Mail Order’s Iron Fist Control may be Ending

Michael Rea, PharmD — Sun, 18 Dec 2011 16:00:53 +0000

This week, the New York governor signed into law a bill that limits the way pharmacy insurance regulates and mandates that you use their mail order pharmacies. Prior to this bill, pharmacy insurance companies could exclude coverage at certain pharmacies which were typically retail establishments. They usually did so for medications labeled “specialty” which were typically very high in price. By funneling insurance claims to one particular location, they were able to buy in larger bulk and control costs from one facility.

The new New York law addresses this issue for consumers who would like to use a retail pharmacy say, down the street from their house instead of having it delivered by the mail. If other states follow suit, the world of pharmacy and their corresponding price differences at mail order vs. retail settings could change dramatically.

A Common Myth: Prescription Insurance Co-pays are always the Cheapest Option

Michael Rea, PharmD — Sun, 29 Nov 2009 20:03:36 +0000

As the debate over healthcare in the United States escalates, it is worth some time to take a look at your own medical benefits (if applicable) and analyze what it is your benefits offer you. Too often, people (both insured and uninsured) are under the impression that filling their prescription medicines will cost huge amounts of money, and don’t do so as a result. In many cases, this is false, and may actually end up costing you more down the road.

Today’s prescription insurance structure is a complicated maze of different copays/coinsurance, certain drugs not being covered because they are not “preferred,” and less coverage for more money. Meanwhile, pharmacy insurance companies (othewise known as PBM’s or Pharmacy Benefit Managers) are making more money than ever by dictating what medication your doctor can prescribe you based on what medications they can get the best deal on from manufacturers. This coupled with the fact that using your insurance can actually cost you more than paying a “cash” price, makes it all seem like a wasteful mess.

So what can you do to decrease some of these costs and the confusion? In conjunction with the normal letters to your local and state representatives and human resource personnel, try avoiding using that insurance all together when possible. By avoiding using the insurance when lower cost alternatives are available, you decrease confusion, increase compliance, and save money in the long run. By utilizing our prescription medication list with your doctor, low cost alternatives for a large majority of medicines can be found for pennies a day. Take control of your healthcare costs now! You’ll feel better, save money, and live a better life!

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Mail Order’s Iron Fist Control may be Ending

A Common Myth: Prescription Insurance Co-pays are always the Cheapest Option