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Prescription drug coverage: the high cost of choice

January 16, 2012 in Health Insurance, Member Stories, News

The recent news about the change in Express Scripts coverage in Massachusetts has led me to think about my own prescription drug coverage. While I still technically have the freedom to choose a pharmacy, the coverage from my provider basically locks me in to its own pharmacy chain (CVS) or else I incur significant out-of-pocket costs. For someone who likes to support local, independent business (including my local pharmacy), this has caused me much angst.

My son has been taking the antiepileptical drug Keppra to manage his epilepsy since 2008. At the beginning, I refilled his prescription monthly: my employer-provided prescription drug insurance (CVS/Caremark) which covered 80% of the cost, and I was responsible for the remaining 20% (approximately $100/month). This was the case no matter which in-network pharmacy I selected (and I preferred to go to a local pharmacy that not only knew me and my family, but also offered more services than the chain stores nearby). In 2011, my coverage changed, particularly with respect to maintenance medications, like the Keppra my son takes. The changes offered savings to those who selected mail order or 90 day supplies of their maintenance medications. The catch? The prescription gets filled by a CVS pharmacy.  If I continued to refill the prescription monthly, at our independent store, I would be responsible for 20% of the drug cost for the first two months and then 50% of the cost for the remainder of the year (approximately $1,750/year). Switching to CVS costs me approximately $650/year, a significant savings, but not without its additional “costs.” The service at CVS is terrible: pharmacists have made labeling/medication instruction errors that I have to tell them to correct, and on three occasions, the pharmacy hasn’t had the full amount of the medication at the time the prescription should be ready. This is unacceptable for a drug I order every 90 days. Should my son go without even one dose of this medication, he can begin having seizures. Unfortunately, the significant cost difference — $1,100/year, nothing to sneeze at! — has me locked in to a subpar option and doesn’t allow me to shop at my preferred pharmacy. I want to be thankful to have an opportunity to save money, but instead, as a consumer, this makes me angry. Am I alone?

Finding Cheaper Medications

December 7, 2011 in Member Stories

Medical costs are rising but this should not be a reason to comprise the quality of health care we get. One way to reduce the monthly medical bills is to reduce cost of medications in particular if you do not have insurance. However, finding cheaper medications is not always easy to find.

Finding the same medication cheaper can be tough but with several search engines you can easily find it. However, what is not obvious is that sometimes you can find another medication that has a very similar action which can be cheaper particularity if there are generics available. Unfortunately, most search engines do not do this.

For example, Carvedilol is a very common medication people take to help reduce blood pressure. Given that the patent has not expired on it, Carvedilol can be very expensive. However, there are several other drugs with a very similar action and significantly cheaper. For those you who can afford, paying the extra dollars for Carvedilol might be worth it for the relatively small added benefit it has compared to another very similar drugs like Metoprolol. But for those who might need to reduce their medical bills, taking the cheaper medication is not a bad option at all. In fact, the added benefit of Lipitor over its brothers is not very significant.

Most may not realize that a cheaper alternative is available. You can use a medication price tool here  by HealthKibo. It will combine prices from across the web therapeutic equivalence to help ensure you find cheaper medications without compromising your health.

You can also setup price alerts to watch changes in medication pricing just like you would set up for watching stock pricing.

In case the above link did not work, you can find the tool at

My Ultrasound: Three Tests, Three Pricetags

August 18, 2011 in Member Stories

My doctor said I needed a pelvic ultrasound.

Fine, I said. Do you know how much it’ll cost?

No idea, she said. But you can ask.

Great, I said. I love comparison shopping (especially when I don’t have to pay).

To be honest, I never would have shopped around for an ultrasound if not for my colleague Martha Bebinger. She’s just launched the cool, forward-thinking, social networking site, Health Care Savvy, which will serve as a forum for patients to compare prices, brainstorm on how to get costs under control and generally vent.

So, motivated to become a savvier health care consumer, I set out on my journey. Read the rest of this entry →