Anyone use Mark Cuban's CostPlus drug company for prescriptions?

[Finance85]

I ran across this while doing some research on insurance and it looks too good to be true. I currently have 2 prescriptions, though I could probably be fine without either of them. One of the drugs is slightly less out of pocket compared to Walgreens (without insurance). The other is 20x less at CostPlus than if I pay out of pocket at Walgreens.

If I can get the prescriptions cheaper by paying out of pocket than by using insurance, I'd rather do that. The downside is that it's mail order, but that's also a potential positive.

 

[BelemNole]

I've considered it. Everything I take is generic at this point.

 

[Joes Place]

I ran across this while doing some research on insurance and it looks too good to be true. I currently have 2 prescriptions, though I could probably be fine without either of them. One of the drugs is slightly less out of pocket compared to Walgreens (without insurance). The other is 20x less at CostPlus than if I pay out of pocket at Walgreens.

If I can get the prescriptions cheaper by paying out of pocket than by using insurance, I'd rather do that. The downside is that it's mail order, but that's also a potential positive.

Shorter: "Cuban's got better pricing on Viagra than 'Hims' "!!!!

 

[QChawks]

I get my ibuprofen in bulk from Mark

it's like $8 for a 90 day supply

 

[Aardvark86]

I ran across this while doing some research on insurance and it looks too good to be true. I currently have 2 prescriptions, though I could probably be fine without either of them. One of the drugs is slightly less out of pocket compared to Walgreens (without insurance). The other is 20x less at CostPlus than if I pay out of pocket at Walgreens.

If I can get the prescriptions cheaper by paying out of pocket than by using insurance, I'd rather do that. The downside is that it's mail order, but that's also a potential positive.

I have not used it, but this is sort of what I do for a living. To wit, your free consumer advice:

1a. Product selection is important - if you're taking generics, as I am, great, you will likely find them there. Brands -- or at least brands with much savings -- not so much.
1b. Note also, if you take multiple meds, some brands and some generics, be cautious about the fact that without all of your Rx records, a pharmacy's drug utilization review tools may not be as good at picking up interactions, etc. (This is a risk of polypharmacy)
2. Be VERY careful about price/savings claims.
a. You should completely ignore anything that is phrased as % off, because those claims are based on list prices which, in the case of generic drugs, are COMPLETELY irrelevant to both pharmacy acquisition cost and consumer price.
b. You could/should compare dead net prices. Without a doubt, they'll have fair prices. But the reality is that many traditional outlets have various forms of "low cost generic" programs that offer comparable savings, which if you like a brick and mortar experience, may be a price wash. (For regulatory reasons, these brick and mortar programs, including WaG's, entail the payment of a modest up front membership fee).
c. Compare apples to apples. If you have insurance, that comparison is your insurance copay (which in some cases for gx might be zero) to the cash price at Cubano's.
3. Re: cash v insurance, yes, it is generally fine and dandy if cash price is lower than insurance out of pocket. Note though that if you deductibles or OOP maxes are relevant to your finances or health conditions, you should check whether you can get credit for the cash expenditures to those amounts under your insurance policy.
4. Finally, don't know if you saw this the other day, but AMZN has a new offer out there too. Basically, as an add-on to Prime, for a fixed cash fee (the number of which escapes me), you can get an unlimited number of program generics each month -- basically like insurance capitation. So if you are taking a lot of program meds, it could be a great value. If you like Amazon, of course.

 

[Finance85]

I have not used it, but this is sort of what I do for a living. To wit, your free consumer advice:

1a. Product selection is important - if you're taking generics, as I am, great, you will likely find them there. Brands -- or at least brands with much savings -- not so much.
1b. Note also, if you take multiple meds, some brands and some generics, be cautious about the fact that without all of your Rx records, a pharmacy's drug utilization review tools may not be as good at picking up interactions, etc. (This is a risk of polypharmacy)
2. Be VERY careful about price/savings claims.
a. You should completely ignore anything that is phrased as % off, because those claims are based on list prices which, in the case of generic drugs, are COMPLETELY irrelevant to both pharmacy acquisition cost and consumer price.
b. You could/should compare dead net prices. Without a doubt, they'll have fair prices. But the reality is that many traditional outlets have various forms of "low cost generic" programs that offer comparable savings, which if you like a brick and mortar experience, may be a price wash. (For regulatory reasons, these brick and mortar programs, including WaG's, entail the payment of a modest up front membership fee).
c. Compare apples to apples. If you have insurance, that comparison is your insurance copay (which in some cases for gx might be zero) to the cash price at Cubano's.
3. Re: cash v insurance, yes, it is generally fine and dandy if cash price is lower than insurance out of pocket. Note though that if you deductibles or OOP maxes are relevant to your finances or health conditions, you should check whether you can get credit for the cash expenditures to those amounts under your insurance policy.
4. Finally, don't know if you saw this the other day, but AMZN has a new offer out there too. Basically, as an add-on to Prime, for a fixed cash fee (the number of which escapes me), you can get an unlimited number of program generics each month -- basically like insurance capitation. So if you are taking a lot of program meds, it could be a great value. If you like Amazon, of course.

Thanks. All good points.

The CostPlus site actually shows you the exact price for each prescription.

My co-pay at Walgreens with insurance is higher than the cash (no insurance) price at CostPlus.

I'll definitely check out Amazon Prime's offering. Thank you.

It appears that drug prices significantly affect the Medicare drug option price, and Medicare Advantage plan prices. Fortunately for me, I don't need anything super expensive to the point where paying cash out of pocket is much of an issue.

 

[Aardvark86]

Thanks. All good points.

The CostPlus site actually shows you the exact price for each prescription.

My co-pay at Walgreens with insurance is higher than the cash (no insurance) price at CostPlus.

I'll definitely check out Amazon Prime's offering. Thank you.

It appears that drug prices significantly affect the Medicare drug option price, and Medicare Advantage plan prices. Fortunately for me, I don't need anything super expensive to the point where paying cash out of pocket is much of an issue.

Re: Medicare, a couple of FYI's for the future.
1. If you require insulin, you'll be moving to a fixed $35/Rx cost share next year. Actually a very consumer friendly reform.
2. Great to hear that you don't require anything superexpensive, but also in 24/25, the benefit is being redesigned to (i) lower the out of pocket max and (ii) eliminate cost sharing in the catastrophic period of the benefit. This is a huge deal for consumers that use/require expensive products like biologics, oncolytics, etc.

 

[Finance85]

OK. After digging further, it doesn't look like CostPlus is a great option at this point, but if anyone here has experience with it, I'd like to hear about it.

Seems like they are just a front end, essentially like a wholesaler to a retail customer base. They take the prescriptions online, and then have an online pharmacy provide order fulfillment. Main complaints seem to be around drugs showing as available on the web site, but not really being available. There also seem to be some issues with fulfillment lead times.

Amazon Pharmacy might be a good choice, but it seems there are some limitations for people on Medicare, and also some states. Good-RX doesn't seem bad if I have to pay out of pocket, but is a bit more than my insurance co-pay.

 

[cfbfan23]

OK. After digging further, it doesn't look like CostPlus is a great option at this point, but if anyone here has experience with it, I'd like to hear about it.

Seems like they are just a front end, essentially like a wholesaler to a retail customer base. They take the prescriptions online, and then have an online pharmacy provide order fulfillment. Main complaints seem to be around drugs showing as available on the web site, but not really being available. There also seem to be some issues with fulfillment lead times.

 

[Aardvark86]

OK. After digging further, it doesn't look like CostPlus is a great option at this point, but if anyone here has experience with it, I'd like to hear about it.

Seems like they are just a front end, essentially like a wholesaler to a retail customer base. They take the prescriptions online, and then have an online pharmacy provide order fulfillment. Main complaints seem to be around drugs showing as available on the web site, but not really being available. There also seem to be some issues with fulfillment lead times.

Amazon Pharmacy might be a good choice, but it seems there are some limitations for people on Medicare, and also some states. Good-RX doesn't seem bad if I have to pay out of pocket, but is a bit more than my insurance co-pay.

A couple of PSA comments on this:

1. Re availability, this is always the rub of "low cost cash option" programs. In general, the pharmacy is able to do this because there are multiple generic suppliers of a product, and the pharmacy basically runs an rfp and picks a single or dual source vendor(s). However, it is the nature of generics, and of generic purchasing, that the best prices sometimes come with the least reliable suppliers, and you have to do a good job weighing both of those in picking your source. Simialrly, sometimes the term of Gx supply contracts can be short, or have termination/outs that are pretty liberal.
2. Re: AMZN's "Medicare limitations," in general what this means is that this is a cash program, and that you can't turn around and submit a "shoebox claim" for your (otherwise) cash prescriptions to your medicare plan (either for payment as a claim, and possibly for credit against your TrOOP deductible/out of pocket max). Generally, it doesn't mean that you are totally excluded for participating, just that you can't have the benefit of low cash prices AND your insurance benefit.

 

[torbee]

I have not used it, but this is sort of what I do for a living. To wit, your free consumer advice:

1a. Product selection is important - if you're taking generics, as I am, great, you will likely find them there. Brands -- or at least brands with much savings -- not so much.
1b. Note also, if you take multiple meds, some brands and some generics, be cautious about the fact that without all of your Rx records, a pharmacy's drug utilization review tools may not be as good at picking up interactions, etc. (This is a risk of polypharmacy)
2. Be VERY careful about price/savings claims.
a. You should completely ignore anything that is phrased as % off, because those claims are based on list prices which, in the case of generic drugs, are COMPLETELY irrelevant to both pharmacy acquisition cost and consumer price.
b. You could/should compare dead net prices. Without a doubt, they'll have fair prices. But the reality is that many traditional outlets have various forms of "low cost generic" programs that offer comparable savings, which if you like a brick and mortar experience, may be a price wash. (For regulatory reasons, these brick and mortar programs, including WaG's, entail the payment of a modest up front membership fee).
c. Compare apples to apples. If you have insurance, that comparison is your insurance copay (which in some cases for gx might be zero) to the cash price at Cubano's.
3. Re: cash v insurance, yes, it is generally fine and dandy if cash price is lower than insurance out of pocket. Note though that if you deductibles or OOP maxes are relevant to your finances or health conditions, you should check whether you can get credit for the cash expenditures to those amounts under your insurance policy.
4. Finally, don't know if you saw this the other day, but AMZN has a new offer out there too. Basically, as an add-on to Prime, for a fixed cash fee (the number of which escapes me), you can get an unlimited number of program generics each month -- basically like insurance capitation. So if you are taking a lot of program meds, it could be a great value. If you like Amazon, of course.

Hey @Aardvark86 --- if this is really what you do for a living, do you mind if I hit you up with a direct message?

My mom has leukemia and the drug she takes is crazy expensive (around $3K a month). Previously, she was in a program where 90% or more of the cost was covered, but after she and my dad sold a condo in Florida that they acquired when my great aunt died, they went over the income limit and now they are being told they have to pay 100%!

I am trying to find some way to defray this cost, as despite the one-time capital gain, they are NOT able to financially handle that amount for more than a year or so. I'd love to pick your brain if you are willing.

 

[IowaPackFan]

Is it better than OptumRx

 

[Aardvark86]

Hey @Aardvark86 --- if this is really what you do for a living, do you mind if I hit you up with a direct message?

My mom has leukemia and the drug she takes is crazy expensive (around $3K a month). Previously, she was in a program where 90% or more of the cost was covered, but after she and my dad sold a condo in Florida that they acquired when my great aunt died, they went over the income limit and now they are being told they have to pay 100%!

I am trying to find some way to defray this cost, as despite the one-time capital gain, they are NOT able to financially handle that amount for more than a year or so. I'd love to pick your brain if you are willing.

T, first, sorry to hear this. Unfortunately I don’t have dm capacity. But some general thoughts.

What I do is drug pricing and patient support programs, so I don’t have much to offer re asset management and eligibility structuring issues.

That said (and apologies if I’m telling you stuff you know):
1. If your parent has commercial insurance, it may be that there is a manufacturer copay support or “bridge” program out there. These are usually not asset tested, in comparison to free product programs.
2. If they have govt coverage, you’re right the financial criteria can be tight for primary eligibility. Beyond that the options are more limited for cost share assistance, but there is a model for it and there are some leukemia drug foundations that do so. https://www.lls.org/support-resources/financial-support/other-financial-assistance. These programs are meansctedted too, but usually more generous.
3. If they are now in a situation of no coverage whatsoever, again there are some manufacturer programs out there with somewhat more liberal eligibility standards. Check with the drugs manufacturer. These can be $ off, or free product.

Finally, if a time based solution helps, many manufacturers give extended payment terms (like,150-80 days) to pharmacies for drugs like these. Press them to pass that on to you in part given that those terms are because of insurance paynebtvdelays and this is now a cash script

 

[torbee]

T, first, sorry to hear this. Unfortunately I don’t have dm capacity. But some general thoughts.

What I do is drug pricing and patient support programs, so I don’t have much to offer re asset management and eligibility structuring issues.

That said (and apologies if I’m telling you stuff you know):
1. If your parent has commercial insurance, it may be that there is a manufacturer copay support or “bridge” program out there. These are usually not asset tested, in comparison to free product programs.
2. If they have govt coverage, you’re right the financial criteria can be tight for primary eligibility. Beyond that the options are more limited for cost share assistance, but there is a model for it and there are some leukemia drug foundations that do so. https://www.lls.org/support-resources/financial-support/other-financial-assistance. These programs are meansctedted too, but usually more generous.
3. If they are now in a situation of no coverage whatsoever, again there are some manufacturer programs out there with somewhat more liberal eligibility standards. Check with the drugs manufacturer. These can be $ off, or free product.

Appreciate the help! Thanks.

 

[Aardvark86]

Appreciate the help! Thanks.

Do let me know if there’s anything more specific that I might have any ability to help with.

 

[runkpanole]

Is it better than OptumRx

Never used cost plus, and I’m new to Optum. I like Optum so far. I had a little battle with my Keppra when I first started and my script was denied. That was a communication error between my physician and insurance.

Looking at cost plus, it would be a lot cheaper on cost plus for a 90 day supply, but I’m not sure how that interplays with my deductible.

 

[Aardvark86]

Is it better than OptumRx

Optum is just a benefit manager for United.

 

[southlakehawk]

when cubans store first opened up, the price for albuterol was about half for what I was paying going through cvs...cubans store $25/cvs $45. But when I went to order some about a month later, it was the same price ($45 both stores. It's remained at that price ($45) ever since.

 

[runkpanole]

Optum is just a benefit manager for United.

Nope. Optum has a mail order pharmacy as well.

 

[anon_b29nm7v7dwp6r]

I have been interested in hearing more about this one. So far nothing I have seen that I use beats Costco pricing.

For my regular stuff I go there…only use Walgreens/CVS/HyVee when I have to.

 

[IowaPackFan]

I know if you use some of these alternatives or things like GoodRx, for whatever reason, those payments don’t count towards your deductible (maybe max out of pocket either).