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How to save money at the pharmacy counter

Christopher Snowbeck, Star Tribune on

Published in Home and Consumer News

Claire Henn, 77, of St. Paul, Minnesota, said a program at Allina Health currently covers sizable co-payments for an expensive medicine she receives via infusions every month for rheumatoid arthritis. She's thankful for the medicine as well as the program: A few years ago, Henn said, she had to stop taking a different rheumatoid arthritis drug when monthly out-of-pocket costs jumped from $60 to $1,400.

"My rheumatologist recommended it," she said of the Allina program. "It's a life-saver."

Whenever possible, patients should check in advance to see what sort of coverage they'll have for their medicines with the various health plan options they can select. It's worth watching for changes, since they can occur regularly.

Wexler said he's annually switched prescription drug plans during each of the five years he's been on Medicare to find the best fit between the drugs he's taking and the benefits different insurers offer.

There are certain situations where consumers at the pharmacy counter decide to bypass their health plan benefits.

Sometimes, patients run into such snags like prior authorization rules or having to argue with their insurer for coverage, so they opt to simply pay cash in order to access the medication now, said Matt Anderson. Anderson is a member of the state's Prescription Drug Affordability Board, a new watchdog group the Minnesota Legislature created last year.


In other cases, a prescription might be cheaper without using coverage because the required out-of-pocket spending through the health plan is greater than the pharmacy's cash price or price through a discount card program.

"If you don't use your benefits, the drug cost you pay doesn't count toward your deductible," said Anderson, who is also a senior lecturer at the University of Minnesota's school of public health. "So the near-term savings of paying cash could be offset because it takes longer to satisfy your deductible."

For people who know they're not going to hit their annual deductible, cash purchases might result in savings, said Jon Hess, a health care consultant in St. Paul.

To scout the best deals using cash, consumers can look at the price they'd pay via the Mark Cuban Cost Plus Drugs Company or prescription discount card programs, such as GoodRx. Prepare to do some homework, though, because there's been a proliferation of discount card programs in recent years, including recent offerings from OptumRx (a division of Minnetonka-based UnitedHealth Group) and CarelonRx (part of Indiana-based Elevance, which runs many for-profit Blue Cross Blue Shield health insurers across the country).


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