$4 prescriptions

Published

I have a question. I have Medicare prescription coverage. Two medications I take are four dollars at WalMart. I get charge four dollars, Part D gets charged $31 pluse. I have talked to several others who also are getting charged. When I finally questioned them, they told me it was because Part D is first provider. I had to tell them I wanted to be listed as a cash payee fore they would stop billing Part D. Also WalMart does not state this anywhere in their stores. Have any of you had relatives or patients with the same complaint?

Woody:banghead:

I am certainly NO expert, but I thought those $4 things were for people without ANY insurance. You have a form of insurance therefor, it is picking up the rest of the tab, while you still only have to pay the affordable $4.

I don't know about that. I have good script insurance, and my co-pay was $5. One time, I filled a prescription at Wal-mart because it was open and I needed the med right away. They took my insurance info and charged me $4 since it was generic. They said they would bill the insurance the usual amount, not the extra dollar. Kind of strange.

Up Vote Up Vote ×

I use to work in a pharmacy and the pharmacy will only bill the insurance $4 if it's on the $4 list. They will not bill any additional amount. For most people, their copay for generic is $5 or $10. So if it's on the $4 list, the insurance company will not pay a single penny for the medication. The patient will pay the full $4 since it's below their copay. There is no need to hide your insurance information from the pharmacy. You will pay the lower amount. For Medicare Part D patient, they only have to pay $1 for generics if they are currently not in the "donut hole".

Up Vote Up Vote ×
Specializes in A little of this & a little of that.

Wal-Mart gives me the $4 rate for a med that my insurance doesn't cover but other than that they bill my insurance.

Up Vote Up Vote ×
Specializes in icu, er, transplant, case management, ps.

Sorry to take so long to return. Let me explain a few things.

1. I enrolled in my Part D and listed them as payer for my prescriptions.

2. About one year later, WalMart began to offer certain drugs for four dollars. When I had two of my prescriptions filled, I was charged only four dollars.

3. Over the following nine months, every three I got a summary from my Part D provider, listing what they had paid out. In December of that year, I got my summary and noticed I was pretty close to reaching the donut hole. I got out my old summaries and read them, something, forgive me, I had not done previously. To my surprise, they were paying for their share of the cost of the two prescriptions. One was twenty-five dollars and the other about thirty five dollars.

4. I called my Part D provider. They told me as long as they got billed by WalMart, they would have to pay, if I had gotten the drugs, which I had.

5. When I went into WalMart, I looked every where for information regarding this practice but was unable to locate any. I asked several others waiting in line if they had had the same thing happen to them. They had.

6. I finally approached the pharmacist and asked him why my Part D was being billed for their share of my four dollar prescriptions. His answer-'because they are listed as first payor'.

Two months ago, I finally got my Part D provider removed as first payer for those two prescriptions. I am now listed as a 'cash' payer and am the only charged. I bought this up because it is apparently being done all over the country. If you have ever listed your insurance as a payer or you have a patient who has, advise them to demand that they be listed as 'cash' payorpayer for any of their four dollar prescriptions. Very few states block WalMart or any other drug provider from billing an insurance provider as well. They only promised to charge the patient the four dollars, not anyone else.

Woody:twocents:

Up Vote Up Vote ×
Specializes in Emergency & Trauma/Adult ICU.

Interesting and eye-opening information ... thanks Woody62.

Up Vote Up Vote ×
Specializes in Med Surg, Tele, PH, CM.
IMO its not fraud. All Wal Mart is doing is reducing what it charges for a co pay for those that are insured. For those that are not insured they are absorbing the loss to keep and attract customers for their other products (not just their pharmacy).

If you'll notice, most of the meds on the list are older generation generics, many of which do not cost more than $4. I did a cost comparison for some of these drugs because I have access to Medicaid claims schedules. Most on the list are in the $3-$8. range, so WalMart is not losing a lot of money. They feel absolutely within their rights to charge a primary payor (your insurance company) if one is listed. Unfortunatly, having two pharmacies is not always a good idea, especially if you have more than one provider writing scripts. The entire list of meds should be available to a pharmacist so they can monitor for drug interactions and dosages.

Up Vote Up Vote ×
I agree with whoever said that it causes problems because people have different meds at different pharmacies. The other problem is when some pharmacies have a "reward" for bringing in a new or transferred rx...like a coupon for some free items, or a gift card to the store...some people actually keep track of which pharmacy is doing what that week and go to whoever gives them the better reward. Highly irritating, because some people get all huffy that WE don't give a reward for coming to our pharmacy, and because these same people have their meds scattered over 6+ pharmacies!

We had problems with that even before Medicare Part D(isaster). I was working in retail pharmacy when that plan was announced, and tons of people asked us why we pharmacists were almost universally opposed to it.

One of my colleagues, who's been in this business 20 years longer than I have and once owned his own store, said, "When it goes online, you will find out just how free it is."

Reason #16,328 why I am glad I work in a hospital and don't have to deal with things like this.

Up Vote Up Vote ×
Specializes in icu, er, transplant, case management, ps.
We had problems with that even before Medicare Part D(isaster). I was working in retail pharmacy when that plan was announced, and tons of people asked us why we pharmacists were almost universally opposed to it.

One of my colleagues, who's been in this business 20 years longer than I have and once owned his own store, said, "When it goes online, you will find out just how free it is."

Reason #16,328 why I am glad I work in a hospital and don't have to deal with things like this.

Believe it or not, I was not happy when Part D was passed by Congress, signed into law and pushed on me. I resisted it for two years. Why? I knew that the providers of Part D coverage would raise the prices to those they insured. I knew that the pharmacies would soon raise their prices, which they have and did. The only reason I signed up for coverage was to avoid the higher cost and penalties that are to come to those who refused to sign up. In a relatively short period of time, those who refused coverage will either have to choose one or they will be assigned one, with the accompanying higher costs and penalties. Part D has proven to be a win fail for the Part D p[provides and pharmacies.

What I would like to see is what I was able to purchase in Canada. Their drugs are all under formulatories and price controlled. All I had to do was drive from NYS to Canada, with my NYS prescriptions, see a Canadian physician, get Canadian prescriptions, get them filled and pay 1/5 of the cost I paid in NYS. And have a wonderful French meal, at a nice French restaurant.

Please do not assume that everyone who is eligible for Part D is happy to be on it. Many of us are not but have to be to avoid the penalties Congress wrote into the law.

Woody:yeah:

Up Vote Up Vote ×
+ Join the Discussion