Posted on 10/21/2022 7:25:51 AM PDT by George from New England
Linzess pricing punishes medicare patients
So make me pay $240 for 90 day supply, not $30.
For those that ask. This is Wellcare Advantage plan. Tier 4 I guess. If anyone sees this med on a different tier, please post.
I suspect the following is the issue. The drug is available at reduced price but only a ninety-day supply, in essence, a trial prescription. After that the price goes up. The reason they won’t honor the same deal with any government insurance is that they must always give the government their lowest price. That means they will always have to sell the drug on a government insurance at the thirty-dollar price even if they are losing money. So, they just lock out any government insurance.
You might try getting it from a Canadian or European pharmacy. But the reason those are cheaper is because they are in medically socialist countries. For the US to grant approval the company must sell limited allotments of the drug to Canadian and European countries. The people who get the drug at sometimes ridiculous discounts then prefer to resell it over the internet to the US rather than at the controlled price at home. Say X sells for ten dollars per pill in the US. The supplier must sell limited allotments to, say, Canada at three dollars per pill. Canada says the Canadian pharmacy is capped at two dollars per pill. The Canadian pharmacy puts it on the market for five dollars per pill. This is why overseas countries are chronically out of simple thigs like heart medications that we can just go to any pharmacy and find it in stock.
I have 5 generic prescriptions. If I paid cash price at Walmart, they would cost me just under $200 for a 3-month supply.
Through my Medicare Advantage insurance, I now pay $0 and the insurance pays Walmart just over $17 for a 3-month supply.
That is quite a disparity.
The reason is more likely the same reason why physicians and other medical providers are not (with a one time exception) allowed to reduce the amount they bill a patient (not what Medicare pays mind you put what is billed). That reason is what is known as “Usual and Customary Reasonable Charges” for a region. Medicare basis their reimbursement on this UCR. So if the government has determined a office consult in Baxter County should be $225.00 your doctor bills you $350.00 and gets reimbursed for 80% of the allowable $225.00. Now here comes the flip side of that. Say your doctor decides to give you a break and charge you $300.00 as part of a discount program Medicare will then consider that the UCR and accuse the physician of Medicare fraud if the other patients are billed that $350.00.
This same principle holds true for prescriptions.
Ooops. Though not adhering to the UCR can result in charges under False Claims Act the reason pharmacy companies are not permitted to offer drug discounts to Medicare patients is a lot simpler. And to quote from Very Well Health,
“It’s illegal for pharmaceutical companies to offer discounts for medications that you purchase through Medicare due to the Social Security Amendments of 1972. Included in those amendments is the Anti-Kickback Statute (AKS).
The AKS prohibits anyone—drug manufacturers included—from giving a customer anything of value that could result in referrals for items or services that are paid for by a federal healthcare program.”
Unfortunately, drug coupons and rebates fall into that category. If a pharmaceutical company entices you to choose more expensive options, Medicare would likely spend more money than it would if you took lower-cost alternatives like generic medications”
You make an interesting point. Before I was on Medicare I was without insurance. While waiting at the scheduler’s desk for a surgery date I noticed she was searching three months out. (Small town, just a handful of urologists.) I said I was paying cash. Her eyebrows went up and she said, “Can you be here Friday morning?” I said yes. She said, “We’re not ordinarily open Fridays. But knock on the door at eight and someone will let you in.”
The total cost was less than my portion would have been on the Obamacare paper mâché plan.
Hey, thanks! I got a little smarter today. Doesn’t happen often.
That’s really awful and I’m sorry for all of us in this kind of situation. It often seems Medicare is determined to get our last dollars.
I’m not too familiar with Linzess, is there an alternative or generic? I hope you find something else.
AbbVie does not have a free goods program for Linzess and per federal regulations any type of copay assistance can’t be provided to those having federal insurance, I.e., Medicare, Tricare etc. it’s not the manufacturer driving this. Depending on your income level there are independent foundations that will award monetary assistance. Check out Pan Foundation or Healthwell. It’s end of year so funds are likely closed but you can get on a waiting list for 2023.
I’ve noticed that with Pharmacies, usually the grocery stores, offering “Get $25 for transferring your prescription.”
Never allowed with Gov programs.
Strangely enough, they do offer a 10% off coupon with COVID and flu vaccines.
mid page is ad for 90 days for $30
YOU MAY BE ELIGIBLE TO GET
90 DAYS FOR AS LITTLE AS $30* WITH THE LINZESS SAVINGS PROGRAM
So if this is not ‘free goods’ what is it called ?
You are welcome. Have you asked the prescribing doctor for a sample. It is likely he has a few from the detail rep. It does not make sense to lay out money for a new drug if you do not know your tolerance level let alone the $$$. Double check that your drug plan allows it on the formulary. If not and the generic is not available or advised the plan will probably require a letter from your doctor as to why it specifically is medically necessary. The drug plan might allow a one time exception without your doctor’s letter. Never hurts to ask.
GoodRX coupons are over $500 for 30 capsules.
My mother is on Medicare and paid $115 for 30 capsules
Not sure how to get it cheaper
did you go to link on post 12 ?
Why is it that if you don’t have insurance and pay cash you get charged more? Actually full amount. Hell. If medical costs were only what was paid by insurers then there would be little or no need for insurance.
“Based on the information you have provided, you are not eligible to participate in this program.”
“you are not eligible to participate in this program.”
That’s why I made this post. Probably the majority of their customer base are seniors !!
So do you support this company misleading seniors with these ads ?
I suspect the fed requirement for drug companies to post prices 2 to 3 years back, resulted in this deception.
The funny thing is, it costs $115 for 30 capsules and $90 for 90 capsules. I think the doctor has to prescribe 30 capsules for the first prescription.
Copay assistance.
The drug manufacturer will provide financial assistance in the form of dollars that satisfy a copay if you meet certain criteria. They are not allowed to send you free drug if you are on any kind of government insurance.
An example of the 90 days for $30 would be if you have a commercial insurance plan but the plan does not cover the drug and your doctor wants you on it. Or you just don’t have any commercial insurance but are also not on Medicare or Medicaid, I.e., self employed
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.