Who to contact about drug prices

[csziggy]

After my stay in the hospital last month, I was prescribed four new (to me) medications, two of which are name brand with no generics.

The hospital had a new pharmacy program where they could give you your prescriptions before you were discharged - I did that and have not received a bill for those medicines. But when I got refills through my regular pharmacy, the two name brand prescriptions were over $500 each!

So I looked and both companies had coupons to get the first 30 days worth for free - one also had discounts for further scripts. Took those into my pharmacy - no go. Since I am on a "federal" plan - Medicare - they could not apply the coupons.

WTF! So old people on Medicare do not have the same rights to get a discount as anyone else?!!!

I'd contact my Congressman or Senator, but I'm in Florida and with DeSantis' gerrymandering, my Democratic Congressman was done out of his district. The last time I contacted the Republican Congressman, he added me to a Republican fund raising list and it took me months to get off of it (got so I was thanking them for reminding me to donate MORE to Democrats).

I know Joe Biden has worked to reduce drug prices so who in his administration can I contact about this?

[NoRethugFriends]

1. They certainly can apply the coupons

[deRien]

4. I had a similar experience

with a prescription and was told that I couldn't use coupons because I'm on Medicare. My yearly deductible of $545 was applied and the prescription was still over $600 for a month. I should have asked if I could pay out of pocket with a coupon to see what the difference would be. I will have to talk with the doctor about a different plan of action.

[marybourg]

5. No, they cannot.

They are correct in that.

[csziggy]

9. The pharmacy clerk tried and tried

Then asked for help and was told that, no, the coupons could not be used. Both she and I were confused but the person who helped her (apparently training her) explained that because of Medicare, the discounts were not available.

I sent a message to the White House since they are trying to negotiate with pharmaceutical companies right now for reduced drug prices for Medicare.

[TwilightZone]

13. There's a statute that makes it illegal to use coupons with Medicare.

"While many of these drug discounts are offered cost-free, the U.S. Anti-Kickback Statute makes it illegal for individuals enrolled in Medicare to use manufacturer coupons or other drug discounts with their drug plan."

https://www.healthline.com/health/medicare/drug-coupons-and-medicare

[csziggy]

15. Yes - that is what the clerk was told

Not in so many words, but that the coupons could not be used. She was very apologetic, but I felt bad since there was a line and I had taken up her time for no good reason.

[TwilightZone]

19. It's completely understandable.

It's frustrating, especially since there are so many rules and regulations that aren't intuitive or obvious.

[TwilightZone]

12. No, they cannot.

"While many of these drug discounts are offered cost-free, the U.S. Anti-Kickback Statute makes it illegal for individuals enrolled in Medicare to use manufacturer coupons or other drug discounts with their drug plan."

https://www.healthline.com/health/medicare/drug-coupons-and-medicare

[nocoincidences]

2. Here is a fact sheet

and down below is an email address at the White House.

It's probably someone at HHS and maybe the WH contact can direct you to that person.

I also think you might need to try another pharmacy!

Good luck!

https://www.whitehouse.gov/briefing-room/statements-releases/2023/12/14/fact-sheet-biden-harris-administration-announces-dozens-of-pharma-companies-raised-prices-faster-than-inflation-triggering-medicare-rebates/

[csziggy]

10. I even checked with Goodrx - my pharmacy prices are lower than most

And the Goodrx prices are actually HIGHER than what I paid!

[Voltaire2]

3. Your representative or your senator, but....

Nothing can happen in congress as it is currently structured. The house obviously will not even consider any reform to medicare that helps anyone other than the oligarchs, and the Senate republican minority will block any reform as well, even if we regain control of the house.

Under the truly awful Part D system, you have to predict what prescriptions you will require for the next year and then choose wisely from the ridiculously complicated brochures provided by the many 'competing' companies that offer Part D programs. It is even worse as your plan can change the price you pay during the time you are enrolled.

Eventually you max out your out of pocket expenses (at around $8000) including the remarkably shitty 'donut hole' phase, and then you have the luxury of paying no more than 25% of the grossly inflated list price.

[csziggy]

11. I am NOT contacting my Senators or Representative

They are all Republican flacks (Rick Scott, Marco Rubio, and Neil Dunn) and totally useless, even though retirees put their useless asses into office - well Dunn got to be my Rep. via DeSantis' gerrymandering.

[gab13by13]

6. I also think you should be able to apply the coupons

I am on Medicare but I have a union-sponsored drug plan and was paying 375.00 for a 3 month supply of Eliquis through Express Scripts. I went to my pharmacist who even filled out the paperwork for me and through the company that makes Eliquis, I forget who, I now pay 10.00 per month. I am good for 2 years and all I have to do after 2 years is make a phone call to renew it.

Maybe you have to have a private plan for the drug maker to give the discount but that would be up to the drug maker I would think and not the government.

[marybourg]

7. That's the difference. Your Rx plan is private

and the OP’s is part D Medicare. OP cannot use coupons. Part D is a Frankensteinian patchwork of Democratic and Publican policies. It was that or nothing.

[csziggy]

8. Yeah, I am using Medicare Part D

So it is a "federal" plan.

[TwilightZone]

14. There's a statute that makes it illegal to use coupons with Medicare.

"While many of these drug discounts are offered cost-free, the U.S. Anti-Kickback Statute makes it illegal for individuals enrolled in Medicare to use manufacturer coupons or other drug discounts with their drug plan."

https://www.healthline.com/health/medicare/drug-coupons-and-medicare

[Voltaire2]

16. The shit that is part D is unfathomable.

[TwilightZone]

22. This particular provision was added to reduce fraud.

It, unfortunately, if you'll pardon the bad pun, has a lot of side effects.

[Voltaire2]

24. They always do, and somehow the 'unintended' side effects generally line the pockets of oligarchs.

It isn't a mystery. Their lobbyists frequently provide part or all of the legislation's text. Our system of government is almost entirely captured by the rich and powerful.

[NoRethugFriends]

17. I have medicare part D, and have often used GoodRx.

Is it just manufacturer's coupons that are bot allowed?

[TwilightZone]

18. That's OK because it's not billed to Medicare.

As long as it's not being billed to Medicare, i.e. you pay the GoodRx price as a cash price, that's fine.

[NoRethugFriends]

20. Wow. That's a really screwed up system

If you got a free coupon from drug company that would go through medicare?

[TwilightZone]

21. Here's the tricky part.

A lot of the "free" coupons are only intended to cover deductibles for people who have insurance. That's often in the fine print.

For example, let's say that a drug is $1,000 and private insurance pays $700. The "free" coupon would cover the other $300 (but not the full $1,000).

In that same situation, but with Medicare, the coupon wouldn't be allowed because part of the cost of the medication is being paid by the government.

You could choose to use the coupon and pay the rest out-of-pocket. As long as none of it is being billed to Medicare, that would be OK.

It's basically either/or. If any part of it is billed to Medicare, coupons/discounts aren't allowed. If you're paying the amount not covered by the coupon, that's fine. If the coupon covers the entire cost of the medication, that's also fine.

[NoRethugFriends]

23. Thank you for the explanation!

[csziggy]

30. Unfortunately since I am a private Medicare user

There are no discounts available to me that I can find.

[IcyPeas]

25. Its appalling that we have to deal with all this crap mumbo jumbo.

[XanaDUer2]

26. I was all set to use coupons

Then found out I can't on Medicare. I was pissed.

[The Blue Flower]

27. There are industry-sponsored patient assistance programs

Depending on your income. I get trulicity and jardiance at no cost from the manufacturers.

[csziggy]

29. Apparently those are not available to Medicare

Unless there is some program I haven't heard about.

[pandr32]

28. Pharmaceutical prices are out of control.

I get an injected drug (brand Nucala) every 4 weeks and originally had to jump through hoops from insurers. I get a total of 300mg every four weeks which is 3 shots in order to control my autoimmune condition (Churg Strauss). When I started I was not quite old enough for Medicare, but did after a year. I also have ChampVA through my 100% disabled veteran husband. They pick up the balance and send me statements.
Since 2018 I have watched the price triple. I also have to go to an oncology center to receive the shots, but could do it on my own if I was only receiving a single shot. You can only get 100mg or 300mg, but it all comes as 100mg preloaded needles so why there isn't a 200mg level or why I can't give myself the 3 shots is not clear.
The price is now over $26,000.00 for my 3shots and they way they've got it is I have to pay $2,900 copay. That's every 4 weeks! For some reason ChampVA has yet to authorize their end. I don't know why this has changed, but we are on a fixed income and my present choice is stop the injections and possibly die or pay $2,900 each month and not afford to live.
I was told there is a grant, but after jumping through hoops it is limited to $2,000 maximum per year. That would hardly make a dent.
I think Big Pharma are a band of pirates.