Is this the record??

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Tiger Wong

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So, when I came to work the other day, our tech told me one patient picked up Sovaldi 400 mg #28 and paid $31,700 for it!!! Paying 31K out of pocket???? I have never seen or heard of someone paying this much amount before!! I couldn’t believe it and I directly went to look at pt’s profile and there it was.

I was told both store manager and assistant manager had to come and they spent good deal of time verifying ID and credit card before the transaction. I am just curious has someone here seen anything like this before? The most I ever saw previously was someone paid $600 for Apidra and even that I thought was too much..

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That's just insane...... I would imagine that is a record for out of pocket.
 
here in the bronx, the record is a 3 dollar medicare copay instead of the usual 50 cent medicaid copay
 
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That is incredible! I have seen people pay $1000 - $1,500 for Zyvox, but that has been with their expectation that their doctor would be able to do the PA later & get them some reimbursement.
 
Prolong viral suppression - undetectable viral load after taking Sovaldi, 90% patients are essentially cured taking this drug. I'd also pay out of pocket if I had HCV.

Now, where is the drug to cure HIV?
 
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Credit card with a $35,000 limit? They can afford it.
 
here in the bronx, the record is a 3 dollar medicare copay instead of the usual 50 cent medicaid copay

Some customers will complain about the $3 medicare copay, ask pharmacy to waive all copays, and refuse to pick up when copays are not waived.
 
To be fair, I have met a few customers who paid cash (10k) for their HIV medications because they re-sell it in other countries where they might not have access to it, or for friends/families.

They came in with a stack of benjamins...
 
Wow. Most I ever saw was one guy paying $1,000 for brand Mevacor for his mom. I was an intern at the time. The RpH told the guy to get Lovastatin and it would be much cheaper and it's the same thing, but the guy went nuts and said he's a doctor and it's not the same....
 
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To be fair, I have met a few customers who paid cash (10k) for their HIV medications because they re-sell it in other countries where they might not have access to it, or for friends/families.

They came in with a stack of benjamins...
If this was the case, they should have bought them in India.
 
Credit card with a $35,000 limit? They can afford it.

They used two credit cards.. It was such a big deal not only for our store, but the entire market.. Even the DM mentioned it in conference call the next day.
 
And in case if anyone is wondering, pharmacy made a profit of $3700 (drug cost = $28000) !!!
 
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That's a lot of airline miles.
 
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And in case if anyone is wondering, pharmacy made a profit of $3700 (drug cost = $28000) !!!
-$1000 to the credit card companies ;)

That guy was an idiot by the way. Next time he comes in send him to this website and save him $6,000. Maybe he will buy you a nice present.
https://www.sovaldi.com/coupons

Edit: Or call him and have him come back to save him $12,000.
 
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-$1000 to the credit card companies ;)

That guy was an idiot by the way. Next time he comes in send him to this website and save him $6,000. Maybe he will buy you a nice present.
https://www.sovaldi.com/coupons

Edit: Or call him and have him come back to save him $12,000.


I am no expert on this but I highly doubt if credit card company will get 1k just for the transaction?? Anyone else can comment?
 
he probably means your company has to pay the credit card company 2-3% fee, up to 3.5-4% if he used American Express. Not only that, he used 2 cards... that could double the fee up to 6-8%

I am no expert on this but I highly doubt if credit card company will get 1k just for the transaction?? Anyone else can comment?
 
he probably means your company has to pay the credit card company 2-3% fee, up to 3.5-4% if he used American Express. Not only that, he used 2 cards... that could double the fee up to 6-8%
Using two cards doesn't double the fee. It's just paid half to each bank.
 
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The pharmacy I work at right now waives copays up to $15.
That's a violation of the contracts that they've signed ...you'd better tell your bosses that they are one audit away from being fined or prosecuted criminally if they're waiving Medicare part D co payments. And if your employer decides to say that was entirely of your doing and they are waiving Medicaid or Medicare co payments then you will wind up on the US inspector general's excluded provider list and no employer that accepts Medicare or Medicaid will be able to employ ouu. Translation: your pharmacist career will be limited severely and likely over.

http://exclusions.oig.hhs.gov/Default.aspx
 
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I am no expert on this but I highly doubt if credit card company will get 1k just for the transaction?? Anyone else can comment?
It had $38k total in CC transactions last month and my total fees deducted were $961.... So it's actually fairly close.
 
I heard of states where people on Medicaid can claim not to be able to afford their medication in and pharmacy is legally required to waive the copay. Is this true, I don't know?
 
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The pharmacy I work at right now waives copays up to $15.

I thought it is a common practice in independents.. One of my friend used to work at independent pharmacy and they actually waived copay on all medicare/ medicaid pts and it was their way of "competing" with chains. Never knew it's illegal !!
 
I thought it is a common practice in independents.. One of my friend used to work at independent pharmacy and they actually waived copay on all medicare/ medicaid pts and it was their way of "competing" with chains. Never knew it's illegal !!

It's not legal.
 
I heard of states where people on Medicaid can claim not to be able to afford their medication in and pharmacy is legally required to waive the copay. Is this true, I don't know?
Yup.. Massachusetts is such state.. My cousin interned there he used to tell me about people showing up with louis vuitton purse and they would get the medication for free since they cannot "afford" it.
 
I heard of states where people on Medicaid can claim not to be able to afford their medication in and pharmacy is legally required to waive the copay. Is this true, I don't know?

In IL, we must legally waive Medicaid co-pays.....as it is, almost none of my customers seem to know this, its extremely rare that someone asks to have their co-pay waived. (or maybe the ones who do know about this, all just go to the independent across the street???)

The pharmacy I work at right now waives copays up to $15.

As others have said, this is very illegal concerning Medicare fraud, and most likely a violation of every insurance contract your pharmacy has signed. You may not have realized this, but I would recommend quickly distancing yourself from this insurance fraud that you are participating in. You may have a sweet job now, but as others have said, this is stuff that could end your pharmacy career.
 
that's crazy. highest i ever saw was over $2000 for Forteo and I think insurance already covered half of it, even then I was shocked. 31k out of pocket? i'm surprised this doesn't make yahoo news or something. i imagine there is some reimbursement to the patient later or something. well you better treat that customer well from now on.
 
I thought it is a common practice in independents.. One of my friend used to work at independent pharmacy and they actually waived copay on all medicare/ medicaid pts and it was their way of "competing" with chains. Never knew it's illegal !!

It is essentially a kickback. You're not paying the patient but you're giving them a financial reason to use your pharmacy. That's not the way medicare works.

I heard of states where people on Medicaid can claim not to be able to afford their medication in and pharmacy is legally required to waive the copay. Is this true, I don't know?

Medicaid I believe because the state negotiates with pharmacies so that the patient doesn't pay anything no matter what. Which sucks for retail in Texas because TX Medicaid makes deals with certain companies so they have to stock certain NDCs for Medicaid to pay. Great example would be Vistapharm liquid hydrocodone/APAP (before it went C2). Costs $160 a bottle and Medicaid won't pay for the cheaper brand so they're forced to stock the expensive crap.
 
I heard of states where people on Medicaid can claim not to be able to afford their medication in and pharmacy is legally required to waive the copay. Is this true, I don't know?

NY was like that when I was an intern 6 years ago.
 
95% of our patients are on Medicaid so it is legal for them, I don't think we have any Medicare patients. And we have like 1 or 2 private insurance patients. Rest are cash payers. Majority of the scripts are dermatology compounds which are faxed directly from the dermatologist to us and we deliver it to the patient's residence unless they want to pick it up in store.
 
The most expensive RX I saw in retail was $1,400 for a month's supply of thalidomide.That was in the early 00s.

When I worked in mail order, there was one prescription, which went out in a huge shipping box, and the insurance company was charged over $60K. (Mid 1990s) That was the one and only time I have ever dispensed Factor VIII.

And then there's Gliadel, for which the patient gets charged about $100,000. I'll never forget the patient who had complications and had to have them removed the very next day.
 
I heard of states where people on Medicaid can claim not to be able to afford their medication in and pharmacy is legally required to waive the copay. Is this true, I don't know?
That is sort of true.

It is illegal IN EVERY STATE to deny a Medicaid covered benefit based upon the enrollee' stability to pay. (FYI: this applies to MCO's contracted by Medicaid, too - but NOT Medicare)

However, that doesn't mean the copay a need to be waived. You could send the debt to a collections agency. Or you could give a few tablets from their month supply and tell them to come back in a few days to get the rest when they can afford it (and if they can't give them a few more and repeat). However, Medicaid copay are low enough that the labor cost of doing these sorts of things is higher than the money you'd likely recoup. So, that's why we waive Medicaid copays.
 
During the first of the year, I know a couple patients who are on a dozen meds in a brown bag and have to meet their deductible so they pay around $1,000 for their brown bag but after meeting deductible it's way cheaper or even free in the following months. Mostly just brand name maintenance meds like zetia, crestor, Lantus solostar, advair, januvia, etc.
 
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