04/04/2025
We encountered an interesting situation yesterday that we wanted to share with everyone. A long-time patient told one of our pharmacists that she switched her inhaler prescription in January to another pharmacy in town to save money. The other pharmacy has a “preferred” contract with her Medicare drug plan, which is supposed to mean that she would have slightly lower copays there. Indeed, when we looked up her plan’s copay structure, we found that the plan charges a copay of 25% of the total prescription cost at a standard pharmacy, but only 20% at a preferred pharmacy. So she should have been paying less, right?
As we looked further into this using Medicare.gov’s plan finder, we were shocked to find that the other El Dorado pharmacy was being paid almost TWICE ($150.81 vs $278.20) what we were being paid for the exact same prescription. So even though she would pay a lower percentage at the other pharmacy (20% there vs 25% here), her copay would be about 50% HIGHER at the “preferred” pharmacy!
Other pharmacy in town
total cost of prescription = $278.20 x 20% copay = $55.64
TrueCare Pharmacy
total cost of prescription = $150.81 x 25% copay = $37.70
But it gets worse. Her Medicare drug plan has a $425 deductible, meaning she would have to pay the full amount of the prescription at first. By following the advice of her plan and switching the prescription to a “preferred” pharmacy, it raised her copay from $150.81 (at our pharmacy) to $278.20!
And believe it or not, it actually gets even worse than that. Someone at this other pharmacy recommended using a prescription discount card instead of her Medicare drug plan in order to lower the cost. Doing this reduced the prescription from $278.20 to $102.34, which probably sounds like a great deal at first. But if you look at the big picture, using this discount card would mean her deductible would never be met and she would actually end up paying even more over the entire year!
Other pharmacy on Medicare drug plan:
January $278.20 (deductible)
February $173.08 (part deductible)
March $55.64
April $55.64
May $55.64
June $55.64
July $55.64
August $55.64
September $55.64
October $55.64
November $55.64
December $55.64
Yearly total $1007.68
Other pharmacy on discount card:
January $102.34
February $102.34
March $102.34
April $102.34
May $102.34
June $102.34
July $102.34
August $102.34
September $102.34
October $102.34
November $102.34
December $102.34
Yearly total $1228.08
TrueCare Pharmacy on Medicare plan:
January $150.81 (deductible)
February $150.81 (deductible)
March $130.24 (part deductible)
April $37.70
May $37.70
June $37.70
July $37.70
August $37.70
September $37.70
October $37.70
November $37.70
December $37.70
Yearly total $771.16
Some key takeaways:
1. Just because a pharmacy has a “preferred” status with a Medicare drug plan, this doesn’t mean that every prescription will be less expensive. And just one instance like this could erase any savings from other prescriptions.
2. Medicare is allowing Medicare Drug Plans to pay giant corporate pharmacies MORE than smaller independent pharmacies, even if these giant companies have contracts to be preferred pharmacies. We believe it’s unconscionable for these plans to steer people towards pharmacies that end up charging higher costs. Congress needs to force Medicare to rein in these Medicare drug plans.
3. Pharmacies that don’t truly understand the landscape of prescription insurance can cause more harm than good, even when they are simply trying to help. We can’t stress enough how terrible the advice was to use a discount card instead of meeting her deductible.
4. Not all pharmacies are the same. Many pharmacies operate with staffing situations that have been cut so short that they simply can’t give their patients the individual attention that they deserve.
