The insurance paperwork is piling up for Curt Burshem
One of his family members has a kidney disorder. And life without this pill would be very difficult.
Your kidneys could shut down, you could be on a kidney machine the rest of your life,"says Curt.
The pill is called MYCOPHENOLATE MOFETIL. it's a mouthful and a budget buster too. The first 30 day prescription filled at CVS cost $104 – about .$87 a pill. His insurance covered most of it.
To save money, his insurance plan advised Curt to use CVS Caremark – a mail order service. So he did. He ordered a 90 day supply. Based on the initial cost, he estimated the cost at about $312 or less - before insurance. Not even close.
"Caremark is saying it's a $2300 drug."
You heard right. With the mail order service, CVS Caremark charged. About $6.62 a pill! Before insurance.
And, remember, the CVS mail-order was part of an insurance plan that's supposed to save money.
So how is the happening? CVS Caremark is what's called a prescription benefits manager. PBM's tell employers they can lower prescription prices because they buy in bulk for a discount. But that also means CVS becomes the sole prescription provider..which can drive up prices.
Dr. Steven Schondelmeyer is one of the nation's leading experts on prescription drug pricing. he warns the monopoly-like pricing is confidential..which can be costly for the consumer.
"They've shut other people out. And they've done so in a way that you don't really know and can't find the prices," says Dr. Schondelmeyer. "They think nobody would cheat us that much. But they do.">
Dr. Schondelmeyer not the only one saying this. CVS Caremark is now being sued for inflating the prices of prescription drugs...something it denies.
All of Curt's research, he discovered something else you need to know. Because the mail-order price before insurance was so high, Curt's co-pay was high. $476. It actually turned out to be cheaper for him to buy 90 days worth of the pills without insurance. $259.
So the two take aways for you:
- Use a website like GoodRX. It will show prices in your area of drugs without insurance.
- Call the mail order pharmact before you order to make sure it's really cheaper.