My pharmacy refused to honor my co-pay.

[CC27]

AirmensMom  (1000+ posts)        Wed Jul-08-09 04:39 PM
Original message
 
My pharmacy refused to honor my co-pay.

Make that my EX-pharmacy.

I've used this pharmacy for 3 years. One of my meds costs $10/month co-pay through my insurance. I'm supposed to get enough for a month, but I ran out 3 days early. So I called the pharmacy to reorder and told them I was short. Nope, can't be. They don't make mistakes.

So I went over to pick up the Rx later and was charged $15. When I questioned them, they said the price had gone up for them, so it goes up for me. I called my insurance company when I got home and they told me that 1) the pharmacy never entered today's reorder into their system and 2) they are only supposed to charge me $10.

I called the pharmacy back and was told that they were losing money by letting me have my meds for $10 and they'd be stupid to keep doing it. They refuse to order them again unless I agree to pay $15. In other words, they are refusing to let me pay for my prescription using my insurance (which is probably why they never called it in) because they don't agree with the co-pay. I told them I'd be stupid to keep getting my prescriptions from them. Then I called the insurance company back and filed a complaint.

It got me thinking: I can afford the extra $5, even though it's wrong for them to charge it, and I'm astute enough to notice that they were charging it ... although I probably should have pulled out my insurance card on the spot and called my insurance company from the pharmacy. Most people in this area can barely afford their co-pay. They certainly can't afford to be ripped off. How many people is this guy ripping off?

Wait unit its "free" DUmmie. 

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6015970
 

[franksolich]

One wonders why she ran out three days early.

Probably one of those pharmaceuticals with recreational uses too.

[BadCat]

With a $10 copay, it is likely a generic.
She could get a 90 day supply at WALMART for $10.

[The Village Idiot]

With a $10 copay, it is likely a generic.
She could get a 90 day supply at WALMART for $10.

She wants it free. These DUmmies think every business ought to conform to their ludicrous ideas

[GOBUCKS]

This is a pharmabouncy.
No way a drugstore screws with copays. If they accept that insurance provider, they charge the indicated co-pay.
Why is it normal people never run into these problems? They only happen to DUmmies.

[Carl]

This is a pharmabouncy.
No way a drugstore screws with copays. If they accept that insurance provider, they charge the indicated co-pay.
Why is it normal people never run into these problems? They only happen to DUmmies.

Exactly.

[miskie]

I like how others are chiming in and mentioning Kroger's Walgreen's and Target -- Chains that on any other day The Primitives would hate.

[Doc Savage]

This is a pharmabouncy.
No way a drugstore screws with copays. If they accept that insurance provider, they charge the indicated co-pay.
Why is it normal people never run into these problems? They only happen to DUmmies.

DING DING DING.  work in a pharmacy, if we could just charge anything we wanted over the agreed on co-pay I would be driving a McLaren Mercedes

[debk]

With a $10 copay, it is likely a generic.
She could get a 90 day supply at WALMART for $10.

Back when I had insurance a couple of years ago...(BCBS of TN) they changed my Rx to only allowing a 30 day from 90 day. I was paying $10 for a 30day supply with insurance that was $253/mo. I pay $8.65 for the same pills for a 30day supply...without insurance.  Same pharmacy (CVS).....

[thundley4]

Back when I had insurance a couple of years ago...(BCBS of TN) they changed my Rx to only allowing a 30 day from 90 day. I was paying $10 for a 30day supply with insurance that was $253/mo. I pay $8.65 for the same pills for a 30day supply...without insurance.  Same pharmacy (CVS).....

You don't suppose WalMart had a hand in that do you?  Even some of the small independent pharmacies here are matching Walmarts prices.

[Vagabond]

CVS once screwed up my wife's medicine pretty bad.  She had to take blood thinning shots when she was pregnant with our daughter.  It was supposed to be $50 copay for a one month supply, preloaded in needles.  The store we went to charged her $150 for three needles and swore up and down it was per treatment.  We contacted the insurance company and explained what happened, CVS gave our money back and apologized for the mistake, but we haven't used them since then.

[RobJohnson]

AirmensMom  (1000+ posts)        Wed Jul-08-09 04:49 PM
Response to Reply #4
10. Good idea!
 I don't watch local news (being in the south ... bible belt ... Republican hell, etc.). But I will definitely see if there is some kind of consumer thing. They messed with the wrong person this time.

 
 

 

Mudoria (1000+ posts)      Wed Jul-08-09 06:10 PM
Response to Reply #10
51. wtf are you on about? You're in the South so local news is freeper-ized?

   

mwooldri  (1000+ posts)        Wed Jul-08-09 08:30 PM
Response to Reply #30

66. Single payer may not make this go away either.  

 The UK's NHS has a drug formulary - drugs that the NHS will pay for, and if it's not on the list, the NHS doesn't pay.

All insurance companies that cover prescription drugs have a formulary. Some stick to the list, if it's not on, it's not covered. Often insurance companies will cover drugs off the list after a medical review (usually a quick chat with the prescribing doctor, but sometimes can get detailed with pricey drugs).

But with the pharmacist, then yep it would appear the pharmacist is at fault. Pharmacist could have ran through the request, in theory could have lied to the customer and told the customer that the drug is not covered by the customers' insurance and the customer may well have paid that higher price and just taken it... if the customer calls the insurance and finds it was covered then the pharmacist has a mess to clean up.

Pharmacists of course are businesses. If the pharmacist has the issue over the price of the drug, i.e. it costs them more to purchase the drug than what they would get through re-imbursement either a) they need to speak to the insurance company and re-negotiate what they will get reimbursed for on that drug, or b) simply discontinue stocking that particular drug. There also is the situation that the pharmacist may well stock that drug as a "loss leader" - ie they may make a loss on selling that drug but gain on the sale of other stuff.

The OP is right to dump that pharmacy, and certainly can complain - definitely to the insurance company (who may well do something - I got charged a co-pay by a doctors' office, the office refused to let me see a doctor without paying even though I don't have a copay and I had met the deductible already... I complained to the insurance company and they sent me a check back... not the docs office, the insurance company did) and certainly BBB and state board.

Mark.

AirmensMom  (1000+ posts)        Wed Jul-08-09 04:51 PM
Response to Reply #6
13. Yes, but they won't order my Rx.
 None of the national pharmacies will. So I found another local one that will. And they told me flat out that if my co-pay is $10, that's what I'll pay them. We'll see if they hold to it.

 
 

 
 

 

[The Village Idiot]

mwooldri is cruising for granite

How dare he point out what happens at the HNS

[EastFacingNorth]

 
 

    

 
 

 
 

 

Might not necessarily be BS.  Some drugs have ridiculously stringent quality assurance requirements and the chains won't touch them in their regular pharmacies for liability reasons, but have specialty pharmacies to handle them. 

[RobJohnson]

Might not necessarily be BS.  Some drugs have ridiculously stringent quality assurance requirements and the chains won't touch them in their regular pharmacies for liability reasons, but have specialty pharmacies to handle them. 

First I have heard of this.  Unless it's a compounded drug. She never would say what the drug was, so I'll go with the rule that DUmmies lie, all the time.