Up withset my pharmasist !!

[cindybear]

I just can not beleive this, He has been charging me a ton for my Topamax,,150.00 dollars more than he should every month. for years,,And I trusted him, I am more hurt than anything and worry he will get in trouble,,He charged my medicare (humana ) and me , plus My husband got me another insurance policy cause of the huge gap,,,and he still charged that company that amount,,Our insurance carrier stated that that will be paying us back a few thousand dollars..now I feel I should get a new pharmacy..Did he do this to my other drugs,,Is 115.00 for generic morphine a month to much..I guess our insurance agent is checking every thing,,Gosh, I;m sick of my stomach,,Hugs to you all, Cindy

[mrsdoubtfyre]

out of pocket and then getting reimbursed?

Is this an independent pharmacy? Or a chain? It this is a chain, then the pharmacist should not be overriding prices..there is no gain for him in that.
It has been my experience that RiteAid is the highest cash charging chain.

You should write down exactly what you take, # of tablets and dosage,
and compare prices with other drug stores in your area. This only pertains to
cash prices.
If you type into www.rxlist.com Topamax, then you sometimes can see quoted prices on that site, to give you an idea.

If you have a 3rd party payment at the point of sale, with a copay only,
they I don't understand this question. If your copay is a % one, then yes, the quoted AWP may be inflated. You however,
do not have access to those numbers..they are not public.

It has been my experience that Costco is the most affordable for cash paying (or personal reimbursment). I have worked there part time occasionally and their prices are the lowest IMO. You don't have to be a member to have an RX filled there, and they use the same quality drugs as other pharmacies.
I get my lisinopril there in fact. Costco uses the real cost price and not the AWP to bill insurance. So if you have a % copay, it is typically lower there too. (I use mail away for brand names). I am now mostly retired and am very careful where I go.

[cindybear]

Our insurance agent was the person who caught it. And said , that it was a problem..He has been working on it for months,,But I hope he is somehow wrong,,I have been paying out of pocket 350.00 a month for the script..Looked on the net at several places,,not near that cost..But who knows,,I'm suppose to be getting my drugs soon, What do I do,,,Hugs, cindy

[Gimpy]

Well don't be feeling bad for the pharmacist, he/they screwed up royally and you will be having a nice little windfall of money that you weren't expecting. If he made this mistake with you, then they are probably double billing others are well and deserve to be caught and possibly shut down. Messing with medicare is a federal problem and they don't like it very much.

Congratulations on your found money!

Gimpy

[BrokenBladder]

Cindy,

I don't think I would use that pharmacist anymore. Apparently he's been over charging you and the insurance companies for quite some time. It sounds like he did something illegal.

If you go to another pharmacy they can call the one you're using now and transfer all of your prescriptions. I think if I were you I would do that for sure.

Anytime an insurance company tell you that they will be sending you a few thousand dollars you can bet that something shady was going on.

I'm really sorry you're having to deal with this. I know you trusted this man and now you must feel so betrayed. I'm really sorry and I hope you find another pharmacist that you can put your faith in.

Take care and many hugs to you!!

[bluebirdy]

I'm not clear on what happened here? Overbilling based on what? And if you were paying out of pocket, where does your insurance company come into the picture? Just not understanding the situation ... but certainly hope you get what's coming to you!!!!

As for more scandals - a major, well-respected hospital here in Georgia was just in the news for charging Medicare for either patients that didn't exist or services that weren't done - I'm not sure which it was. The Whistleblower is getting a big cut of the recovered millions - and I'm THRILLED FOR HER!!!!!

bb

[houghchrst]

Just more reasons for us all to be on our toes. It is a shame that the general public pays for all these doings. It is a shame.

[911]

cindy please just try to enjoy the new found money it seems you have coming , trust me on this we need not be sorry for others screw ups specialy if they were not a mistake ??? i know easier said than done look at me with my thread , just do the best you can and i would also find another pharmacy , i have had no luck with my local rite-aid and had to switch , its a big corperation so ,,,,,,,,,,,,, best of luck ,,,,,,,, Dave ,,,,,,,,,, 911

[cindybear]

Try to make this a little more clearer. When my Humana got to where it was a gap-Over 3600.oo I had to pay out of pocket. Basically , because the topamax cost so much every month..My hubby who owns his own propane biusness, decided to put me on his policy that his workers are on..But for some reason,,I had to pay up front all monies ( my insurance agent said that should have not been so )..Anyhow, I would end up writing my check up to 600.00 dollars a month for my drugs, Then they would send me a check back of 80%..Now Sometimes it isn't real easy to get 600.00 up for my drug payment..And there has been a couple of times when they sent it ti humana and not my new drug coverage (then I got nothing back ) they would say, we didn't realise which one you wanted billed..And I told them..The one that I get 80% back,,I have told every person in here this...Would not you..And then ask them if they could try and get my money back,,But I never did..So it got loss..Is wall mart good, or krogers ? I think my pain managerment Doc will understand..I have been going to this same pharmacy for 10 years..I know everyone by first name basics. : ( Cindy

[GardeniaGirl]

I could be wrong, but I thought pharmacies could set their own prices on meds.

I have found as much as a $200 range on prices on some of my meds by calling around to different pharmacies.

My insurance was paying 70% of whatever price the pharmacy charged, so I, of course, wanted to go to the one with the best prices.

In my area, for my meds, Walgreens has had the best prices.

[Gimpy]

I have been getting my pain meds through Krogers for several years, I followed the pharmacist there from another store I had been using. Maybe it's him, but I have never, ever had a problem with Krogers as far as my pain medications go. They always have them and never have they made me feel like a druggie.

G

[BrokenBladder]

Cindy,

I use Walgreens but to be honest I never checked around for pricing. I guess that was pretty dumb of me but I just assumed it would be the same cost everywhere I went since I do have prescription coverage.

I will be making some calls, needless to say, just to make sure that I'm getting the best deal possible.

One thing I'm still confused about. Since you had the huge doughnut hole why didn't the coverage that your husband added you to pick up the difference. Why do they make you pay everything up front? Sorry if I'm missing something.

[sandi1016]

I used to use Rite Aid, but started having problems with one pharmacist who would claim that my oxycontin was not in "stock". What was weird about it, was that I could wait until she went off shift, on a non delivery day and mysteriously , they would have it in stock.
I had been going there for all of our prescriptions for almost 10 years. She also called my doctor and argued with him about my dosage. This was the same dosage that I had been at for a year at that point. She just didn't want to fill them.
From what you are saying, it sounds like he was billing all of your insurances at one point, and collecting payment from them. And making you pay for all of the cost directly at the pharmacy as well.
I use Target pharmacy now. The pharmacist there is also a chronic pain patient, so I have no trouble with him at all, in fact, he's a knowledgeable pharmacist, very helpful and he is a great help. It's refreshing to not have to deal with all of the garbage that I dealt with at Rite Aid.
Sandi

[Pharmacist.steve]

When it comes to direct billing to insurance companies by a pharmacy the INSURANCE COMPANY sets the price. Do you have a "drug card" for both of your drug coverages? many/most pharmacy software packages can bill first and secondary insurers directly.. IF they know up front to do so.

You should be getting an EOB(explanation of benefits) - or be able to get on line - what has been paid for drugs by each insurer.. if you haven't yet ... ask for a copy... as well as asking the pharmacy for a copy of what was billed.

For the money that "was lost" .. I would get your insurance agent or insurance company involved .. most insurance companies will pay for claims submitted by the patient up to a year from date of service..

For me... there is not enough details presented to form a conclusion.

[Pharmacist.steve]

Cindy,

I use Walgreens but to be honest I never checked around for pricing. I guess that was pretty dumb of me but I just assumed it would be the same cost everywhere I went since I do have prescription coverage.

I will be making some calls, needless to say, just to make sure that I'm getting the best deal possible.

One thing I'm still confused about. Since you had the huge doughnut hole why didn't the coverage that your husband added you to pick up the difference. Why do they make you pay everything up front? Sorry if I'm missing something.

IF you have a "drug card" and the store is billing directly to the insurance company and you are paying a flat co-pay or a %... every pharmacy is going to be within pennies..

Pharmacies/Pharmacists CANNOT tell you what your copay will be until they process the Rx... BECAUSE the pricing/copay is determined by the insurance company's computer and tells the pharmacy computer what to charge the patient.

Formularies and which copay tier a drug is on .. can change at any point in time.. there is no way that a pharmacy/pharmacist can keep up with the thousands of variations out there.

Right now there appears to be a lot of formulary changes coming Tues with the Part D programs... none of which have been sent to the pharmacies.. but to show you how "tricky" these things are as of Tues... certain drugs now require step therapy that as of today were "preferred drugs" .. BUT .. step therapy is only required on NEW THERAPY for a patient... all patients that have been on these drugs in 2007 .. can stay on them without going thru step therapy... without the pharmacy computer talking to the insurance company computer ... if a Pharmacist gets a new patient on one of these drugs... how would he/she know if they patient had been on them before - just getting them at a different store???

If you are paying CASH - which < 10% of patients do - then the pharmacy can determine the price - just like anyother merchant.

In Sept ... I became a manager for a in-house pharmacy for a out-patient mental health facility... I think that the file clerk at the facility put it quite well... I am in and out of medical records multiple times a day trying to get info to get meds billed/paid for the facility's patients.... after several weeks ... she said to me "... there is a lot more to your job than one would think !!!..."

DUH!

[mrsdoubtfyre]

I have worked in many places in the past 40 yrs.

Chains are run from a main frame and the rules/prices trickle down to
each unit and if you work there you follow company policies.

Cash prices in chains are not determined on site. (occasionally chains allow for "price matching for competition"..when that happens the price can be LOWERED thru the computer within the parameters set at corp headquarters) But I have never seen RAISED prices. The price comes out of the printer after going to
the corp mainframe where all the data is kept.

Independent pharmacies set their own prices on site. Typically where I live and work, there is swift competition, and independent pharmacies are LOWER in price to attract customers who pay cash. I think it is very rare to be fleeced this way, as you describe. Of course, being an independent unit they can charge whatever they want, and think the market will bear.

You need to compare prices locally and not on line. You can call on the phone.
I strongly urge you to do so. On line prices often are less than local ones.
And even the online pricing on Costco's site is often not accurate.

Target is a chain and quite nice IMO. I have worked there, and they run a tight ship on their employees. Their prices are fair too, but not the lowest of the low for cash customers. Kroger's is a chain too.
If I were going to go back to retail dispensing I would choose Target.
I do NOT like K-Mart and recommend you avoid it.

So call a few chains on the phone and simply ask how much would
100 Topamax 50 mg cost ? (or whatever your dosage happens to be)
In my state, they have to tell you and it is done all day long everyday.
I would ask 4 different places... 3 chain and one independent (if there is one left in your area! ) Then you will have accurate comparison for your issue.

[cindybear]

They have both copies of my cards. And thats is what the insurance agent said was he had to go by the price of the company..Humanas was a different price and my other insurer was at a different price..But what I understand he charged both places way over ,,Why they didn't catch it,,?? But it is my insurance company that is paying me the money back, not the pharmacy,,I just do not feel right going back there with these things happening,,If he has done this to me, I'm sure he has done this to others..I heard something about double billing, but I;m not 100% sure,,My hubby knows the whole deal,and just told me the littlest details..He doesn't want to stress me out about thing like this,,with my problems,,,Hugs , Cindy

[illusion129]

Cindy-

I'm kind of having some trouble following your post but that's A-OK. I think I get the main part of it. But something didn't sound right at all to me...

I go to Kroger pharmacy for my medication. They always have everything in stock unless I start a new med or a new dosage of pain medicine, I may have to wait a day or two, tops for it to come in and that doesn't bother me at all.
Over all I'm very satisfied with them; they're very prompt, courteous, and I've never had to wait more than 10 minutes before to pick-up, or I drop off and wait I've never waited more than 20-25 minutes, and I usually drop off at least 2-3 scripts at at a time. I usually get my 4 regular ones filled on one day and then my 2 pain meds filled on another.

What is the name of this pharmacy, if you don't mind saying? I know that I take morphine as my pain medication and I do have insurance; after $100 at the beginning of the year I pay 20% of the cost of the drug. My prescription is written for Oramorph SR but I take the generic, Morphine Sulfate ER. 2 prescriptions actually, one for 100mg BID and one for 15mg BID.

After insurance, my 100mg prescription is $17 and my 15mg prescription is $7, so I think you were being charged a VERY excessive amount. As you can see, my 20% co-pay is only $17. If the actual cost were $100, I'd pay $20, so the cost is less than $100. If you were paying more than $100 OUT OF POCKET then your pharmacist was not only ripping the insurance company off but also you.

Hon, you should not feel sorry for this wo/man. If s/he has done it to you for a long time, as you seem to imply, he obviously knew what he was doing because mistakes don't happen like that continually. Don't worry at all about them...or if they get into trouble. They do deserve to be reprimanded!

As far as the money goes, I hope you have records of all the payments you made to your pharmacy. You need to pull out bank statements and reference how much you paid out. Get print-outs of what was charged to the insurance company and what you were supposed to pay FROM the pharmacy, get Explanation of Benefits (EOBs) from your insurance company. Make sure this person didn't over-charge you at the register as well to get even more money!

To get an idea of what other pharmacies in your area are like, call around to the different ones, ask to speak to the pharmacist if they're not extremely busy, and just chat a minute, ask if they have any chronic pain patients, if they keep pain medications on hand, how long will it take if you need something ordered, how many pharmacists work there/who is the pharmacy manager, etc. And you may even want to go in and actually visit with the pharmacist; it's always nice to meet who you're going to be dealing with BEFORE you get "stuck" filling your prescriptions at a new pharmacy.

Don't let this stress you out, doll. Lord knows that's the last thing you need with an aneurysm! I'm sendin' you lucky thoughts...

Just make sure everything seems to add up in the end at that you GAIN from this...as in get money back and not have to lose any. I bet when you take your script to this new pharmacy and present both your insurance cards you'll be surprised at your cost...unless of course you haven't met your deductible or something.

[cindybear]

The pharmacy , I go to is Medicine Shoppe. And my other insurance besides Humana is Medical mutual..They pay the 20% that medicare doesn't pay plus has drug coverage..I pay 115.00 for 90 pills of genetic morphine,, Seems like alot for genetic. But My insurance agent ( Actually my hubbies for his company is checking into all of this ) It all started because they was making me pay for all my meds instead of 20%,,He said that is all I should pay up front..But never was the case..So he started a investagation a couple of months ago. With the topamax..I guess because it was so expensive..But I guess he is going to check all my drugs..I just can not beleive this at all..It so saddens my heart..Thanks for your replys..You have all helped me get through this tough situation..Thanks, Cindy