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#1 barefut


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Posted 14 December 2006 - 07:43 AM

I had my Cellcept Rx transfered to a pharmacy which quoted me a MUCH lower price (over $100) even though that meant driving 1/2 hour one way to get there.

Yet I was charged the same amount when I got there.

The best answer my insurance comapany could give me is that they have a "contracted price" with the pharmacies.

SO, from that answer, what I understand to be true is that it doesn't matter what the pharmacies pay, or what cash price they would charge you before insurance, they will get paid the same amount from the ins co.'s and there is no savings passed on to me.

How fair is THAT?!

Pharmacy A quotes me over $700 before insurance

Pharmacy B quotes me $614 before insurance



#2 Elehos


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Posted 14 December 2006 - 12:26 PM

Hi Barefut,

At this point I'm downright enraged over the way your ins. co. is "taking care" of you!!!!!! How can they set a contract price while your part is only 30%? Is there some sort of small print that only allows them to pull this on certain medications?? I'd be on them like brown on mud if I were you to see if what they're doing is legal or not! Ins. co.'s aren't immune to legal responsibility, but they want to make you think so. Personally, I'd seek legal counsel if they don't have anything in their policy that allows them to change copays on certain meds, and worse yet if the brand names or class of drugs is not clearly named up front. My insurance sent something about certain classes of drugs having to be by mail order only, and only from one particular company, but at least they were up front about the changes and gave everyone time to make the changes necessary. Let us know how it goes--if you need to scream at the top of your lungs at times, like always, we'll be here for you. There will most likely be others on the board that can give some good advice, and it might help you out in your situation. I'm so sorry you're going through this!

Hugs to you,

#3 Sweet


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Posted 14 December 2006 - 12:39 PM

Hi Barefut!

Oh boy, what an awful situation. I am so sorry. Medications can sure be expensive, and we feel so stuck in the middle because we need them!

I'm truly sorry for this upset. Try not to get too worked up because as you know stress only makes us worse!
Warm and gentle hugs,

ISN Support Specialist
International Scleroderma Network (ISN)

#4 barefut


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Posted 14 December 2006 - 03:05 PM

The insurance plan administrator customer service agent had a hard time answering my simple question and she kept putting me on hold to talk to their "prescription dept." (Why couldn't she just transfer me and let ME talk to them?) :angry:

I stumped her and she was annoyed by this and really wanted to get me off the phone. She practically hung up on me while I was saying thanks for her "help"

They haven't heard the last from me. I will take it to our local TV station's consumer reporter to help me with getting answers if I have to. :o

The last time I did math, 30% of $614 was LESS than 30% of $700+.

#5 whirlway


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Posted 16 December 2006 - 01:31 AM

Barefut, sorry you seem to be getting the run around. I have never heard of having to a percentage for your co-pay. I also take cellcept, but I do have a set amount for my co-pay, which is $15. I consider myself very lucky after reading your post. My co-pays are $5, $15, & $30. I spend around $200 a month for about $2000 worth of meds. I will be very glad when some of the meds I take have a generic form so I won't have to pay the $30 co-pay anymore.
Stick to your guns, what they are doing to you is wrong.
Good luck.