2 years ago ·
by alan ·
Did you know that your pharmacist can often lower your out of pocket expense for your medications if you ask? Just ask the cash price.
You read that right. All you have to do is ask, especially if your prescription is for a generic. It’s fairly common knowledge that there are many different prices for medical services and prescriptions, depending on your particular payment method. We all know that healthcare providers frequently charge higher prices to patients with insurance than cash-paying clients. Why this is legal remains a mystery to us, but that’s another topic for another day…
What you may not know is that insurance carriers often have “gag orders” in their contracts with pharmacists that prevent them from disclosing to their customers that a lower price exists on a medication. In many instances, the cash price for your medication may actually be less than your co-payment amount, and your insurance company may be pocketing the difference. Cash prices for generic drugs began dipping below co-pays many years ago when big-box retailers like Walmart, Walgreens, and Rite-Aid started offering $4 prescriptions for dozens of generic drugs. Although these programs are not as common as they were a few years ago, they have successfully driven down cash prices for generics to often “below co-pay” levels. The result is that your pharmacist can’t tell you there is a lower price, but you can ask and they have to tell you.
While no one really denies that these clauses exist, insurance carriers and drug manufacturers naturally deny that they are common, although a 2016 survey of 600 pharmacists found that 84% reported that patients had been overcharged 10 or more times in the previous month, and 35% reported that it had happened 50 or more times. A recent research letter published in the Journal of the American Medical Association reviewed 9.5 million Medicare Part D prescription claims and found that 25% of drugs purchased had a lower cash price than the co-payment that was actually paid by the customer. The overpayments were usually small, although some were as high as $30.
So the next time you visit your pharmacist, be sure and ask the cash price before you file it on your insurance. You might end up saving some money in the process.
Questions or comments? Post a comment below and let us know what you think! Also, don’t forget to contact us and get a FREE review of your drug plan to see if you are saving the most money possible.
2 years ago ·
by alan ·
So if you’ve turned on a cable news program in the last year, you’ve probably heard that the Affordable Care Act is tied up in the courts – again. But why is it back in the news this week, what’s really going on with it, and what does it potentially mean for you? Well, the answer to that question is kind of a mess, and the fact is that nobody really knows where we are or what to expect. It’s a long and messy tale, but here is what we know and don’t know.
The legality of the Act has been challenged in court since virtually before the ink was dry by multiple Republican state Attorneys General. In 2012, the US Supreme Court led by Chief Justice John Roberts ruled 5-4 that while the Congress does not have the Constitutional authority to order people to purchase health insurance, it was within Congress’s taxing authority to levy a financial penalty on people who don’t purchase it. Roberts wrote, “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax.” So that is the legal leg that the law has stood on since then. It’s a tax law.
Republicans in Congress have tried repeatedly over the years to repeal the act, with the House and the Senate voting no less than 50 times on the issue, and actually sending a bill to President Obama’s desk in 2016, where it predictably died with a veto. Republicans most famously tried to repeal it under the Trump administration in September 2017, where it passed the House and subsequently died in the Senate by one vote, with Senator John McCain giving his famous “thumbs down” to join two other Republican Senators in defeating the measure.
Unable to pass a full repeal, the Republican-led Congress settled for what they could get – in the massive 2017 tax bill, they sneaked in a provision that eliminated the tax penalty on people who don’t purchase insurance. The rest of the ACA, including its protections for people with pre-existing conditions, remained in effect as always. However, that move had unintended consequences.
Sensing an opportunity, several Republican state Attorneys General, led by Texas and supported by the Trump Justice Department, launched a new legal challenge to the law under a relatively novel theory. They argued that without the financial penalty, the requirement to purchase insurance cannot stand, and that that single requirement is so central to the entire law that the whole thing must be struck down. In 2018, a Federal District Court Judge in Texas agreed. Judge Reed O’Connor accepted that argument and ruled the entire ACA unconstitutional.
This predictably sent waves of uncertainly throughout the healthcare world, but legal scholars on both sides questioned O’Connor’s reasoning and did not give the decision much chance of being upheld on appeal to the 5th Circuit Court of Appeals. However, during oral arguments before a three-judge panel at the 5th Circuit last week, two of the three judges hearing the case indicated that they might be inclined to support O’Connor’s reasoning, opening the door to the possibility that the law might actually be invalidated after all.
Regardless of how the 5th Circuit rules, that ruling will almost certainly be immediately appealed to the Supreme Court, where there would be two possible courses of action. First, the Supreme Court doesn’t have to hear any case it doesn’t want to, and they could simply decline to hear the case, allowing the lower court ruling to stand and become the law of the land. Considering the stakes and the intense media scrutiny of the case, it seems pretty unlikely that they would refuse to hear it. In the more likely scenario, the Court would agree to hear the case, and there would be no action on it until the Supreme Court returns to session in October. After filing briefs and hearing oral arguments, the Court would then take several weeks or months to deliberate and make its decision. The Supreme Court historically saves big, high-profile rulings for the last couple of weeks of the term in late June or early July, so we are very unlikely to have a final decision for at least another year or so, maybe longer.
So what does this all mean for you and your health insurance coverage? For the next few months, probably nothing. If the 5th Circuit upholds the District Court’s ruling invalidating the ACA, that decision would likely be stayed (not implemented) pending appeal, meaning that nothing would change until the Supreme Court hears the appeal. This is fairly normal procedure when all parties know that the ruling is going to be appealed and the Court doesn’t want to completely flip over the apple cart and create chaos, only to be reversed on appeal.
However, if the 5th Circuit affirms the lower court’s ruling and the Supreme Court either declines to hear the appeal or upholds the decision, the impact would be widespread and immediate. Any protections for people with pre-existing conditions would be gone, meaning that you could be denied coverage altogether or pay higher premiums for your coverage if you have a pre-existing condition. Additionally, an estimated 20 million Americans who obtained health insurance after the Affordable Care Act was enacted, either through the marketplaces that were established or through the state Medicaid expansion, could lose it.
If that happens, there doesn’t appear to be any contingency plan in place. Democrats are all over the map in terms of healthcare proposals with no consensus on how to proceed, and Senate Majority Leader Mitch McConnell has said that the Republican-led Senate will not take up any healthcare-related issues before the 2020 election. Of course, that can change if the political situation becomes desperate enough for him, but for now we are left with nothing but uncertainty. As much as Republicans have dreamed of repealing the Affordable Care Act, it might be a case of the dog that caught the car, because now that they might have, they don’t know what to do with it.
Watch this issue carefully, and call your Senators and Representatives in Washington and ask them what they plan to do to protect people with pre-existing conditions if the Affordable Care Act is struck down. You deserve an answer. Do you have thoughts on it? Post a comment below and let us know what you think!
Contact us today to discuss your coverage and see if you might be at risk.
2 years ago ·
by alan ·
Well, after several weeks of sweat, hand-wringing, and haggling, our new Tupelo office is finally open. We have everything painted, patched, and (with a couple of exceptions) installed. The signs won’t be installed for another week or so, so we might be just a little hard to find until that gets in. We are at 1744 Cliff Gookin, which is between South Gloster and Lawndale. That’s actually right before you get to Lawndale if you are driving from Gloster. Here’s the Google Map link:
As you can see, our brand spanking new web site is also live. It’s still missing a little polish around the edges, but everything should be working and ready to go.
The office is open, the web site is live, and we are ready to roll. So stop by and see us, because we’re handing out quotes like Halloween candy. 😁 Even if you don’t need a quote today, stop by anyway just to say hi and see the office.
See you there!