How does/can Walmart offer such inexpensive prescriptions?

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Ruger
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Ruger »

arcticpineapplecorp. wrote: Sat Oct 21, 2017 2:27 pm
I think they can make up any losses because they're getting a ton of money from the insurers.
I also think this. I pay for my prescriptions out of pocket at WalMart because it costs me less than if I go through the insurance company.
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heartwood
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by heartwood »

dm200 wrote: Sat Oct 21, 2017 2:08 pm I have (in my opinion) a very good Medicare plan (medicare cost - like advantage - with drug coverage). I take a drug (will need to take for the rest of my life) and now pay $30 for a 90 day supply (refill US Mail). I see this same drug available at Walmart for much less (I have a friend who gets that same drug at Walmart) - cash price, not through any insurance.

How do they do this (profitably)??

I also see it at Rite-Aid for $16. How do they do it?
Back to the OP, here's a link to an article that suggests easy to sell generics for less than your copay.

http://www.pharmacytimes.com/contributo ... scriptions

It blames the PBM (Pharm Benefits Manager) like Express Scripts etc. "Nevertheless, one respondent indicated a major PBM required the pharmacy to collect a $35 co-pay for a generic allergy spray, then took $30 back from the pharmacy. Another said a PBM charged a $15 co-pay for zolpidem, then took back $13.05."

As others have noted actual costs for generics can be pennies a tab so Walmart and many others can make money if they have a reliable source. If your Rx is for a common generic, the advice is not to use any drug plan you have, but ask the pharmacist what the charge is using cash outside your coverage.
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ram
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by ram »

When I volunteer at medical camps in a 3rd world country I prescribe a pill for a chronic disease which costs $0.25 for 100 tablets (typically 100 day supply). This pill has many side effects but is a very good choice when the options are this pill or no pill. The manufacturer and pharmacy are making a small profit even at that price.

It is no longer in use in US. The $4/ mo option available in the US for the same condition has much less side effects.

Another brand name drug that I prescribe costs $700/ x mg. Guess how much 2x mg costs. Same.

This is possible because the actual cost of manufacturing are very small.

For example for the x mg dose:
Manufacturing cost $1.
Drug development, marketing, potential liability, profit: $699

Thus the 2x mg dose in this example should be priced at $701.

The side effects of a new drug frequently becomes known many years after it is sold. Sometimes drug manufacturers have substantial liability costs. Liability costs are substantially higher in USA than in many other countries. The manufacturer has to take that into consideration at the time of setting the price. This is one (out of many) potential reason why a given drug is more costly in US than in other countries. ( I do not work for a drug company and my investment in drug manufacturers is as part of broad market indices)
Ram
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ResearchMed
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by ResearchMed »

retiredjg wrote: Sat Oct 21, 2017 8:39 pm
rxtra8 wrote: Sat Oct 21, 2017 4:10 pm I was in the RX business for many years and now retired. I worked for a megacorp HMO and ran a $15mil inventory. Most generic drugs cost very little; even less than 1 penny per tablet for quite a few. It is easy to make money on $4 generic RXs.

I am of the opinion that generics are basically the same as the brand name in almost all cases. The only exception is for NTI drugs; narrow therapeutic index...such as warfarin, seizure meds, thyroid meds. These should always be monitored after a change of mfg. If there is a difference it is usually very little, but remember the bell shaped curve for response; some will be on the tail end. We once changed a brand name seizure med and the generic actually gave better bioavailability.
I found this interesting since I have seen something similar in a seizure drug for one of my animals. I observed a dramatic change in seizure activity when the manufacturer changed. The pharmacy says they have no control over what generic they get when they order it. This has been very frustrating.
Try another pharmacy, one that will help you with requesting a different manufacturer. It might need to be a smaller non-chain pharmacy.
Or a compounding pharmacy might be able to help, given they have a variety of resources.

RM
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mouses
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mouses »

dm200 wrote: Sat Oct 21, 2017 4:53 pm
My cardiologist is adamant that his patients take the brand name Toprol rather than any of the generics.
Go to this web site https://projects.propublica.org/docdollars/ and type in your cadiologist's name and state and see how much he/she received from the manufacturer of Toprol. I typed in the name and state of a cardiologist I saw two years ago, and he got $93 (4 payments) in 2014 and $14 (one payment) in 2015. Payments include free drugs, food/beverage, speaking fees aand some others (all detailed).

Let us know what you find out.
Go to google and type in recalls metoprolol and let us know what you find out. Indian companies seem to be making the generics in their bathtubs or something. Just joking, but one would think that from the recalls.

$14. Wow, that would probably buy the average cardiologist half a lunch.
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Re: How does/can Walmart offer such inexpensive prescriptions?

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me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
Thank you for caring for the patients on the financial side.
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ResearchMed
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by ResearchMed »

me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
I have a few questions about "how" this all works, at least much of the time.

You wrote: "In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy."

I'm not sure if our insurance differs a lot from others, as we've been with the same health insurance for some time, and it's from an employer who self-insures, but has a regular insurer manage the process. (I'm assuming that means somewhat less of a profit motive overall?)

So, we do see some generics especially that are billed to us at lower than the copay. It could be something like $9.17 when the copay is $15 (fictitious numbers throughout). Then there is the other line item of "billed to insurer", which becomes "$0.00".

But when there is an additional amount billed to insurance (which is far more common), is that what you mean about "... your insurance pays an additional amount for the drug to the pharmacy"?
Or is there something else of a hidden kickback somewhere/somehow?
Or...??

And yes, thank you for your assistance to those who need it!

RM
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Salmon Maki
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Salmon Maki »

ResearchMed wrote: Sun Oct 22, 2017 8:51 am
me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
I have a few questions about "how" this all works, at least much of the time.

You wrote: "In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy."

I'm not sure if our insurance differs a lot from others, as we've been with the same health insurance for some time, and it's from an employer who self-insures, but has a regular insurer manage the process. (I'm assuming that means somewhat less of a profit motive overall?)

So, we do see some generics especially that are billed to us at lower than the copay. It could be something like $9.17 when the copay is $15 (fictitious numbers throughout). Then there is the other line item of "billed to insurer", which becomes "$0.00".

But when there is an additional amount billed to insurance (which is far more common), is that what you mean about "... your insurance pays an additional amount for the drug to the pharmacy"?
Or is there something else of a hidden kickback somewhere/somehow?
Or...??

And yes, thank you for your assistance to those who need it!

RM
I think your confusion is because some PBMs charge the full copay no matter what and some charge just the pharmacy price if the copay is higher than the drug price. I believe Express Scripts does charge the higher amount while some others do not.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by me112964 »

ResearchMed wrote: Sun Oct 22, 2017 8:51 am
me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
I have a few questions about "how" this all works, at least much of the time.

You wrote: "In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy."

I'm not sure if our insurance differs a lot from others, as we've been with the same health insurance for some time, and it's from an employer who self-insures, but has a regular insurer manage the process. (I'm assuming that means somewhat less of a profit motive overall?)

So, we do see some generics especially that are billed to us at lower than the copay. It could be something like $9.17 when the copay is $15 (fictitious numbers throughout). Then there is the other line item of "billed to insurer", which becomes "$0.00".

But when there is an additional amount billed to insurance (which is far more common), is that what you mean about "... your insurance pays an additional amount for the drug to the pharmacy"?
Or is there something else of a hidden kickback somewhere/somehow?
Or...??

And yes, thank you for your assistance to those who need it!

RM
I think that I am most concerned about the profit margins for medications that are vital and, unfortunately, often needed by those who can least afford them. I believe in responsible capitalism that respects the consumers. I don’t feel that exists when it come to pharmaceuticals. It is heartbreaking when my Medicare patients hit the “donut hole” where they have reached the maximum amount their Medicare D plan will cover. When Medicare D was first introduced, that typically occurred in the final month of the year. Now I am seeing patients enter that as early as June or July. Yet these companies conitinue to show growth and profit. This is medicine and people that we are talking about. Not luxuries
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dm200
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

With a previous physician and insurance, I was taking 50 mg of a drug. Get the generic at the generic price. There were some supply problems with the generic. Then, I was charged much higher, and the pharmacist said I got the brand. OK, since no generic, why not lower price? He said their is a generic, but only 25 mg. OK, then why not give me 2 25 mg? Can't do that, he said, because prescription written for 50 mg.

Asked doctor to write prescription for 2 25 mg - and I got the much lower price generic.

Switched doctors and insurance. Initially, new plan just filled the existing prescriptions without question. I then asked doctor to change from 2 25 mg to one 50 mg. "Oh no", she said, "This drug (on our formulary) is only allowed for Heart failure and you do not have heart failure. We can look for another drug for you." I said, what about just stopping it?" She said, "OK, but drop to 25 mg for a few weeks and then stop". I did and NO problems.

Just "bureaucracy" can add unnecessary costs to prescription drugs.

It has also been my experience (over many years) as a patient - that Physicians are usually very reluctant to initiate telling a patient that the patient could/should stop any existing prescribed drugs. My current physician (7 years), though, is cooperative when I ask/initiate whether I can stop taking a drug or reduce the dosage.
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dm200
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

I think that I am most concerned about the profit margins for medications that are vital and, unfortunately, often needed by those who can least afford them. I believe in responsible capitalism that respects the consumers. I don’t feel that exists when it come to pharmaceuticals. It is heartbreaking when my Medicare patients hit the “donut hole” where they have reached the maximum amount their Medicare D plan will cover. When Medicare D was first introduced, that typically occurred in the final month of the year. Now I am seeing patients enter that as early as June or July. Yet these companies conitinue to show growth and profit. This is medicine and people that we are talking about. Not luxuries
One (of many questions) about drugs needed by so many folks is whether they all need expensive drugs when there is (or might be) a lower cost one that (for them) is just as good. The drug companies and their reps that we often see in Physician offices with their bags and boxes of goodies, I am sure are promoting and "educating" Physicians about new and more expensive drugs. I doubt they will ever tell a Physician that some old, inexpensive drug is just as good for most patients.
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ResearchMed
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by ResearchMed »

Salmon Maki wrote: Sun Oct 22, 2017 9:06 am
ResearchMed wrote: Sun Oct 22, 2017 8:51 am
me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
I have a few questions about "how" this all works, at least much of the time.

You wrote: "In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy."

I'm not sure if our insurance differs a lot from others, as we've been with the same health insurance for some time, and it's from an employer who self-insures, but has a regular insurer manage the process. (I'm assuming that means somewhat less of a profit motive overall?)

So, we do see some generics especially that are billed to us at lower than the copay. It could be something like $9.17 when the copay is $15 (fictitious numbers throughout). Then there is the other line item of "billed to insurer", which becomes "$0.00".

But when there is an additional amount billed to insurance (which is far more common), is that what you mean about "... your insurance pays an additional amount for the drug to the pharmacy"?
Or is there something else of a hidden kickback somewhere/somehow?
Or...??

And yes, thank you for your assistance to those who need it!

RM
I think your confusion is because some PBMs charge the full copay no matter what and some charge just the pharmacy price if the copay is higher than the drug price. I believe Express Scripts does charge the higher amount while some others do not.
That's interesting (and unfortunate).
But I wonder if that is "plan" specific. Until about a year ago, we used Express Scripts before our plan changed to a different pharmacy manager, and there were also times that we paid less than the "co-pay", with zero obviously billed to insurer.

In cases like you are describing, can one ask for the cash price, or would that automatically get you the "uninsured" price, which is often higher?

And... does this happen with Medicare, charging the patient more than the actual cost, up to the full co-pay?
What about when "insurance pays an additional amount for the drug to the pharmacy" - does that ever happen with Medicare, such that the pharmacy ends up charging "too much", and then takes a kickback (under whatever name?)?

Also, separately, is there a concise history of how the "donut hole" came about, anywhere?

RM
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Salmon Maki
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Salmon Maki »

[/quote]

That's interesting (and unfortunate).
But I wonder if that is "plan" specific. Until about a year ago, we used Express Scripts before our plan changed to a different pharmacy manager, and there were also times that we paid less than the "co-pay", with zero obviously billed to insurer.

In cases like you are describing, can one ask for the cash price, or would that automatically get you the "uninsured" price, which is often higher?

And... does this happen with Medicare, charging the patient more than the actual cost, up to the full co-pay?
What about when "insurance pays an additional amount for the drug to the pharmacy" - does that ever happen with Medicare, such that the pharmacy ends up charging "too much", and then takes a kickback (under whatever name?)?

Also, separately, is there a concise history of how the "donut hole" came about, anywhere?

RM
[/quote]

No, the policy doesn’t happen with Medicare. I’m not sure about the history of the coverage gap, but it’s being phased out and supposed to be eliminated in 2020.
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neurosphere
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by neurosphere »

Big Dog wrote: Sat Oct 21, 2017 3:54 pm
That being said, you are exactly correct in that all generics do not react exactly the same in the body as the branded Rx. Partly that is due to the fact that the FDA only requires that the generic come close to 100% of the brand -- it could be +/-. But also, the binders and fillers are different and maybe digested faster or slower.
This is not true. There is no "close enough" allowed with generics that does not also apply to branded drugs. Generics have to have the same amount of active drug AND the same amount of active drug which gets into the system AND the peaks/valleys in the blood need to be the same. This is tested on the pill level (just measure the drug in the pill) and on the patient level (health volunteers are given brand and generic and blood levels measured).

One FDA study of several generic drugs showed that generics were within 3.5% in "bio-equivalence".

In most studies the batch-to-batch variability of the brands drug had more variability than different generics had with each other.
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dm200
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

Also, separately, is there a concise history of how the "donut hole" came about, anywhere?
As I recall, this was a political compromise needed to get the Medicare Drug coverage bill passed. This "donut hole" reduced the cost of providng drug coverage and still provided significant drug benefits to the vast majority of Medicare recipients (those below the donut hole). it also placed a kind of cap on drug expenditures for those with high or very high drug costs. This compromise (as best I recall) was necessary to get the votes to pass the bill.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Toons »

This may not pertain to their negotiating medicine prices with suppliers,,,but
I recall quite a few years back reading a quote about Walmart in the Wall Street Journal,
when negotiating real estate prices,,,,,
"They aren't satisfied until they are tap dancing on your grave" :shock:
"One does not accumulate but eliminate. It is not daily increase but daily decrease. The height of cultivation always runs to simplicity" –Bruce Lee
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mouses »

RM, the donut hole was Congress at work for BigPharma.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mmcmonster »

Salmon Maki wrote: Sat Oct 21, 2017 5:55 pmDo you follow through to find out if they are successful in getting sildenafil? The generic is for pulmonary hypertension, and every company I know limits use to patients with pulmonary hypertension. And those tablets are definitely not $1.
I've had followup via my office nurses. If the pharmacist asks the patients what they are using it for and the patient replies 'erecile dysfunction', the pharmacists may not fill the presciption. If they reply 'it's private' or 'none of your business', the pharmacists are filling the scripts.

The tide is turning, locally. I've had more patients note on followup that they're getting it filled no questions asked. The hospital pharmacy went the other way: They actually had one of my old scripts for 'Viagra 100mg' and asked if it was okay to do a therapeutic interchange for sildenafil 20mg 5 tablets.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mmcmonster »

dm200 wrote: Sun Oct 22, 2017 12:01 pm
Also, separately, is there a concise history of how the "donut hole" came about, anywhere?
As I recall, this was a political compromise needed to get the Medicare Drug coverage bill passed. This "donut hole" reduced the cost of providng drug coverage and still provided significant drug benefits to the vast majority of Medicare recipients (those below the donut hole). it also placed a kind of cap on drug expenditures for those with high or very high drug costs. This compromise (as best I recall) was necessary to get the votes to pass the bill.
I like the donuthole. It puts a little pressure on the physicians prescribing the medications to have a conversation with the patients about why they need to start paying for things.

That being said, there should be a list of medications (updated regularly) which are exempt from the donuthole. Made up of medications that are proven to work but expensive (ie: that cure for hepatits C).
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Pajamas »

As someone above suggested, sometimes the cash price for a prescription is less than the copay with insurance. I always ask because in my experience at the chain pharmacies near me, they don't check to see if that is the case, unless I ask. I have also been on an expensive medication for which a generic became available and again, I had to ask for the generic.

Some pharmacies also have a minimum amount that they charge to fill a prescription. If you get ten tablets, you may pay just as much as when you get thirty tablets. Occasionally it might be appropriate to ask your doctor for a greater quantity if that is the case.

When it is best to stick to the same manufacturer for the few medications such as levothyroxine for which the various versions differ slightly in their effect, your doctor can prescribe a specific brand name that may be a little more costly than a random generic but not as much as the leading brand name, such as Synthroid, which is sometimes referred to as a "brand-name generic".
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by cutterinnj »

me112964 wrote: Sat Oct 21, 2017 3:04 pm I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
You are a very good person.
However, be careful.
That is technically illegal, as it could be considered an inducement.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by cutterinnj »

Salmon Maki wrote: Sat Oct 21, 2017 5:55 pm
mmcmonster wrote: Sat Oct 21, 2017 3:20 pm I am a physician (as are many on this Forum, I would suspect!).

Walmart, KMart, and Target all have $4/month lists that they keep up to date with a wide variety of generic pills. The latest lists you can get from their websites. As some have mentioned, these are loss-leaders, to get you in the door and buy both your more expensive meds as well as other non-pharmaceuticals.

If you're shopping around for medications, you should also check out https://www.goodrx.com/ . It will give you an idea of which is the least expensive place to get your meds close to you.

We live in an age of inexpensive medications. If you have meds that cost you more than $10/month, you should ask your physician if there are alternatives that are less expensive (and if the alternatives are as good as the one that the physician was planning on prescribing).

My favorite prescription vs. generic story: I have patients come to me for Viagra (for erectile dysfunction). Provided that I feel that it is safe for them to take it, I tell them that Viagra is generally not covered by insurance plans and costs ~$60 for a single 100mg pill. On the other hand, Sildenafil, the active ingredient in Viagra, is generic and costs ~$1 for a 20mg pill. :shock: Would they mind taking five of the 20mg pills instead? You should see the look on their eyes!!!
Do you follow through to find out if they are successful in getting sildenafil? The generic is for pulmonary hypertension, and every company I know limits use to patients with pulmonary hypertension. And those tablets are definitely not $1.

I'm a urologist, and I see tons of men with erectile dysfunction.
I am probably one of the ONLY urologists in the USA who doesn't prescribe viagra/cialis/levitra/staxyn/etc...

100% of my patients who are candidates for medical therapy get sildenafil 20mg.
I use Medisuite, which sells 90 pills for 95 pills shipped. There are others as well; GoodRx may have coupons for local pharmacies that are sometimes even cheaper.
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ram
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by ram »

dm200 wrote: Sun Oct 22, 2017 9:16 am
I think that I am most concerned about the profit margins for medications that are vital and, unfortunately, often needed by those who can least afford them. I believe in responsible capitalism that respects the consumers. I don’t feel that exists when it come to pharmaceuticals. It is heartbreaking when my Medicare patients hit the “donut hole” where they have reached the maximum amount their Medicare D plan will cover. When Medicare D was first introduced, that typically occurred in the final month of the year. Now I am seeing patients enter that as early as June or July. Yet these companies conitinue to show growth and profit. This is medicine and people that we are talking about. Not luxuries
One (of many questions) about drugs needed by so many folks is whether they all need expensive drugs when there is (or might be) a lower cost one that (for them) is just as good. The drug companies and their reps that we often see in Physician offices with their bags and boxes of goodies, I am sure are promoting and "educating" Physicians about new and more expensive drugs. I doubt they will ever tell a Physician that some old, inexpensive drug is just as good for most patients.
See the WHO list of Essential medicines. http://www.who.int/medicines/publicatio ... May-15.pdf This is what I would consider as the equivalent of the '3 fund portfolio' that we frequently discuss here.
Certainly adding small caps or REITS or Value stocks may modestly increase the returns. But most of us will agree that a 3 fund portfolio will deliver at least 90% of the return of anybody's spiced up portfolio. And many of us say that is good enough.

Coming back to medicine I am inclined to speculate that on a worldwide basis simply using the WHO list will capture 90% of the health benefits of all the drugs available. For many poorer countries that is good enough. It is good enough for me and my wife when we volunteer overseas. It is NOT good enough for me when I practice in the US. My patients demand the best and I am obligated to offer it to them.

Many of my patients go into the donot hole around this time of the year. I change them to cheaper options for the rest of the year. (with its attendant recaliberations). Come Jan 1 almost all patients want to go back to the costlier options with another round of recaliberations. The cycle repeats. I do give them the option of staying on the >90% as good cheaper option on Jan 1 but I have few takers.

I believe other industrialized countries (say NHS of Britain) do not have to go through such things. If you are interested the NEJM (New England Journal of Medicine) ran comparison articles on health systems across the world a couple of years ago. These should be available free at their website. You do not have to be a physician to understand most of it.
Ram
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mouses »

mmcmonster wrote: Sun Oct 22, 2017 2:29 pm
I like the donuthole. It puts a little pressure on the physicians prescribing the medications to have a conversation with the patients about why they need to start paying for things.
Perhaps you can explain that statement a bit further. I shell out about $800 a month in the donut hole. I would be interested to know why you think insurance should not cover this.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mouses »

cutterinnj wrote: Sun Oct 22, 2017 3:34 pm
me112964 wrote: Sat Oct 21, 2017 3:04 pm I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
You are a very good person.
However, be careful.
That is technically illegal, as it could be considered an inducement.
Occasionally my doctor hands me samples of meds I take that reps have left. How is that different?
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by mrc »

mouses wrote: Sun Oct 22, 2017 4:55 pm
cutterinnj wrote: Sun Oct 22, 2017 3:34 pm
me112964 wrote: Sat Oct 21, 2017 3:04 pm I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
You are a very good person.
However, be careful.
That is technically illegal, as it could be considered an inducement.
Occasionally my doctor hands me samples of meds I take that reps have left. How is that different?
Docs don't pay for samples. Packages are marked "sample not for sale" too. Good person trying to do good things. But ...
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Yooper »

On the flip side, Walmart charges me $30 for 90 days of generic Lipitor, whereas I can get it for free from Meijor (a Michigan chain) just down the road.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by bottlecap »

mouses wrote: Sat Oct 21, 2017 2:13 pm I will hazard a guess.

My understanding is that Walmart has low prices because it has low salaries for its employees, low benefits, buys stuff from China, etc. If it is losing money on prescriptions, it can make it up, probably, in other areas of the store. The theory might be that if people come in to buy low cost prescriptions, they will buy other stuff before they leave, net profit.
I don't know what the answer is, but this is implausible.

Walmart pays benefits and more than the federal minimum wage. Better than Mom and Pops for sure.

Yet when Walmart sells life-giving medicines for cheap, it's because it is an evil corporate entity that is luring customers in to spend the big dollars on: inexpensively priced goods that are more expensive elsewhere.

Somebody please let me in on where the real conspiracy is!

JT
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Pajamas »

bottlecap wrote: Sun Oct 22, 2017 8:30 pm
I don't know what the answer is, but this is implausible.

Walmart pays benefits and more than the federal minimum wage. Better than Mom and Pops for sure.

Yet when Walmart sells life-giving medicines for cheap, it's because it is an evil corporate entity that is luring customers in to spend the big dollars on: inexpensively priced goods that are more expensive elsewhere.

Somebody please let me in on where the real conspiracy is!

JT
Walmart has improved their labor practices to some degree but there have been egregious violations in the past, such as locking in employees overnight. Other abusive practices continue.

http://www.nytimes.com/2004/01/18/us/wo ... -mart.html
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by bottlecap »

Pajamas wrote: Sun Oct 22, 2017 8:35 pm
bottlecap wrote: Sun Oct 22, 2017 8:30 pm
I don't know what the answer is, but this is implausible.

Walmart pays benefits and more than the federal minimum wage. Better than Mom and Pops for sure.

Yet when Walmart sells life-giving medicines for cheap, it's because it is an evil corporate entity that is luring customers in to spend the big dollars on: inexpensively priced goods that are more expensive elsewhere.

Somebody please let me in on where the real conspiracy is!

JT
Walmart has improved their labor practices to some degree but there have been egregious violations in the past, such as locking in employees overnight. Other abusive practices continue.

http://www.nytimes.com/2004/01/18/us/wo ... -mart.html
Let's assume everything the Times writes is true (cough). There are thousands of stores and over the last 20 years, I'm sure that not all of them have been perfect every day. Nor have small businesses.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Pajamas »

bottlecap wrote: Sun Oct 22, 2017 8:39 pm
Let's assume everything the Times writes is true (cough).
Not only the NYT reported that and as far as I'm concerned, that type of comment without a quick Googling to see that means that the conversation is over.

Have a good evening.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by bottlecap »

Pajamas wrote: Sun Oct 22, 2017 8:45 pm
bottlecap wrote: Sun Oct 22, 2017 8:39 pm
Let's assume everything the Times writes is true (cough).
Not only the NYT reported that and as far as I'm concerned, that type of comment without a quick Googling to see that means that the conversation is over.

Have a good evening.
Considering your comment wasn't even germane, you are correct.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by hushpuppy »

delete
Last edited by hushpuppy on Fri Nov 17, 2017 8:58 am, edited 1 time in total.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Farmboyslim83 »

It's really not that complicated:

*Buy low/sell low

*Walmart's "cash" prices, or "negotiated prices" if you are on a HDHP, will almost always be lower than other chains/independents, because the others usually charge too much.

*Your employer/health plan/Medicare plan sets copays with their PBM. If you have a $10 or $15 dollar "tier 1" generic copay, AND if your benefit language does not say "if the cash price is less than the copay, the member pays the lower of the two," you better watch it, and shop around. Employers/health plans/Medicare plans don't like it when you don't use your insurance, but most patients do anyway.

*Not sure where "...money from insurers" got started, all chain pharmacies and independent pharmacies have contracts with as many health plans/PBM's as will let them in the network. I.e. they get paid what they've negotiated.

*OP, most Medicare plans have preferred pharmacy networks, where the copays are lower. A $5. per Rx difference adds up, if you're on 5 or 10 generic meds.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

hushpuppy wrote: Sun Oct 22, 2017 10:48 pm
dm200 wrote: Sun Oct 22, 2017 9:11 am It has also been my experience (over many years) as a patient - that Physicians are usually very reluctant to initiate telling a patient that the patient could/should stop any existing prescribed drugs.
There is much good information in this thread, but this in particular hit home with me. I was placed on one medicine after a heart attack (Protonix) that is not recommended for long term use. It likely contributed to bone density loss (discovered due to cracked ribs) and increased kidney damage among other issues I won't mention in polite company. I survived much longer than expected and after approximately five years, I spoke to my cardiologist. My cardiologist agreed I need not continue Protonix. YMMV.
Regards,
hushpuppy
Glad you spoke up..

I always ask my Physicians (and do the best to understand) why anything is prescribed or advised - even continuing medications.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by ResearchMed »

rgnort wrote: Mon Oct 23, 2017 8:43 am It's really not that complicated:

*Buy low/sell low

*Walmart's "cash" prices, or "negotiated prices" if you are on a HDHP, will almost always be lower than other chains/independents, because the others usually charge too much.

*Your employer/health plan/Medicare plan sets copays with their PBM. If you have a $10 or $15 dollar "tier 1" generic copay, AND if your benefit language does not say "if the cash price is less than the copay, the member pays the lower of the two," you better watch it, and shop around. Employers/health plans/Medicare plans don't like it when you don't use your insurance, but most patients do anyway.

*Not sure where "...money from insurers" got started, all chain pharmacies and independent pharmacies have contracts with as many health plans/PBM's as will let them in the network. I.e. they get paid what they've negotiated.

*OP, most Medicare plans have preferred pharmacy networks, where the copays are lower. A $5. per Rx difference adds up, if you're on 5 or 10 generic meds.
Why would "Employers/health plans/Medicare plans [not] like it when you don't use your insurance"?
Wouldn't that save them money, if the patient pays out of pocket to save money (e.g., in this case, for an Rx price lower than the co-pay)?

RM
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by sport »

Salmon Maki wrote: Sun Oct 22, 2017 9:06 am
I think your confusion is because some PBMs charge the full copay no matter what and some charge just the pharmacy price if the copay is higher than the drug price. I believe Express Scripts does charge the higher amount while some others do not.
My Part D plan uses Express Scripts. I frequently pay less than the full copay for some generics.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by misterno »

mouses wrote: Sat Oct 21, 2017 2:13 pm I will hazard a guess.

My understanding is that Walmart has low prices because it has low salaries for its employees, low benefits, buys stuff from China, etc. If it is losing money on prescriptions, it can make it up, probably, in other areas of the store. The theory might be that if people come in to buy low cost prescriptions, they will buy other stuff before they leave, net profit.
low salaries?

I live in the cheapest city on earth (Houston) and minimum wage is 7.53 and walmart pays employees who can not even speak English some very old some semi disabled people new immigrants they are paid $10/hr

Is this low wage? They are payin g way above minimum to someone who can not even talk.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by boglesmind »

ResearchMed wrote: Sat Oct 21, 2017 3:41 pm
dm200 wrote: Sat Oct 21, 2017 3:25 pm
With all due respect, I'd love to get down in the weeds. As far as I know, to be a certified generic in the US, the FDA requires the exact same active ingredients. Now, a manufacturer may change the non-active fillers, but those should have no medical effect.
OK. I do agree that for true "generics" - it should not make any difference.

This drug is Synthroid or Levoxyl or Levothroid or Levothyroxine Sodium. According to what I read and have been told, the generics, while equally effective, should not be mized or switched unless you have the regular thyroid hormone blood tests. When my health plan refilled my 90 day prescription last year, there was an insert in the refill to consult with the prescribing physician that the supplier of the generic had changed and the Physician may want to run more tests.

So, in this one case, there are these "issues" with different generic suppliers.
This is what we've been told, since the early '80's.

Every few years, I check again with an endocrinologist, expecting them to say, "Oh, that's old; it's okay to take any of them nowadays", but nooooo!
They still (as of about a year ago) tell us that we should stick with (in our case what we've been using) Synthroid, and "accept no substitutes" [what is that phrase originally from!?].
I still find that very surprising.

RM
I know many close friends/relatives who take thyroid hormone replacement. They have all switched to Levothyroxine generic and did blood tests every 3 months a couple of times to ensure that their thyroid level is stable and their co-pay for 3 month supply dropped to $10. A doctor friend of mine told me he does not prescribe Synthroid to his patients.

Cost of production of most medicines (not all) is pennies on the dollar and the price you pay has no relationship to costs. Amazon is supposed to be working on entering pharmacy business and remove the middle man PBMs. Athena Insurance is reportedly working on bypassing PBMs -- hopefully this will lower their costs and benefit the consumer.


Boglesmind
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by ddurrett896 »

loss leader. Huge trip driver!
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by dm200 »

I know many close friends/relatives who take thyroid hormone replacement. They have all switched to Levothyroxine generic and did blood tests every 3 months a couple of times to ensure that their thyroid level is stable and their co-pay for 3 month supply dropped to $10. A doctor friend of mine told me he does not prescribe Synthroid to his patients.
At one point a few years ago, my insurance plan actually preferred Synthroid - during a period, I was actually on Synthroid. At another period, I was on one of the generic versions, but had to be switched to Synthroid because the exact dosage pill was only available with Synthroid.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by heartwood »

sport wrote: Mon Oct 23, 2017 9:44 am
Salmon Maki wrote: Sun Oct 22, 2017 9:06 am
I think your confusion is because some PBMs charge the full copay no matter what and some charge just the pharmacy price if the copay is higher than the drug price. I believe Express Scripts does charge the higher amount while some others do not.
My Part D plan uses Express Scripts. I frequently pay less than the full copay for some generics.
We have Express Scripts too. If I fill a Rx by mail, I get charged the full copay regardless. If I get it at the local pharmacy, still using Express Scripts I'm charged less, sometimes only a dollar or two. It all shows up in my online ES history.

Yes the mail process is for a 90 day supply and the local pharmacy is for a 30 day or less fill, but it makes no sense and the math does not work.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Pajamas »

heartwood wrote: Mon Oct 23, 2017 1:09 pm
We have Express Scripts too. If I fill a Rx by mail, I get charged the full copay regardless.
I have Express Scripts as well, but they charge less than the base copay of $15 for a 90 day supply of a couple of meds, so it may depend on your plan. One med is less than $4 for a 90 day supply.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by AgingOne »

me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
As a pharmacist, this thread has been particularly bashing and assumes I am the devil. However, let's dissect this comment from the altruistic physician.
1) He gives away meds at cost. I have no reason to doubt him. I will point out though that his business is not solely dependent on the revenue generated from the sale of medications. He still gets to charge $150 to the patients insurance plan for the visit, I do not. The insurance will only "allow" maybe $90 of that $150 but still, he is collecting $90+$3.17. Vastly different than the pharmacy charging $6.34 with that "100% profit". Imagine if the pharmacy got to charge you $90-150 just for showing up at the pharmacy.
2) 100% Profit? Are you serious, Clark? Profit is the money left over after all expenses have been paid. According to this premise all pharmacy employees are paid nothing, they work for free (who is altruistic now). Pharmacies do not require phones, internet, electricity, or even running water because those all cost money. Pharmacies are also not allowed to pay rent or other building costs (maybe the building was donated by an altruistic physician?). I will also note that pharmacies are charged a fee by the software vendor for every prescription sent to them electronically (physicians typically do not have to pay this fee because it would reduce the incentive for physicians to use e-scribing technology). Pharmacies are also charged a fee every time a claim is submitted to an insurer for payment, if the insurer imposes a limitation on quantity or anything else and the pharmacy needs to resubmit a different quantity, the pharmacy is charged a second time. This fee can be charged many, many times for a single prescription if the insurer is being particularly difficult. Pharmacies also suffer the wrath of insurance audits which involve finding any and all reasons to take back money previously paid to a pharmacy. One of the primary reasons an insurer will take back money is clerical errors made by the prescriber. The prescriber made a mistake, like not putting a date on the prescription or forgetting their DEA number, and if the pharmacist doesn't catch that mistake, the pharmacy suffers the consequence for the prescribers error. That last point leads to pharmacists calling Dr's over clerical issues which upsets the Dr because they don't understand why they should be bothered with such nonsense. If it was their money being taken away I bet they would make the phone call themselves.

10 years ago the estimated cost to fill a prescription was $7.77, this number excludes drug costs. Therefore, any prescription where a pharmacy charges less than $7.77 is sold at a loss no matter how cheap the drug is (I mean come on, people need paid for showing up to work). Inflation will have increased that number, but I don't have a current figure. Pharmacy is actually a very low margin business these days. I may sell a prescription for $2500, but it may cost me $2400-$2600 to purchase. Brand name drugs often cost me more money than I get reimbursed for by the insurance. Selling hundreds of generics a day with a price over cost of $5-10 is how pharmacies survive. One of my insurers reimbursement averages about 3-4% above my cost to purchase the medications. That means I have to pay all my staff and utilities and cover audit expenses and pay myself with 3% of my sales. For $11,000 in sales I have $330 at the end of that day to pay everyone and make ends meet. Not exactly the cash grab portrayed in the previous comment. A busy pharmacy may generate $20-25,000, which is $750 but involves 2-3 pharmacists needing paid instead of just one.

So, lets pump the breaks on vilifying pharmacies for billing practices all you physicians are doing too. Anybody looked at their EOB (explanation of benefits) after a Dr visit or God forbid, an ER visit? The Dr's physician fee is upwards of $1000 just for walking into the room (to be fair, he/she is only likely to collect 20-30% of that charge, but we are condemning one profession for doing the same thing).

The question at hand about what a pharmacy charges is based on a number of things. 1) contracts - what can the pharmacy buy it for. not every pharmacy buys every drug at the same price as the pharmacy next to it. Meijer may have better pricing for Drug A and WalMart may get better pricing on Drug B 2) Supply and Demand - umm, what CAN you charge? See that example about the ER physician charge, which is a real example of when my wife took my daughter to the ER for burning her hand (they gave her a single dose of Tylenol and wrapped her hand. I had to go to the villainous pharmacy to get the SSD cream for her hand).
Personally, I haven't seen a cash price be cheaper than an insurance price since the roll out of the $4 generics, but that was quickly quelled by upset insurance companies not wanting to be charged $12.99 when a cash customer received a charge of $4. Since then, I have never seen this occur, but I assume it has to as I hear so much about it. Also, most pharmacists will simply bill it as cash if they see this occurring as we are people too, and we tend to value doing the right thing.
The other answers all involve PBMS - the OP using his plans mail order provides that pharmacy with ultimate discretion to charge whatever they see fit. I have heard of some of these mail orders using medication package sizes that are highly atypical and allows them to manipulate the pricing as most remimbursement and thus pricing is based off of a wide scale benchmark like average wholesale price or AWP. All clawbacks are returned back to the PBM and the insurer and are not kept by the actual pharmacy dispensing the medication. there are many states employing legislation to eliminate the ability of PBMs to institute these clawbacks.

I hope this was enjoyable. [OT comments removed by admin LadyGeek]
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by me112964 »

AgingOne wrote: Mon Oct 23, 2017 2:54 pm
me112964 wrote: Sat Oct 21, 2017 3:04 pm Interesting thread. I am a family physician and have gone through the process of pricing generic drugs for patients. When you buy them in bulk, as Walmart most certainly does, the cost is really pennies compared to what retail pharmacies charge. What looks like an awesome deal is simply a gimmick aimed at making you think they care when they really just want to draw you into their stores to purchase other items. In fact, a thirty day prescription for most generic drugs costs less than your copay. What I find most interesting is the fact that not only does the retail chain get your copay, often your insurance pays an additional amount for the drug to the pharmacy.

I can give you hundreds of examples buts let’s try one for now. Simvastatin 40mg can be bought (by me, at a far less discounted rate than bulk buyers) for $3.17 for ninety tablets. When you consider the buying power of Walmart I would guess that they pay half that. That amounts to greater than 100% profit. Not bad for “giving it away”. Pharmacies and drug sales are truly in need of reform. I am tired of having elderly patients trying to decide if they should pay for heating oil or their meds. I began buying drugs for my financially challenged patients a few years ago. I take no profit and give the meds at cost, or free.
As a pharmacist, this thread has been particularly bashing and assumes I am the devil. However, let's dissect this comment from the altruistic physician.
1) He gives away meds at cost. I have no reason to doubt him. I will point out though that his business is not solely dependent on the revenue generated from the sale of medications. He still gets to charge $150 to the patients insurance plan for the visit, I do not. The insurance will only "allow" maybe $90 of that $150 but still, he is collecting $90+$3.17. Vastly different than the pharmacy charging $6.34 with that "100% profit". Imagine if the pharmacy got to charge you $90-150 just for showing up at the pharmacy.
2) 100% Profit? Are you serious, Clark? Profit is the money left over after all expenses have been paid. According to this premise all pharmacy employees are paid nothing, they work for free (who is altruistic now). Pharmacies do not require phones, internet, electricity, or even running water because those all cost money. Pharmacies are also not allowed to pay rent or other building costs (maybe the building was donated by an altruistic physician?). I will also note that pharmacies are charged a fee by the software vendor for every prescription sent to them electronically (physicians typically do not have to pay this fee because it would reduce the incentive for physicians to use e-scribing technology). Pharmacies are also charged a fee every time a claim is submitted to an insurer for payment, if the insurer imposes a limitation on quantity or anything else and the pharmacy needs to resubmit a different quantity, the pharmacy is charged a second time. This fee can be charged many, many times for a single prescription if the insurer is being particularly difficult. Pharmacies also suffer the wrath of insurance audits which involve finding any and all reasons to take back money previously paid to a pharmacy. One of the primary reasons an insurer will take back money is clerical errors made by the prescriber. The prescriber made a mistake, like not putting a date on the prescription or forgetting their DEA number, and if the pharmacist doesn't catch that mistake, the pharmacy suffers the consequence for the prescribers error. That last point leads to pharmacists calling Dr's over clerical issues which upsets the Dr because they don't understand why they should be bothered with such nonsense. If it was their money being taken away I bet they would make the phone call themselves.

10 years ago the estimated cost to fill a prescription was $7.77, this number excludes drug costs. Therefore, any prescription where a pharmacy charges less than $7.77 is sold at a loss no matter how cheap the drug is (I mean come on, people need paid for showing up to work). Inflation will have increased that number, but I don't have a current figure. Pharmacy is actually a very low margin business these days. I may sell a prescription for $2500, but it may cost me $2400-$2600 to purchase. Brand name drugs often cost me more money than I get reimbursed for by the insurance. Selling hundreds of generics a day with a price over cost of $5-10 is how pharmacies survive. One of my insurers reimbursement averages about 3-4% above my cost to purchase the medications. That means I have to pay all my staff and utilities and cover audit expenses and pay myself with 3% of my sales. For $11,000 in sales I have $330 at the end of that day to pay everyone and make ends meet. Not exactly the cash grab portrayed in the previous comment. A busy pharmacy may generate $20-25,000, which is $750 but involves 2-3 pharmacists needing paid instead of just one.

So, lets pump the breaks on vilifying pharmacies for billing practices all you physicians are doing too. Anybody looked at their EOB (explanation of benefits) after a Dr visit or God forbid, an ER visit? The Dr's physician fee is upwards of $1000 just for walking into the room (to be fair, he/she is only likely to collect 20-30% of that charge, but we are condemning one profession for doing the same thing).

The question at hand about what a pharmacy charges is based on a number of things. 1) contracts - what can the pharmacy buy it for. not every pharmacy buys every drug at the same price as the pharmacy next to it. Meijer may have better pricing for Drug A and WalMart may get better pricing on Drug B 2) Supply and Demand - umm, what CAN you charge? See that example about the ER physician charge, which is a real example of when my wife took my daughter to the ER for burning her hand (they gave her a single dose of Tylenol and wrapped her hand. I had to go to the villainous pharmacy to get the SSD cream for her hand).
Personally, I haven't seen a cash price be cheaper than an insurance price since the roll out of the $4 generics, but that was quickly quelled by upset insurance companies not wanting to be charged $12.99 when a cash customer received a charge of $4. Since then, I have never seen this occur, but I assume it has to as I hear so much about it. Also, most pharmacists will simply bill it as cash if they see this occurring as we are people too, and we tend to value doing the right thing.
The other answers all involve PBMS - the OP using his plans mail order provides that pharmacy with ultimate discretion to charge whatever they see fit. I have heard of some of these mail orders using medication package sizes that are highly atypical and allows them to manipulate the pricing as most remimbursement and thus pricing is based off of a wide scale benchmark like average wholesale price or AWP. All clawbacks are returned back to the PBM and the insurer and are not kept by the actual pharmacy dispensing the medication. there are many states employing legislation to eliminate the ability of PBMs to institute these clawbacks.

I hope this was enjoyable. [OT comments removed by admin LadyGeek]
First, this was not about pharmacists. There are many pharmacists that I respect and patronize my practice. Sorry you felt this was a personal attack. Actually, I have a great relationship with several smaller pharmacies and appreciate their approach to patients. Many will and have given significant breaks to these patrons. My issue is with the larger, corporate pharmacies that pretend to advocate for patients but really couldn’t give a damn. Their motive is profit not patient centered care.

Second, you have made great personal assumptions about my care. I see many patients and some cannot afford the visit and do not get charged. I would do that more often but contracting with Medicare limits my ability to do so as a result. If I offer my services at a discounted rate beyond a certain percentage of my practice they can audit me and demand that all Medicare patients that I serve are offered the same discounted rate, which would mean free service.

Third, the example given of the vast number of the medications available for me to purchase has not been fabricated. You can look these up for yourself. I buy small amounts for patients in need and can obtain them for much less than the amounts you quote. The example given of simvastatin suggests greater than a 100% markup. I am a capitalist and believe profit is fine but patients should have the ability to shop for medications for the best price, not be misled to believe that the big company cares, they certainly do not.

Lastly, what is your beef with being critical of the bigger companies that have repeatedly shown that they place profit before people? This is not about the many conscientious pharmacists that care about the people they serv. Furthermore, I don’t believe these corporations respect you as a pharmacist either. That is evidenced by the constant turnover of your colleagues in these corporations. Highly educated people disrespected
Last edited by me112964 on Mon Oct 23, 2017 9:24 pm, edited 1 time in total.
Salmon Maki
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by Salmon Maki »

sport wrote: Mon Oct 23, 2017 9:44 am
Salmon Maki wrote: Sun Oct 22, 2017 9:06 am
I think your confusion is because some PBMs charge the full copay no matter what and some charge just the pharmacy price if the copay is higher than the drug price. I believe Express Scripts does charge the higher amount while some others do not.
My Part D plan uses Express Scripts. I frequently pay less than the full copay for some generics.
CMS regulation most likely. It’s different for standard commercial drug coverage
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ResearchMed
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by ResearchMed »

Salmon Maki wrote: Mon Oct 23, 2017 7:53 pm
sport wrote: Mon Oct 23, 2017 9:44 am
Salmon Maki wrote: Sun Oct 22, 2017 9:06 am
I think your confusion is because some PBMs charge the full copay no matter what and some charge just the pharmacy price if the copay is higher than the drug price. I believe Express Scripts does charge the higher amount while some others do not.
My Part D plan uses Express Scripts. I frequently pay less than the full copay for some generics.
CMS regulation most likely. It’s different for standard commercial drug coverage
By "standard commercial drug coverage", to you mean non-Medicare?
If so, until about a year ago (maybe a bit more recently), we had Express Scripts, and we often paid less than the co-pay for some drugs.
Same thing now, with Optum (I think that's the new one).

RM
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munemaker
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by munemaker »

mouses wrote: Sat Oct 21, 2017 2:13 pm
My understanding is that Walmart has low prices because it has low salaries for its employees, low benefits, buys stuff from China, etc.
I ask this in all seriousness. Isn't this pretty much true for all retail?
criticalmass
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by criticalmass »

mouses wrote: Sat Oct 21, 2017 2:13 pm I will hazard a guess.

My understanding is that Walmart has low prices because it has low salaries for its employees, low benefits, buys stuff from China, etc.
Target, CVS, Walgreens, and even Macys buy (a LOT) of things made in China. So do Best Buy, Amazon, Dollar Tree, and Costco. So why would Walmart be any different? Try buying a Dell Computer or Apple smart phone (among others) that is NOT made in China.
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Re: How does/can Walmart offer such inexpensive prescriptions?

Post by madbrain »

mmcmonster wrote: Sat Oct 21, 2017 3:20 pm I am a physician (as are many on this Forum, I would suspect!).

...

We live in an age of inexpensive medications. If you have meds that cost you more than $10/month, you should ask your physician if there are alternatives that are less expensive (and if the alternatives are as good as the one that the physician was planning on prescribing).
Age of inexpensive medications ? Surely you jest. That really depends on what you take.

If your prescriptions are called Atripla, Descovy, Elmiron, Isentress, Norvir, Reyataz, Tivicay, Truvada, to name just some of the ones we have taken/still take, the sticker price will be in the thousands of dollars per month. Of course, they are covered by insurance, and we only pay $10 for a 3 months supply of each one. But without insurance, we would be stuck paying some $5,000+/month in prescriptions. No generics exist for any of them.
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