Healthcare Economics

Honesty 1.01 | Always Ask, “What’s the Ca$h Price?”

ScriptSave WellRx - Ask the Cash Price image

Always ask, “What’s the Ca$h Price?”
Always show your ScriptSave WellRx card

The ScriptSave® WellRx Facebook page sees a lot of interaction…and we love getting questions. By far the most common questions and comments we get from the public are those related to insurance.

  • “Can I use ScriptSave WellRx with my insurance?”
  • “How does it work if it’s not insurance?”
  • “I have insurance, so your card isn’t for me.”

For the record, not only is that last one a misconception among consumers, it’s also a fast-track to over-paying for your meds (and it’s the starting point for this blog post).

Here’s our “Honesty 1.01” post, on what to expect from ScriptSave WellRx and how to stretch your family’s prescription dollars.

  • Not Insurance
    ScriptSave WellRx is NOT INSURANCE. The discounts we’ve negotiated are off the cash prices for your medications. The prices you see in our free online prescription price look-up tool reflect the savings relative to what you would pay if you walk into the pharmacy as a patient with no insurance or other assistance.

So why is it so important to know the cash price? Furthermore, why is it ESPECIALLY IMPORTANT for those with insurance? The answer lies in an article everyone should read, published by Bloomberg News on Feb 24, 2017[1], and titled, “You’re Overpaying for Drugs and Your Pharmacist Can’t Tell You.”

The Bloomberg article highlights how, “Gag clauses stop pharmacists from pointing out a cheaper way” (and, yes, ScriptSave WellRx is one of those CHEAPER WAYS).

“[because of contractual constraints] Eric Pusey has to bite his tongue when customers at his pharmacy cough up co-payments far higher than the cost of their low-cost generic drugs, thinking their insurance is getting them a good deal,” states the article’s author.

Copays that look more like ‘You-Pays’

Pharmacy Benefit Managers (PBMs) and insurance companies use so-called “clawbacks” to generate additional revenue. “Clawbacks” are when PBMs tell local pharmacies to still enforce & collect the patient’s stipulated copay even when it is more than the cost of the actual medication being dispensed. To be clear, when this happens, the additional revenues that are created are not kept by the pharmacy – they are “clawed back” by the PBM

Clawbacks work like this, for example: the cost of a drug is $3.15, plus the pharmacist’s fee (his profit) of $5.83. This brings the total cash price to $8.98. However, owing to the contractual constraints placed on the pharmacy as a condition for being included in the insurer’s network of pharmacies, the pharmacist has to charge whatever copay is stated in the patient’s insurance policy; let’s say it’s a $20 copay for all covered Tier 1 drugs. So, what happens to the remaining $11.02 (the difference between what the pharmacist earns in profit and what the patient pays in copay)? Well, it is taken by the insurance company’s pharmacy benefit manager. In other words, regardless of whether the patient pays the lower cash price or the higher copay, the pharmacy still only makes the same $5.83 in fees. In theory, the pharmacist is no better or worse off regardless of whether the patient pays $8.98 or $20…but he is contractually prohibited from alerting the patient to the concept of paying cash, because he is obligated to always charge the stated copay.

These so-called copays might be better renamed, “You-Pays.” There is no shared (or co-) payment at all. In fact, the insurer picks up zero-percent of the tab on this transaction. Instead, the patient not only pays 100% of the medication cost ($3.15) and 100% of the pharmacist’s fee ($5.83), but the patient also pays an additional “You-Pay” fee of $11.02 to the insurer’s pharmacy benefit manager.

This is why knowing the prescription Cash Price is vital! ScriptSave WellRx - How Clawbacks Work image

The moral of the story is to always ask, “WHAT IS THE CASH PRICE?” and always SHOW YOUR SCRIPTSAVE WELLRX CARD. And, if you are fortunate enough to have insurance, be sure to only pay the copays, not the You-Pays!

Not only is the ScriptSave WellRx program free to all members, there’s also no cost to the patient if she or he asks for a quick price-comparison. However, you have to know how and what to ask. Our closing points, below, will wrap up our Honesty 1.01. Once you understand these points, you’ll be armed against spending unnecessary extra money at the pharmacy counter. Become a member today to get the best deals on your prescription medications..

  • Combining Discounts
    • Patients can’t combine discounts. Although that might be disappointing, it does keep things simple. Find out what your final out-of-pocket cost is with any other assistance/insurance program you have…then compare that to the ScriptSave WellRx price. Select the option that makes most sense to you & your family. HINT: our online pricing tool will help you determine the out-of-pocket cost under our program (but you can also ask the pharmacist).
  • What to Ask For
    • When you greet the pharmacist, hand over your ScriptSave WellRx card and ask, “Could you please price my prescription using the processing details on this discount card? …and, if you have insurance, also add, “…and please compare that to my insurance copay.”
  • Pharmacy Resistance
    • The pharmacies that are featured in our online pricing tool have contracted with us to accept the ScriptSave WellRx card. There are over 62,000 of them, and they process a LOT of scripts every day. They see a lot of different assistance programs and not all of these programs are created equal. Many are not at all “pharmacy friendly” or easy to work with. That being the case, there will be times when a pharmacist might not recognize your ScriptSave WellRx card. If you experience difficulty, we have a toll-free number 1-800-407-8156. Feel free to make use of it. Better yet, ask the pharmacist to call us (there’s actually a special dedicated toll-free number specifically for questions from the pharmacy).

Whether you’re benefit disadvantaged or not, you owe it to yourself and your family to be a savvy ScriptSaver and learn how to save money on prescriptions. Ask for the prescription cash price with your ScriptSave WellRx card next time you fill or re-fill, and avoid the “You-Pays.”

 

————–Addendum (17 Oct, 2017)————–

If we’d known that Lester Holt would end up reporting on this very same phenomenon on NBC Nightly News[2], we might have just waited so that we could let them summarize things for everyone. Oh well, it’s good to know that others in the media have picked up this story (great minds think alike). Check out what Lester and the NBC news team have to say…

 

Reference:

[1] https://www.bloomberg.com/news/articles/2017-02-24/sworn-to-secrecy-drugstores-stay-silent-as-customers-overpay

[2] https://www.nbcnews.com/nightly-news/video/nbc-news-investigation-prescriptions-may-be-cheaper-without-insurance-1074629699698 


For the best Rx price on medications, like
Crestor (rosuvastatin),
Celebrex (celecoxib),
ProAir HFA,

visit
www.WellRx.com.

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