What's the most you paid out of pocket for prescription?

[gingersmom]

Or how much do you think you would pay?

 

I had amazing insurance for 3 years, then Obamacare seriously messed things up.

 

My son has Crohns and is in the midst of a flareup. The doctor prescribed medicine for 2 weeks. Insurance said they would not cover the medicine, cost $1000.

 

Today a new prescription is called in, same thing. Cost $450.

 

I leave message with doctors medical assistant who tells me she got message that I don't want to pay for the prescription (the wrong thing to say to a very stressed out mother)

 

Now I have to call doctors office again and try for the third time. Add to that its not common medicine so it takes additional day to get here (so Wednesday at the earliest)

 

I'm frustrated and feeling like bad mother that I don't fork over $1000. $450 is actually sounding better and better.

 

Ughh. I don't know if I hate insurance companies or drug companies more.

 

Update:post 45

Edited May 24, 2016 by gingersmom

[Arcadia]

My mom paid $400 for the rheumatologist visit and two months worth of prescription drugs for RA without insurance when she visited us and stayed for a few months. She paid cash. That was a few years ago.

[busymotherof4]

Sometimes we have better luck talking to the pharmacy. They can look at the formulary and talk to the dr about a possible change. It is possible to get an insurance company to pay for non-formulary meds but you have to work step by step.

[zoobie]

Tap posted an app in another thread that she recommends for finding cheapest prices without going through insurance. It's called GoodRx.

[gingersmom]

Sometimes we have better luck talking to the pharmacy. They can look at the formulary and talk to the dr about a possible change. It is possible to get an insurance company to pay for non-formulary meds but you have to work step by step.

The problem is time is of the essence. The stupid insurance company would take weeks to decide.

[zimom]

Also look at Costco.  They have great prices on generic meds.  Not sure on non-generics.  I usually pay for my own meds and in the past I have saved several hundred dollars a month for several of my meds at Costco over other pharmacies.  

 

edited to add:  and you don't have to be a member to use their pharmacy.

Edited May 24, 2016 by zimom

[ElizabethB]

I know someone who paid $20,000 over the course of a year...between the insurance and direct subsidy from the company, a fair amount of it eventually got reimbursed. This is a speciality medicine that would often result in death if you do not take it, the company is very good about working with people to make sure it can be afforded. That is at a few thousand per dose, the exact dose varies with body weight and other factors.

[gingersmom]

Tap posted an app in another thread that she recommends for finding cheapest prices without going through insurance. It's called GoodRx.

$900 was the cheapest.

[marbel]

I've had the insurance refuse to pay for something until they get a letter from the doctor saying that the medication is necessary and that either they've tried cheaper alternatives that haven't worked, or there is a reason the cheaper alternatives will not work.  But that can take some time, it's true. 

 

I'm sorry you are having to deal with this.

[bensonduck]

Pinkeye drops. $300. There was some reason why insurance didn't cover it, maybe we hadn't used up the deductible yet. I could not believe how expensive they were for a pretty basic medical issue!

[Guest]

I have quite good health and no prescription drug coverage. Unfortunately the emergency medicine I need is about $800 without any discounts running. Ouch.

 

Thankfully my normal dialog prescriptions are inexpensive and I don't need many of them.

[sbgrace]

Epi pens have gone through the roof. It was nearly $500 when we filled a year ago; I'm sick because we have to fill again this month, and I fear it's even worse.

We have a $6000 deductible that includes prescriptions so we pay 100% of our prescriptions most years. It makes the expensive ones like this hurt.

 

I feel for you. I wish our system wasn't broken.

[Guest]

Tap posted an app in another thread that she recommends for finding cheapest prices without going through insurance. It's called GoodRx.

Yes to the GoodRx app. It is extremely useful for finding the lowest price and oftentimes it isn't at the same store for all the meds you'd consider, or the prices shift back and forth among suppliers.

[Guest]

Epi pens have gone through the roof. It was nearly $500 when we filled a year ago; I'm sick because we have to fill again this month, and I fear it's even worse.

We have a $6000 deductible that includes prescriptions so we pay 100% of our prescriptions most years. It makes the expensive ones like this hurt.

 

I feel for you. I wish our system wasn't broken.

Yeah, that would be the $800 I mentioned. Ouch!

[AK_Mom4]

$750 for an RX. 30 days of a drug. And that was the pharmacy's discounted cash price with some sort of discount card.

 

It was a tough decision but totally worth it. My doctor helped me file an appeal and insurance approved. My cost is is now $25 per month

[Tap]

Check to see if there is a copay assistance card online.  For a med that is that expensive, I assume it is brand name.  A lot of companies have coupon/copay cards on their brand name website.  

 

Google the name of the medicine and go to the brand name website only.  If find your self at a site like "pharmacy coupons R'us" then those are pretty much bogus and don't bother.  Once at the website, then see if there are any links to coupons or patient assistance links. 

 

 

BTW, if your insurance is paid in part or full by federal or state funds, you are not eligible for manufacturer coupons.  ie if you work for the Government or even some universities. 

 

 

[Tap]

Epi pens have gone through the roof. It was nearly $500 when we filled a year ago; I'm sick because we have to fill again this month, and I fear it's even worse.

We have a $6000 deductible that includes prescriptions so we pay 100% of our prescriptions most years. It makes the expensive ones like this hurt.

 

I feel for you. I wish our system wasn't broken.

if you have private insurance, go to the epi pen website and download a coupon.  There are a few people who are not eligible due to their insurance being state/federally funded, but most people are eligible.  

 

It will take off $100 from your copay.

[zimom]

The last few years I have had to hit my deductible before insurance will even begin to consider prescriptions.  The first one this year was $1200, although it is a specialty medication, 4 times a year. 

[Anne in CA]

My MIL pays more than $15k a year when she hits what is called the Medicade doughnut hole. It's very tough on her, her husband has been unable to retire because without her medicine she will die. He must work to pay for it.

[KatieJ]

Check to see if there is a copay assistance card online. For a med that is that expensive, I assume it is brand name. A lot of companies have coupon/copay cards on their brand name website.

 

Google the name of the medicine and go to the brand name website only. If find your self at a site like "pharmacy coupons R'us" then those are pretty much bogus and don't bother. Once at the website, then see if there are any links to coupons or patient assistance links.

 

 

BTW, if your insurance is paid in part or full by federal or state funds, you are not eligible for manufacturer coupons. ie if you work for the Government or even some universities.

Yes try this. My recent hospital stay for Pulmonary Embolisms has resulted in me being on Xeralto . My co pay was supposed to be 80.00 according to the hospital, but Costco later told me it would be 70.00.

The hospital sent a pharmacy patient advocate to our room and she got me signed up for a card and xeralto covers my deductible. I have had to call them several times as my dr messed up,the dosage on the refill and they were very helpful.

Edited May 24, 2016 by KatieinMich

[gingersmom]

Check to see if there is a copay assistance card online. For a med that is that expensive, I assume it is brand name. A lot of companies have coupon/copay cards on their brand name website.

 

Google the name of the medicine and go to the brand name website only. If find your self at a site like "pharmacy coupons R'us" then those are pretty much bogus and don't bother. Once at the website, then see if there are any links to coupons or patient assistance links.

 

 

BTW, if your insurance is paid in part or full by federal or state funds, you are not eligible for manufacturer coupons. ie if you work for the Government or even some universities.

There is a co pay card but it says patient must be 18 or older and he's not.

Edited May 24, 2016 by gingersmom

[TechWife]

The problem is time is of the essence. The stupid insurance company would take weeks to decide.

Pharmacy issues go much faster than other medical issues. Ask the pharmacist if they can work on it for you. Usually the doctors office has to fill out a form, insurance approves and sends it to the pharmacy. Our medications that require an approval have a 48 hour turnaround per the contract. Usually between the doctors office calling and the pharmacy calling with follow ups it moves much faster.

[Alessandra]

There is a co pay card but it says patient must be 18 or older and he's not.

I ran into something like that. My pharmacist helped -- iirc, I registered ds, and the pharmacist ignored the age restriction.. But I was able to get a coupon which worked.

 

Also doctors offices may have a limited number of coupons. I also found that there was a pharmacy in the doctors medical building that had coupons when everyone else had run out.

 

The entire process is super stressful.

 

One thing I have learned to do is get a written prescription, rather than have Doctor call it in to a specific pharmacy.

Edited May 24, 2016 by Alessandra

[Spryte]

From 2005 - 2009 the copay on *one* of my monthly meds alone was $800. That was our portion, after insurance. With the other meds our copays for my 4-5 monthly meds was well over $2000. I don't recall how much it would have been without ins, but we could not have paid. I'd be dead now.

 

The ACA enabled us to get better coverage.

 

Currently, DS's monthly meds, so he can breathe, are $750. Mine are much lower now, and in the $3 - 400s each month. I think. But those aren't copays any longer, now once we meet our deductible, everything is covered 100%.

Edited May 24, 2016 by Spryte

[purplejackmama]

$789 for a compounded powder for a swimmers ear that turned NASTY. The drops were only making the problem worse so we had to switch to a powder.

[Tap]

There is a co pay card but it says patient must be 18 or older and he's not.

if there is an 800-number on the card, call it and ask if there are any options for minors. 

[6packofun]

Check to see if there is a copay assistance card online.  For a med that is that expensive, I assume it is brand name.  A lot of companies have coupon/copay cards on their brand name website.  

 

Google the name of the medicine and go to the brand name website only.  If find your self at a site like "pharmacy coupons R'us" then those are pretty much bogus and don't bother.  Once at the website, then see if there are any links to coupons or patient assistance links. 

 

 

BTW, if your insurance is paid in part or full by federal or state funds, you are not eligible for manufacturer coupons.  ie if you work for the Government or even some universities. 

 

YES.  Dh was prescribed a newer drug to take for one year after having stents put in.  It was $430 per month, I think.  We checked the manufacturer's website and they have a program that makes it NO cost.  We were shocked that was even possible!  If that hadn't been available, the dr. was prepared to write us a prescription for an older, less effective drug because we just can't do over $60/month for any one medication--and that's if there aren't OTHER meds needed by family members!  Ugh.

[redheadmom]

So after my recent pregnancy I had to be on blood thinner injections for 12 weeks. They were $120 a week. Then my dr prescribed a medicine to stabilize my blood levels ( not pregnancy related) and it is $3500 a month. But the insurance refused to cover it and by the time my dr got them to approve it we were using something different. She recently told me about another drug and it is 4k a month but we are holding off on that one too.

 

If you have time for the prescription, a few family members have used health warehouse .com for cheaper prescriptions without insurance

[Laura Corin]

In England it's £8.40, no matter what the medicine concerned.  In Scotland prescriptions are free of charge at the point of need.

[G5052]

Approximately $3000. It was for one week of IV antibiotic bags for home use following a near-fatal infection.

 

Ultimately insurance did cover it, but I went in not knowing if they would or not, and they took their time to reimburse us.

 

When my dad was alive, his out-of-pocket for medication ran $15000-20000/year.

[kiwik]

In England it's £8.40, no matter what the medicine concerned.  In Scotland prescriptions are free of charge at the point of need.

 

In NZ it is $5 per item for approved items.  For suff that isn't approved or if you don't want the generic version (I hate the generic form of Ventolin that is the approved drug) you pay the full market rate so it can vary wildly.  Our Government bulk buys (pretty much) pharmaceuticals and they prefer to only buy one or two versions for most conditions.  Epi pens are not subsidised but a syringe and a vial of the drug is.  I don't know that many parents who can draw a dose out of a vial and inject a child or themselves safely in a crisis though so most people scrimp and scrape to get epipens.

[kewb]

$1500 per week for IV antibiotics.  Paid out of pocket becasue insurance wouldn't cover it.

$110 at the pharamacy for a prescrioption that was cpvered but no generic available.  WIthout insurance it would have been $400.

 

Not really fair to blame ACA.  Even before obamacare prescription meds were all over the place with tier 1 and tier 2 drugs.  They dont want to pay for name brand drugs.I have been taking synthroid since I was 15,  When I started taking it way back when I could get a 3 month supply for one copay of $8.  Then it went up and up,  Then it became that unless I did mail order I could only get a one month supply at the pharmacy.   If I did mail order they would charge me two and half months copays instead of 3.  Big savings.

 

I definitely recommend working with an independent pharmacist instead of a chain like CVS..The independent pharmacist will look for deals for you and be willing to work with you for solutions,  And give you a few days supply on a med you take regularly when you are out and the doc hasn't called back with the refill yet.

 

And I also recommend goodrx.

[Spryte]

$1500 per week for IV antibiotics. Paid out of pocket becasue insurance wouldn't cover it.

$110 at the pharamacy for a prescrioption that was cpvered but no generic available. WIthout insurance it would have been $400.

 

Not really fair to blame ACA. Even before obamacare prescription meds were all over the place with tier 1 and tier 2 drugs. They dont want to pay for name brand drugs.I have been taking synthroid since I was 15, When I started taking it way back when I could get a 3 month supply for one copay of $8. Then it went up and up, Then it became that unless I did mail order I could only get a one month supply at the pharmacy. If I did mail order they would charge me two and half months copays instead of 3. Big savings.

 

I definitely recommend working with an independent pharmacist instead of a chain like CVS..The independent pharmacist will look for deals for you and be willing to work with you for solutions, And give you a few days supply on a med you take regularly when you are out and the doc hasn't called back with the refill yet.

 

And I also recommend goodrx.

Oh! I forgot about IV abx. Yep, that was the highest here, too. About $5000 per month. Insurance covered 3 months, we paid out of pocket for 3 months. And I still needed the $800/month med on top of that. That was pre-ACA.

[madteaparty]

We paid 1200 out of pocket for one dr visit for DH's Lyme disease and also quite a bit for the variety of abx he was put on ( doxy, etc).

My local rural pharmacist says a lot of people in our area don't fill prescriptions. I think it's an obscene state of things but don't get me started.

[73349]

We only paid a couple of hundred dollars as our co-pay for the one for newborn DS IIRC, *BUT* the insurance company forced us to buy it from them to even cover it partially (because they also sell prescriptions) and then raised the price after it had already been used. (We refused to pay more, and they backed down after multiple phone calls.)

 

Robber barons.

[kewb]

Let me rephrase then, the insurance companies used the affordable care act as a convenient scapegoat to raise prices and shift things around.  It is nothing new.  It has been going on for decades.  Businesses are always looking for ways to increase profits.  This is why more and more costs have been pushed onto employees for a decade before there was ACA.  This is why the HMOs were created and the HSAs.  All as a way to help businesses save money, get the consumer/employee to pay for more for the benefit, and cover less at the same time.  It is a crime that people can't get the meds they need because the insurance company gets to decide what is a necessary drug and what isn't.

[Serenade]

Epi pens have gone through the roof. It was nearly $500 when we filled a year ago; I'm sick because we have to fill again this month, and I fear it's even worse.

We have a $6000 deductible that includes prescriptions so we pay 100% of our prescriptions most years. It makes the expensive ones like this hurt.

 

I feel for you. I wish our system wasn't broken.

 

 

I am dreading when we next need to fill an epi-pen subscription.  It's not something you have much of a choice about, either.

[SparklyUnicorn]

Ouch, well I hope they can find something else.  That's crazy.

 

I've been fortunate.  We've only had scripts for very minor things like antibiotics. 

 

 

[Entropymama]

My mom pays $2000/month for her meds. Luckily she has a $12,000 deductible, so for the last half of the year it's free. It's the reason she still works, and will probably never be able to retire. 

[J-rap]

I've used the GoodRX site to save money on prescriptions.  It has saved us some money, although it does mean lots more running around.

 

What we've run into lately is that acne meds are no longer covered by most private insurers if you're over 18.  That means that what used to be virtually free to us, for my dd, now costs us hundreds/month.  It is horrible and I'm planning to write our state reps about it to see if they can help change this.  So, I guess my dd's cystic acne was supposed to magically clear up at age 18.  If she doesn't have the special creams, etc., her acne is so severe that it really takes over, completely out of control, very, very quickly.  With the meds, her skin is flawless.  

 

Grrr!!!

[TechWife]

I've used the GoodRX site to save money on prescriptions.  It has saved us some money, although it does mean lots more running around.

 

What we've run into lately is that acne meds are no longer covered by most private insurers if you're over 18.  That means that what used to be virtually free to us, for my dd, now costs us hundreds/month.  It is horrible and I'm planning to write our state reps about it to see if they can help change this.  So, I guess my dd's cystic acne was supposed to magically clear up at age 18.  If she doesn't have the special creams, etc., her acne is so severe that it really takes over, completely out of control, very, very quickly.  With the meds, her skin is flawless.  

 

Grrr!!!

 

You can appeal this with appropriate documentation of medical necessity from a dermatologist. This rule came about because many acne medications also reduce wrinkles (it started years ago with Retin A). The insurance companies don't want to pay for that, for obvious reasons. 

[J-rap]

You can appeal this with appropriate documentation of medical necessity from a dermatologist. This rule came about because many acne medications also reduce wrinkles (it started years ago with Retin A). The insurance companies don't want to pay for that, for obvious reasons. 

 

Interesting.  I should give that a try then.  Her dermatologist actually personally called them to see if there was anything else she could do (we really appreciated her doing that) so that they would cover it, and they didn't give her any indication that they would change their stance.  On the the other hand, that wasn't an actual appeal so I guess we can try that route first.

[QueenCat]

 

Not really fair to blame ACA.  Even before obamacare prescription meds were all over the place with tier 1 and tier 2 drugs.  They dont want to pay for name brand drugs.I have been taking synthroid since I was 15,  When I started taking it way back when I could get a 3 month supply for one copay of $8.  Then it went up and up,  Then it became that unless I did mail order I could only get a one month supply at the pharmacy.   If I did mail order they would charge me two and half months copays instead of 3.  Big savings.

 

So true, before ACA, our one drug for ds was $4500/month. We paid 20% of that every month, $900. Thankfully, our insurance got better and we only had to pay $50-75. Drug price went down a bit but it costed our insurer well over $3000/month towards the end of ds being on the drug. Thankfully, he doesn't need it anymore.

Edited May 24, 2016 by QueenCat

[gingersmom]

Update:

 

I talked to one drug company and they said medicine was only approved for 18 and over. I explained he was 6 feet and 200 pounds (mini adult :) ) but it is considered off market use and the discount card won't work.

 

A second prescription was called in that I thought was $500. Turns out it was $2800 !!!!

 

They were able to get me generic of prescription #2 which will cost $314 which I will happily pay!!!!!

[Mergath]

I am dreading when we next need to fill an epi-pen subscription.  It's not something you have much of a choice about, either.

 

I'm waiting until mine actually goes bad. From what I've read, as long as the liquid is still clear, it will still be more than 90% effective. 

[Tap]

You can appeal this with appropriate documentation of medical necessity from a dermatologist. This rule came about because many acne medications also reduce wrinkles (it started years ago with Retin A). The insurance companies don't want to pay for that, for obvious reasons. 

Yes, lots of times this is true. If you call the pharmacy benefit line on your card, or log into their website they can tell you if there is an appeal process for you to try.

 

If not, you may ask the pharmacist if there is a cheaper way to get a similar medicine. 

 

Many acne meds are combination ingredients and you can often get the ingredients separately. 

 

If you use Benzaclin or Duac: You may be able to buy over the counter Benzoyl peroxide and then spot treat with clindamyacin.  The ratios may be slightly different but the active ingredients are the same.

If you use Epiduo, it is Adapaline(Differin) and benzoyl peroxide

There are lots of other ones, these are just a few examples

 

Another one that people don't know about... even in generic form RetinA micro is more than twice the price of regular Retin A cream

[TechWife]

Interesting.  I should give that a try then.  Her dermatologist actually personally called them to see if there was anything else she could do (we really appreciated her doing that) so that they would cover it, and they didn't give her any indication that they would change their stance.  On the the other hand, that wasn't an actual appeal so I guess we can try that route first.

 

Yes, there should be a way to appeal in writing. 

 

If the appeal is denied there is usually a review of that decision available as well. 

 

Documentation that is helpful: 

other medications that have been tried and failed to treat the problem

notes on increase in severity of acne when the medication in question is discontinued

notes on effectiveness of medication

 

Th dermatologists' office is probably quite familiar with filling out the forms in question. Unfortunately, they have to do it with some regularity. 

[J-rap]

Yes, there should be a way to appeal in writing. 

 

If the appeal is denied there is usually a review of that decision available as well. 

 

Documentation that is helpful: 

other medications that have been tried and failed to treat the problem

notes on increase in severity of acne when the medication in question is discontinued

notes on effectiveness of medication

 

Th dermatologists' office is probably quite familiar with filling out the forms in question. Unfortunately, they have to do it with some regularity. 

Thank you.  I appreciate your suggesting this.  It hadn't occurred to me to appeal it since her dermatologist had already called them.

[prairiewindmomma]

The most we have paid:

 

Medication administered in an office setting via iv (billed to medical): $6000 (our deductible)--the medicine was $10,000 for one vial of Avastin

Medication billed through our prescription insurance: $600ish for an asthma medication 

 

We have relocated across the country to take a job with good prescription coverage.  The relo saved us about $20K a year that we were otherwise paying in medical.

[kroe1]

It cost me $5000 once to clear up a fungal rash I contracted from a patient. Fortunately for the rest of the world, that same prescription is now generic.

 

We have overseas family members check costs sometimes.