Medication Procurment

Recently. I replied to a message from friend/member Vij, about medication procurement and insurances. It seems plans vary from county to county. state to state, country to country, as does insurance coverages. I would like to open up a discussion with all members about HOW DO YOU RECEIVE YOUR MEDICATION AND PAY FOR THEM. Please reply with your prescription coverage and general location. Your opinions about procurement would also be helpful.

Let me begin by stating that I reside in Massachusetts and am covered by Medicare Part D and private Medigap coverage. Using mail-order prescriptions lowers the cost significantly and Tier One and Two meds are $ 25 each for a three-month supply, while Tier Three and Four scripts cost the same in co-pays, only a one-month supply is available.

In my opinion, there is too much "FOR PROFIT" even in government-funded insurance coverages. There should NOT be any variation in costs from one location to another. Governments should be allowed to negotiate drug prices from suppliers. Private insurers usually follow government cost guidelines and respond, in kind. So, there, that's my two cents, how about replying with yours

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  • Hello:


    I live on Cleveland, OH and have Oscar via ACA.  It's the only insurance a self-employed person can obtain and go our 'best' hospital (for kidney) - Cleveland Clinic.  Regretably, for last year and this - they've changed Mycophenolate & now Tacrolimus to "Group D".  In short - you'll pay 50% of the cost they claim it costs them.  When I asked what that was, the person was quite flippant - it was, what it was.  After demanding an answer it was ~ $350 / quarter.  I now receive it via GoodRx for ~ $90 / quarter (each Tac + Myco).


    I actually am insulted that they think no one is going to shop.  Obviously, some people don't.  Also, Amazon offers Rx's now (some are less than Good Rx, some not).


    All require an Rx from your Transplant Doc / Dept.  If anyone has ideas how to find a friendly doctor who'd prescribe these, it's good to have a back up plan.  I like to keep some extra & glad I did when COVID broke out.  My Transplant Dept sometimes give me flack like how dare I not use their insurance (Oscar is partially owned by CCF).

    • Thank you for replying!

  • As far as "variation in costs", LoL! The US pays for the development costs of drugs for the world! Medicare does not negotiate with drug companies like other countries. Medicare is not allowed to do so by law.

    I recall quite vividly when I started on my "journey" after being diagnosed with advanced Hepatitus C I was prescribed a drug "Sovaldi" made by Gilead Phamacuetical. I was very fortunate to be working full time with very good insurance plan, as I needed to take 1 400mG Sovaldi per day for 16 Weeks, and the drug cost $1,000.00 EACH PILL. That is to spell it out - ONE THOUSAND DOLLARS per pill! As I needed 1 pil/day for 16 weeks that was over $100,000.00 for the entire prescription. I had delivery each month, by signature required courier, as each bottle cost $24,000.00! I was going to a pulmonary doctor from Sri Lanka at the time and was discussing this with him and he said..."In the USA people without insurance go to India, because there a 12 week supply only costs $1000.00"!

    That is because India, like most other countries in the world, negotiates with the drug company that if they want to sell the drug at all, they will sell for a lower price.

    • I agree that Medicare should be allowed to negotiate prices for prescription drugs. An overhaul is in order. Thank you for posting this reply.

      • "An overhaul is in order."

        Yet that "overhaul" is the entire system of corporate donations to political campaigns - with drug companies running at #1 in the donor class.

  • My "special" medications, Prograf and MyFortic, are both covered by Medicare PART A. I get them from the hospital specialty pharmacy and they are even delivered to my door by a courier every month. All for NO CHARGE.

    I guess I don't understand, as I thought in the USA, for Medicare insurance, it was the same for everyone as far as Part A paying for the specialty meds if Medicare was your primary insurance when you had the transplant. I have a suppliment (Plan F) and Part D, but my immunosuppresant drugs are covered by Part A.

    Medicare has very convoluted regulations and I believe, for whatever reason, the medications are NOT covered for end stage renal desease which seems rather odd. 

    • This article may help you decide:

      Medicare Advantage Plans - A Good Fit?

      Know the Pros & Cons of Medicare Advantage Plans
      Are you wondering if Medicare Advantage is right for you? Learn more about the Pros and Cons of Medicare Advantage Insurance.
      • Yea - I just had that discussion with my insurance guy for the yearly "sign up". He had thought maybe an advantage plan instead of a supplement would be better as they are changing for the better. He got another person on the phone who agreed with my "gut feeling" - DON't ROCK THE BOAT! In my case, the only other drug I take that costs much of anything is a very expensive inhaler. The most imprtant item are my immuno suppressants. After I saw in another trhead you mentioned that Medicare only covers the first three years I checked with my coordinator and just got the reply that they are covered for life as long as I maintain coverage under a Medicare drug coverage plan.

        • Three years is "nationwide," some states cover more. "Quid pro quo" if the plans offer more in benefits, where do they make it up, in capped totals, benefit limitations, ????. When you are on a slab trying to recover, do you then want to learn where the limits are? Ask lots of questions before switching.

  • Merry Christmas friends.  My first 3 yrs was covered 100% by Medicare.  I reside in Michigan.  The last 2 years I have paid about $25/month for all of my prescriptions.  This includes Tacro, Cellcept, Insulin, and various other medications .  I am fortunate to be covered by my husband's BC/BS. I am 53 and retired as a Nurse Practitioner.  


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