studies, but it is probably worth giving if someone is very young or old, or if they look really sick or are hospitalized, and it’s not very useful if symptoms have been present for over 48 hrs.
Thanks for the feedback! Glad to hear that it’s Dr approved. After the first botched attempt at CVS, I was able to get the $71 refunded and replaced with the $40 charge. I’m curious to see whether I can apply this to the deductible.
Thanks for the advie on Tamiflu. I think we caught it within 48hrs, but it’s too bad it’ll only help cut 12 hrs off of the illness. I suppose $40 to alleviate 12 hours of misery is a decent value proposition.
Hope your family is doing well! I think we’ll be driving pas you on 84 in the not-too-distant future. It’d be fun to meet up.
Worth a shot if you do not mind the time.
I called CVS Caremark and they confirmed the following: If I want the drugs to count towards my deductible, I need to pay nearly double the price. It was an infuriating phone call. Apparently there is no other recourse.
We’ve been loyal GoodRx users since leaving our employer sponsored health plans a few years back. They have discounts on flu shots too, and we keep the receipts for the HSA.
Glad to hear. I guess I was definitely “out of the loop” on this one!
We’ve used a Good Rx coupon at Target pharmacy without a problem for a one time prescription instead of our CVS/Caremark plan. In another case, just days ago, we found out our CVS/Caremark plan charged over $67 for three allergy drugs, while it was $5 at Walmart. Turns out that in our CVS/Caremark plan, that WALMART,not CVS, is the preferred pharmacy. I find that humorous!
That is infuriating.
Given that your insurance is through CVS/Caremark, like me, have you had any success applying these GoodRx expenditures towards your deductible? I only tried once via the phone but customer service was very unhelpful.
We use so few pharmacy items, getting to the deductible threshold is highly unlikely unless there was a catastrophe.
Sounds reasonable. I’m envious of your situation. With 7 of us, it seems that if two of us sneeze in a year we hit our OOP max.
Oh, I’m sure you have 5 excellent reasons that are not “deductible.” 🙂 Just think Professor if you were required to pay for public education on a “per head” basis vs “per house” basis. Meanwhile, some of us are paying for public education with no student(s) to show for it. So, um, no need for envy now, huh? I’ll just consider it a charity that I can’t deduct. 😉
GoodRX is a great deal. The price differences can be quite extreme. I have a medication that costs $560 for a 90 day supply from my insurer that I can get through GoodRX for $160. I do not get credit towards my deductible, but the difference in price is so huge that it probably makes the risk worthwhile.
The other thing to look into is coupons/discounts directly from the drug manufacturer. My son has a nut allergy and needed three $1000 shots used in desensitization. After some research, my wife found that the company had an assistance program that gave us those shots for free.
Bottom line: the healthcare system is incredibly convoluted and non-transparent. This is one of the big contributors to high cost of healthcare in this country. Some research goes a long way if you want to get the best value for money. Huge savings can be found when comparing prices of X-Rays at hospitals vs. imaging centers, for example.
Thansk for sharing your experience. $160 vs $560 is quite the price differential!
I really had no idea how pervasive this drug pricing problem was….
See the following article:
Thanks for sending! I loved the article. I guess it’s not surprising because it is written by a logical economist. I agree that the skin-in-the-game-but-with-subsidies is the solution to our country’s problems, not a universal zero-skin-in-the-game “medicare for all”.
The problem remains though, what if you are in a severe natural disaster, car-wreck, etc., and you wind up in the ICU with a 6-7 figure bill. Most other societies have public coverage that provides for preventative care (which is cost-efficient) as well as astronomical care. Maybe we should adopt something like that? The problem remains we started down a different road and it’s frequently harder to ask for permission than forgiveness….
I’m not understanding your point. 6-7 figure bills are routinely covered by insurance companies, right? Or are you implying that at this level of expenses people hit their lifetime coverage limits and are dropped by their insurers? In this case, I agree that it’s indeed problematic and I don’t have any answers for you.
Insurance covers you, but you will likely hit your annual cap, which many people can’t afford. Or what if you have no coverage? I used to practice in a state at the county health system where the most common insurance was none. There’s also the horrible situation where you are involved in an accident, wind up in an ICU and they took you to an out-of-network hospital (because it was closest or the trauma center). Anyhow, there are a myriad of situations where people can wind up with medical bankruptcy.
Costco pharmacy has a lower price for members, and their prices are already pretty good. Also, Kroger and their brand of stores offers an Rx Savings Plan for families at $72/year (up to 6). The savings are pretty good, but I’d compare what you usually take to GoodRx. Also, physicians don’t always know the price of things, and sometimes if you ask for a less expensive substitute you can get it too.
I have started asking patients to just use GoodRx instead of their plan, because it’s frequently around the rate they would get after I’m forced to spend hours of time fighting their insurance company for why they need the prescription. I frequently wonder if premiums could be lowered if PBMs were just replaced with GoodRx.
I’m really happy to hear that you consider economics in helping patients. Good on you. We need more docs like you!
With respect to GoodRx as a PBM replacement, I think this is brilliant.
I love that you thought through this to the point where you see how this decision may interact with your insurance benefits. I have to ask, how much is your max out-of-pocket and deductible? : )
Premiums = $1,620
Deductible = $5,400
Co-insurance = 20%
Stop Loss (in excess of deductible) = $1,700
OOP Max (ignores premims) = $7,100
OOP Max (includes premiums) = $8,720
For me, the co-insurance region is basically non-existent. I’m either on-my own or hitting my OOP max.
I’m still double and triple guessing my decision to use GoodRx. It’s all a function of whether we hit our deductible or not this year. Given that we’re 4/52 through 2020, it’s hard to forecast with any degree of certainty. We hit our OOP max the last two years due to multiple surgeries. No surgeries are currently scheduled, but we still have large recurring expenses (athsma meds, allergy shots, and perhaps some counselling). It’s a really difficult math problem, which is fun, but the uncertainty is frustrating.
Thanks for sharing, your attention to detail got this nominated for the first edition of “Max’s Back Pocket”. I hope the traffic doesn’t shut down your site. ; )
I have you beat by about $500 on the Max Out of Pocket, but I pay way more for premiums.
There are some negatives to GoodRx (and any Rx Discount card)…most notably your privacy. They are marketing firms, and sell your data (including drug) for their profit. Don’t think that any of these companies are doing things out of the goodness of their heart. Discount cards set the prices extremely low and then charge the pharmacy a significant fee for the privilege to process them.
Don’t get me started on how PBMs are taking advantage of everyone (patients, pharmacies, manufacturers, payers) in the healthcare business…
Off my soapbox from the other side of the Rx Counter…
It’s great to hear the perspective from someone on the other side of the counter!
I read an article the other day about GoodRx that brought up this exact issue you mentioned.
I guess I’m just accepting the fact that we’re living in an era of zero privacy.