A bitter pill to swallow
- By Milt x_Zall
- Dec 10, 2000
If you're in the Blue Cross and Blue Shield federal employee health plan,
you probably think that you would pay the same price for prescription drugs
at any local pharmacy. Well, guess what? That's not true: It pays to shop
I recently filled a prescription at my local pharmacy for a medication
that an Internet pharmacy sells for about 6 cents a pill. I figured I'd
probably pay that amount — or less. After all, I'd be getting the rate negotiated
between my health plan and the pharmacy, and certainly that would be equal
to or less than what an Internet pharmacy was charging everyone.
Was I ever surprised when the local pharmacy price came to 15 cents
a pill! Because my insurance covered 75 percent of that, I wound up paying
3.75 cents a pill. But even though the online pharmacy selling the medication
for 6 cents a pill was not part of my health plan, I would have been reimbursed
for 55 percent of the cost and paid less out of pocket — about 2.7 cents
When I called the plan's local pharmacy service for an explanation on
the price discrepancy, I was told that the plan pays local pharmacies a
percentage of what the drugstore charges people who don't have insurance.
The discount is probably standard for every medication the local pharmacy
Of course, not every pharmacy is a participating pharmacy. Some charge
so much that the plan just can't negotiate an acceptable discount. But most
pharmacies in the Washington, D.C., area (where I live) participate in the
Blue Cross plan.
However, their basic prices for prescription drugs aren't identical.
Some charge more than others do to begin with, which affects the final price.
So the amount you pay for a prescription drug won't be the same in every
pharmacy that participates in your plan.
Here's the best part: The representative from my health plan told me
about a major online pharmacy that is a participating provider. Which one,
I asked? Drugstore.com, I was told. That's a well-kept secret, I said, to
which I didn't receive a reply. When I went to that Web site, I found my
medication selling for 6 cents a pill. That means it would cost me 1.5 cents
a pill at drugstore.com (25 percent of 6 cents). And no charge for shipping!
Of course, I was buying a relatively inexpensive medication. For anything
expensive and long-term, you'd probably want to use the mail-order pharmacy
and get a 90-day supply for $12 or $20, depending on whether you're ordering
a generic or brand-name drug. And for medications you need in a hurry, you'll
likely want to use your local pharmacy.
But if you have the time and the choice of more than one pharmacy, it
definitely pays to shop around.
Zall is a retired federal employee who since 1987 has written the Bureaucratus
column for Federal Computer Week. He can be reached at [email protected]