Is CVS Pharmacy Ripping You Off With Your Prescriptions?

melodyrama · 3 months

Hey. Rite Aid pharm tech here. Let me try to explain what is going on.

This is actually mostly an issue with your insurance. Not the pharmacy you are going to get your prescriptions filled. Most insurance plans that I Have dealt with do not want to pay for a 90 day supply and limit you to a 30 day supply. They don't want to pay for a 90 day supply because that is more money they have to cover for you. They force you to refill your prescription monthly.

Your insurance may not cover some medications at all. Including cheap ones like generic zoloft. In your case, your insurance did not cover any of the cost of the medication.

Major retail pharmacies have a discount that can be applied to your prescription. This discount doesn't stack with your insurance. It is just if you do not have insurance. Usually this is given to people who have "point cards" or whatever you call them. You know, the thing we ask you for every time you are at the register? At rite aid it is called the "wellness" card. Most likely the first time you got your prescription filled the pharmacist/technician looked at the cash price (without the discount) and your prescription insurance price. The second time they probably applied the discount which brought the price down. Also, you aren't limited to just 30 pills with the discount. If the scrpit is written for 90, then you can pay for those 90 pills. The CVS discount brought the cost down for you.

TL/DR: your prescription insurance sucks.

If you have any other questions or if anything is unclear feel free to ask. I'll try to answer with the best of my abilities.

Edited for clarity

Dawggoneit · 3 months

Dude, this isn't an issue with CVS and it's not fair to say they're ripping you off.

Your insurance company charges you a $15 flat co-pay per prescription no matter how much the medication actually cost. Most of the time this works out in your favor, but for a lot of older generic prescriptions the price per pill is very low and the cost of your script could be less than your $15 co-pay.

The individual you dealt with was probably lazy or just a newb who didn't want to go through the hassle of deviating from his normal routine. I don't have insurance, and I've had many instances of CVS pharmacists being very helpful to make my medications more affordable, and less of a complete ass rape.

If anyone is ripping you off it's your insurance company, and you should take up the price difference with them.

Itkovan · 3 months

To be successful in social media you need to have bite sized chunks people can digest, and then more details available for those who want to look. I would focus on this bit (maybe bold or italicize it?):

This means that if I had gone to CVS to fill the prescription (a total of 270 capsules, 90 caps X 3 refills) I would have paid $15 X 9 (they only gave me 30 at a time) or $135, while at the other pharmacy I would only pay $30. I called CVS and asked for an explanation, but they were unable to provide one for me.

The message would also be much clearer if you were focusing on either CVS or insurance companies. If you compared CVS vs another company then attack CVS, but in this case you should probably leave them out of it, and instead frame it as a "YSK" regarding filling prescriptions with and without insurance.

charles__ · 3 months

YSK that copayments have a purpose also. Before you decry how evil insurance companies are, understand that moral hazard exists when insurance pays for absolutely everything. I see you are a dentist, so you may be familiar with the Rand Health Insurance Experiment. If you are truly interested, read: http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment

That should explain a little bit about why copayments and coinsurance exist. There is a sweet spot for the percentage that they should be to maximize utility. For instance, I would get my teeth cleaned and whitened all the time if my insurance payed for it. They realize that the best thing for me is to pay for a cleaning every six months. Whitening is purely cosmetic, so they do not pay for that. Also, you are not incorrect that insurance companies care about making money. They are a business as is your practice.

Now, more interesting to me is the fact that the copayment did not scale down. Really, you should have only had to pay the $10 either way. You aren't supposed to pay $15 for any medication, you should just pay up to $15 and after that insurance will take care of all or part of the rest. I would look at the fine print for your health insurance. Also, CVS was definitely ripping you off.

BornOnFeb2nd · 3 months

The inverse of this was at a Publix. Needed basic antibiotics prior to getting some dental work. They took my information and just gave them to me. No insurance involved, using it as a loss leader I guess.

Since I was visiting family and don't have a Publix near me I offered to pay, since I felt like an ass for just taking it, but they wouldn't have anything to do with it.

Nice place though.

cplat · 3 months

Pharmacy intern here. I agree to some extent with what some other commenters said. I think your main complaint was that the people filling your Rx didn't communicate effectively with you regarding the cost of the medication. I feel your pain.

It might help to know how the pharmacy calculates what you pay. First, the pharmacy can only bill your insurance company after inputting the prescription information, so they can't know your insurance copay right away when you drop off the prescription. It is possible that the copay (calculated according to your insurance plan) will be larger than CVS's "cash" (non-insurance) price. This "cash" price is not the same as what I'll call the "discount plan" price. CVS's discount plan covers "400+" different medications, and you have to enroll in the discount plan to get the discounted price. The medications covered on the discount plan are likely to change as drug prices change. So when the technician told you $15, that may have been the cash price rather than the discount plan price.

Because of all these variables, when you ask the technician or pharmacist how much your prescription will cost without insurance, they probably won't know off the top of their head. And if the medication is already covered on your insurance plan, they will be less likely to suggest the discount plan unless they know it will save you a significant amount of money because of the time it takes to enroll you. It is easy for me (as a pharmacy staff member) to see how your situation could have arisen at any retail pharmacy, not just CVS. Pharmacy staff don't always bill your prescription the cheapest way, especially if the technician is inexperienced (as many are: they can be high-schoolers and start at minimum wage).

For these reasons, you need to check out prices for yourself. Understand your insurance formulary and check the discount plans and/or cash prices at various pharmacies if you want to make sure you get the lowest price.

TL;DR CVS wasn't trying to screw you, there's just a lot going on when billing your prescription. It's your responsibility to know your options and what you're paying for before you pay.

AbaddonSF · 3 months

Pro tip, Use costco, or Sams club, I was about to get a 90 day supply of a Anti depressant for 30 bucks at costco, CVS wanted to charge me 230 bucks.

tubssmcgee · 3 months

My dad recently had a heart attack and is now on a few different meds. CVS charged my parents $80 for one of them. My mom went to another chain prescription place and got it for $10. So while the insurance companies are ripping everyone off (as we should all be aware by now), CVS is also ridiculous.

deelowe · 3 months

Hanlons Razor - http://en.wikipedia.org/wiki/Hanlon's_razor

Clerk scans bottle, enters insurance info, price shows up. Not a second thought was given. I'm guessing it's a software glitch or some other error. I doubt CVS has orchestrated a massive conspiracy to rip people off 5 dollars at a time in the extremely rare case that they are buying prescriptions priced below the co-pay. Seriously, what do you think the frequency is of people buying meds that are billed as less than the co-pay? Finally, I'm sure there are laws against this sort of thing. CVS can't defraud the insurance company by charging bogus fees to get the full amount of the co-pay.

Seicair · 3 months

Prices vary widely depending on pharmacy. Was surprised when my then-girlfriend picked up a prescription in the pharmacy at our regular grocery store, it was $40. Checked around before refilling it, target was $10.

Craysh · 3 months

Did you pay using insurance at CVS? if you did, the other place would probably have told you about the 30 day limit too...

cgfromtexas · 3 months

I used to work for a prescription drug insurance company. This is not the pharmacy ripping you off. This is the insurance industry "ripping you off".

The insurance company has a preferred provider network which includes independent and chain pharmacies. The contract says they collect a certain minimum amount of money from the patient (the copay). Then the insurance company reimburses the pharmacy for the contracted cost of the drug (eg. average wholesale price plus 10%).

Sometimes the pharmacy takes a beating. Sometimes they score some loot.

In addition to discount pricing, we also did drug utilization review to screen for allergies and drug conflicts. In these modern times where pharmacies can do drug conflict screening, it is less risky to ditch your insurance and pay retail if you are staying with the same pharmacy for all your prescriptions.

And having said all that, the pharmacy tech was a jerk to not tell you the uninsured price. I would speculate that was a personal issue with not wanting to look greedy versus actual corporate policy.

oktboy1 · 3 months

I had a similar experience with CVS. A few years back we got scabies in our household which when we went to the doctor we were told that it was going around and prescribed cream for the first treatment. I did not have insurance at the time but since my siblings did I received treatment since the whole house had to be treated. So the next week when it was time to do the second treatment we went to CVS and they wouldn't give us the same amount as they had given us before and we were charged $25/tube and had to buy 4 as there were only 2 covered by insurance the second round and the first round we got 6 for I think $15 or $20 for the copay. CVS doesn't know what they are doing I don't know why anyone goes there.

[deleted] · 3 months

I'm a pharm tech and that sounds more like an insurance issue, like everyone else is saying. Lots of insurance plans don't like doing 90 day supplies, regardless of what your doctor says. Insurance companies only care about money.

I work at a local, family owned pharmacy. I'd highly recommend staying away from big chain pharmacies. I've seen the people I work with go above and beyond just to fix minor issues for patients, especially people without insurance.

coned88 · 3 months

The person at CVS could have been telling you the truth. Your insurance could have bound you to 30 pills and CVS very well may have given you the full 90 pills if you paid them the $15 without insurance. As for the difference between the $10 at pharmacy #2 and the $15 at CVS this all depends on their generic provider. Most pharmacies carry only one or two lines of generics across all medications. Doing this makes bulk ordering easier. So it very well may be possible that CVS has one brand while pharmacy #2 used another.

Also you are a dentist, you can just order prescription drugs like a pharmacist does pending your DEA licence allows it. You will get wholesale prices. Just so you know. I take a medication which costs $10 for 90 pills. Via my dental office we can order $500 pills for $4

naveedy · 3 months

As a pharmacist, fuck dentists. And learn to dose amoxicillin right.

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