Wow. "Donut Hole" shopping as we get ready for Medicare. What a difference!

[DebJ]

It doesn't take very much to hit that donut hole, does it?

I'm getting ready to sign my husband up for supplemental health care coverage and Part D for prescriptions, and there sure is a big
difference in the pricing at various pharmacies. My husband is down to 'only' four regular prescriptions now (used to be many more, for diabetes, etc); 2 heart meds (prior heart attack), a cholesterol med (he's down to taking it twice a week though and may go to once a week soon; doc is playing it safe as his cholesterol levels are actually very, very good now), and an ARB because he has kidney disease (though his blood pressure has been fantastic after he lost 120 lbs and got his diabetes 'cured'. Here is the annual retail cost for all four meds at various places in our area in south central PA.

Keep in mind that the donut hole starts at $2960, and that I've seen antibiotic prescriptions that were over $300 at times.


Weis Pharmacy 2780
CVS Pharmacy 2479
Giant Pharmacy 2225
Walmart Pharm 1983
Target Pharmacy 1802


So Weis charges more than 150% over Target's prices: though note this is due to a crazy cost on just one of his meds, way out of line with everyone else.

I am SOOOOO glad Target wins, and Walmart loses. Furthermore, my hubby has been using CVS for over a decade, and their service just sucks so bad that I refuse to pick up his prescriptions for him. About half the time, he goes to pick up the prescription and they are out of the med, give him two pills, and say 'drive all the way back here in two more days'. Seriously, for half of his prescriptions, and he's been taking these prescriptions and getting them filled at this pharmacy for like 15 years or more. They also once gave me a bottle marked with one pill, but filled with some mystery pill...thank God my husband wasn't taking this for the first time and knew what they were supposed to look like. The people working in the pharmacy consistently, constantly look unhappy, tired, angry, and harassed. They have very long lines that move very slow, and they are located across town in an area with bad traffic. My husband is just resistant to change of any type with his health. Well, now he will have to, or we will most likely hit the donut hole. YEAH!!!

[djean111]

1. You might want to check Costco's prices. You do not have to join Costco.

They were a literal lifesaver before my son got on Medicaid, don't know how they stack up if you have insurance. They have a different kind of contract with the drug companies.

[DebJ]

3. I wish I could but the closest Costco is about one hour away.

And no one brings new locations to York anymore; and many businesses are closing them down here.

[djean111]

4. Here is their website information for home delivery.

This says "members". We did not have a membership at the time we used Costco, jut told the person at the door we were going to the pharmacy. Anyway, it costs $55 a year to join and you may get savings that would more than cover that. They always cheerfully gave price quotes over the phone, too. None of the drugstores here, stand alone like CVS, or in-store, like Publix, could meet their prices, different contract. At the time, 90 days of all of the meds my son was taking cost $170 at Costco, $1198 at Walmart, $1446 at CVS, $1572 at Publix. I literally broke down in tears at the pharmacy window!
http://www.costco.com/pharmacy/about-home-delivery.html

[DebJ]

6. Wow that is great information. Thank you.

I'm going to give them a call tomorrow!

[DebJ]

7. Wow wow wow. Just called Costco.

They do not normally stock one of his four meds, so that one is higher than 4 of the 5 pharmacies I called for full retail price.
The other three are all cheaper than anyone else.

One of those is 45.52 PER YEAR, instead of the $505.08 that CVS charges for a year's worth. That's a Donut Hole saviour
right there all by itself.

The third one is 93.64 per year, versus an average of $200 per year at the other pharmacies.


So, if we get the one prescription at Target, and the other three at Costco, then our annual total retail price
for his prescriptions comes down to $1351.44, almost HALF of what our insurance has been charged through CVS.

Wow,wow, wow. I can't thank you enough. And actually, I had forgotten that my husband drives to Harrisburg
several times a month to meet with hobby members, so he can pick up his prescriptions then. They all expire
within one week of each other, so he can get them all at once (as long as I am the one who keeps track and calls
them in for him; he waits until he has one or two or zero pills left and then calls, the boob...especially dumb when
CVS never has them in stock...)

Thank you Thank you Thank you!

[djean111]

8. That is fabulous!!!!! I am so glad for you!

Like I said, I starting crying when my son's meds - no insurance - went from $1200-$1400 for 90 days to less than $200.
We had been buying clonopin and venlafaxine XR a few pills at a time - oh, and here is another "feature" - the fewer pills you can afford, the more expensive they are. Great for poor people!

I trot my little Costco story out too much, I know - but I think everyone who needs expensive meds should at least call them and ask.

[DebJ]

9. Oh yes I'm familiar with that type of stuff.

In 2002, my son, who has bipolar disorder, was being thrown off my insurance policy through work.
Then came the tricky business of getting medicaid or social supports for an adult child living at home...
the answer is always nope you keep paying for them in full forever, even when that means you might
not make your rent. I was paying $800 a month for his medications. Fortunately we found a special
program called Way Station (in Maryland), and those people knew what they were doing. With their
help, within 60-90 days they got him on public assistance for meds, doc visits, and even got him
public housing.... sadly we had reached a point where him living with me was not in his best interests...
bipolar can make its victims the most stubborn blockheads at times, where you cannot reason or argue,
and he was doing nothing but sitting and eating and gaining horrible weight amounts. Wouldn't take out
the trash or clean up at all after himself, left piles of pizza boxes and soda around, etc. Was really bad.
Way Station took him in, and taught him to be independent. Now, 13 years later, they have him in his
own apartment and much more independent. He works when he can (though sadly each time at some
point his condition gets the best of him and he ends up quitting because he can't do it anymore). But
he can now make the most of his life as is possible. He's really a good soul, with a loving heart, when
he is stable.

At that time, his medicines were almost as much as my rent, and I didn't make that much. It was a
nightmare.

I wish I'd known about Costco then, because I think there was one very close by. I worked 12 hour shifts
at the time in a restaurant, so I never went out to shop except for groceries... no money, energy, or time.

[djean111]

10. Sounds like you have been through a lot, and handled a lot, too. With class.

My son has PTSD (non-combat). Been a struggle.

[DebJ]

2. Once you get in the donut hole, looks like the chances of getting out are pretty slim

unless you are already in a pickle with many or severely high cost drugs.

If I understand this right, you don't get out until you fork over $4700 )(or you and YOUR PLAN fork it over).

Boy this is exhausting.

[Downwinder]

5. If you can qualify for "Extra Help" it closes the donut hole.

[Bluenorthwest]

11. I opened the thread to say 'Costco' but that's been covered!

Just got one today, $12.00 instead of $57.00

[daredtowork]

12. Some ppl have mentioned Good Rx

Good Rx is some sort of web site that finds the best price for drugs.

[csziggy]

15. After I saw GoodRx here on DU I checked their discounts

I threw away my comparison chart but my most expensive drug was dropped from $241 to $85 using their coupon. It costs nothing to sign up and they show the prices from various pharmacies in your area.

So far I am happy with using GoodRx but I've only had one set of refills since signing up.

[HeiressofBickworth]

13. Before I went on Medicare

I had a conversation with my primary care doctor. We switched all that we could to generic drugs. Only one remains that is not a generic. Then I shopped around.

I now get all the generics from Costco -- we already had a membership so there was no additional charge for that. I only get the brand-name drug through my Part D insurance. I pay less for the generics that I would if I had to pay a co-pay under Part D.

The problem with the donut hole is that while in the hole, you have to pay full retail for EVERYTHING. By dividing up the generics (not under Part D) and the brand-name submitted to insurance, I've avoided the donut hole.

[DebJ]

14. You mean that you just pay cash in full for the generics?

Interesting strategy.

[HeiressofBickworth]

16. Yes, cash in full for generics

When I first signed up for Medicare in 2010, I used the Plan D calculator to find a plan that had no yearly deductible and yet had a monthly premium I could afford. I then used the drug calculator on the medicare website and found that by using the insurance and based on the brand-name drugs I was taking, I would hit the donut hole in May and then would have to pay full retail until I hit $4,700 in out of pocket costs. I then went to my GP and we discussed the various drugs and switched to the least expensive generics wherever possible. I now use the insurance for only the most expensive of the drugs, one which does not have a generic equivalent. I checked a couple of drugstores, but decided to use Costco for the generics which keeps those costs down. There are other places (like the wicked Walmart) that has very inexpensive generics, but, just as a personal matter, I would never, but never go to a Walmart, even if they were GIVING the stuff away. So far, this plan has worked out just fine for me.

As an example of how it is working, there was one drug I had been taking for quite some time that the price (even at Costco) tripled in one month. Went back to the doctor and got a prescription for the same class of drug, different name, different manufacturer which brought the cost down again.

The donut hole will not disappear until 2020. By then, the pharmaceuticals will have bought enough congress critters to change the laws again to further squeeze money out of our pockets.