topic Re: Negotiating Prescription Prices in Personal Finance

Negotiating Prescription Prices

AndrewF — Mon, 02 Feb 2026 18:21:36 GMT

Medicare Part D plan costs keep rising, and the benefits are usually not good enough to justify the premium.

This is a guide to what I am now doing to contain prescription drug costs. It should work for anyone who is sick and tired of their Medicare Part D plan premiums going up and wants to do something about it, but the advice should work for anyone who is uninsured or who has bad drug coverage/co-pays on their health insurance plan.

Late last year, I was notified that the cost of my Medicare Part D plan would be going up, again. It would now cost over $50 a month, which is too much, especially considering that they very nearly never have the best co-pays. I decided to take advantage of Open Enrollment to change to the $0 premium option in my State, which was one of Wellcare's plans.

Other than a couple of generics that have no co-pay, I am essentially now uninsured for drug cost purposes. The only protection I would have is if my out of pocket for the year went over $2,000 and I ran all my prescriptions through Part D to get there. Since all of my medications are generic, this is actually a lot of money compared with drug discount programs like BuzzRX and GoodRX Gold.

GoodRX Gold is different from the "free" GoodRX coupons in a few ways. One is, that it costs money, either $9.99 a month, or $88 up front for an entire year. The idea is that they'll negotiate better prices than the regular PBMs, and another benefit is that the card is unique to you and does not change depending on the drug, pharmacy, or anything else, wherever Gold is accepted (denoted by an icon next to the prices).

If you fill so many generic prescriptions that the cost savings on Gold can beat $88 (paid in full per year), then GoodRX Gold might be worth using. Your mileage may vary because while there's plenty of Gold pharmacies in my area (in the vicinity of Chicago), there's only one where my mother lives in rural Indiana, and so she was like "Why are you paying for GoodRX?"

In my case, I fill a lot of medicines and the Gold prices usually beat the standard coupons anywhere from $3-10 per fill. So on top of the "walking medicine cabinet" stuff I usually take, there's also some odds and ends, and I estimate that I should be able to save almost three times what I pay.

GoodRX Gold may also require using multiple pharmacies to hunt down the best prices. In my case, the spread works like this:

7 drugs (90 day fills):

Go to Jewel Osco and make sure they use GoodRX Gold.

2 drugs (90 day fills):

Go to Jewel Osco and make sure they use Wellcare Medicare Part D for the $0 co-pays.

1 drug (180 day fills):

Go to CVS and make sure they use GoodRX Gold. (This particular drug is $112 per 90 days at Jewel Osco with GoodRX Gold, but $51 at CVS for 90 days, but since GoodRX Gold isn't insurance, you can buy whatever the doctor wrote the order for, and for some reason 180 days works out to $67 at CVS with GoodRX Gold but double the price of a 90 day fill everywhere else! So I get an extra three months for only $16 more as opposed to a second 90 day fill at $51.)

1 drug:

Go to Jewel Osco and make sure they use a specific publicly available coupon from BuzzRX for this particular drug.

It's become a real mess trying to contain prescription costs.

One thing I noticed about the drug I fill at CVS is that it uses a different supplier than Jewel-Osco. However, this should not be an issue since the FDA requires that generic drugs be as potent as the name brand and work identically.

Why are cash prices without coupons so expensive?

The prescription drug pricing system in the US works the same as it does at the hospital or doctor's offices, where they use what is called a "Chargemaster". The chargemaster is essentially a big book of fake prices that insured people see before the insurance "negotiates". The main benefit of having insurance isn't that the insurance pays part of the bill, it's that it protects you from these fake prices, which are actually REAL if you are uninsured.

Every drug store in America is more than happy if a clueless consumer walks in and pays too much, and many of them are not allowed to tell you how to beat their system and save money. Some realize that many consumers are getting wise to them and say they have a plan that you pay for "to save money" that only works in their store, like Walgreens does. In some cases, Jewel Osco will even go rummaging through other coupons to prevent having to run your prescription through GoodRX and say they found you a better deal.

(But why don't they do that for people who aren't showing them a GoodRX Gold card? According to the pharmacists I've spoken with, although GoodRX doesn't pay them and routes them to PBMs that use contractually negotiated prices, GoodRX costs them a couple dollars every time they run it. Thus, the stores have an incentive to keep the volume of prescriptions ringing up as GoodRX down, so just presenting the card is sometimes enough for them to lower the price voluntarily and say they found you a better deal.)

But you don't have to play their game.

Another thing I like about GoodRX (Gold or free) is that if you sign up for their rewards, you get 1,000 points per prescription filled using GoodRX. You can cash these out whenever they go past 3,000 points. Every 1,000 points is good for $1 off your next fill using GoodRX (so I dumped out 5,000 points to fill an antibiotic yesterday that was going to be $29 with my Part D, but only $9.08 at Jewel with GoodRX Gold) and walked out having paid $4.08.

Prescription drugs are a place where caveat emptor ("Let the buyer beware!") applies heavily.

As an aside, I have Discover It, PayPal Debit, and an AmEx BCP. So I get a minimum 3% back at the pharmacy and sometimes 5% because Jewel Osco codes as a grocery store. Since I can use my grocery categories, I net another $20-25 or so in credit card cashback over the year vs maybe $5-7 at a standalone pharmacy or Walmart.

Also, since I have GoodRX Gold, I also get $19 telehealth visits. Which are cheaper than my Medicare Part B co-pays to go to Urgent Care (which are usually in the ballpark of $59), and they can treat you over a video call. During my free trial, my partner came down sick with bronchitis, and the NP was able to call him in some antibiotics. I briefly changed it over to a family plan, put him on it, then took him off before the free trial ended.

Is using drug discount programs "dishonest" or does it hurt the pharmacy?

Absolutely not. They negotiated to use these prices if an insured person comes in and that's their Pharmacy Benefit Manager. They set the cash price as an "opening" for negotiations for PBMs. You are "working the system", but the pharmacy agreed to pay those prices, and they are still making a profit.

One alternative to GoodRX Gold, that can result in slightly more savings, is Mark Cuban's "Cost Plus Drugs", where the pharmacy is mail order, and they simply add 15% profit margin and a small pharmacy fee to every order. Their prices are usually comparable or even a little cheaper than GoodRX Gold pharmacies. Why? Well, because that's how cheap pharmacies are getting these drugs.

In one case, (my 180 day fill example), the cash price for 180 days at CVS was listed at over $1,900, but they sell to me at $67 with my coupon. Mark Cuban's Cost Plus is a few dollars cheaper at $63, but requires me to go through the hassle of a mail order pharmacy. Turns out $63 is 15% profit margin and a small pharmacy fee, so don't worry. These pharmacies are still making a tidy profit even if you go in there with a coupon.

In fact, my cat's vet got tired of drug companies jacking people around for pet medicine, and she sells the medicines herself for just barely over what she pays for them. She's a very honest person, and it's never worth taking a prescription and trying to fill it somewhere else unless she's just out of that and can't get any. (There was a national shortage of my cat's thyroid meds a couple of years ago and I ended up having to get the wrong dosage from a mail order company and use a pill splitter to render the right dosage, but right after they shipped mine, they ran out too!)

The vet said she was telling people to go to pharmacies, but then they came back to her saying they couldn't afford it.

Once a patent expires, it's dirt cheap to make most prescription drugs. In fact, for an excellent example there was a blockbuster medicine for men with commercials with people in bathtubs 20 years ago, and if you went to the pharmacy to fill that, they'd sock you with a $1900 co-pay, however with BuzzRX the generic is $22 a month at Jewel Osco.

Patrick Stewart fans might recall him doing the voiceover of a cholesterol pill called Crestor. A very small dose packs a wallop. I take 5 mg and I do (off label) alternate day dosing with the advice of my doctor, which results in less than 25% of what the drug company says the "minimum starting dose" is, and it works great for me. However, it was $1600 a month in 2011, and today it can be $10 with GoodRX Gold, or even free on my Medicare Part D plan.

Shouldn't the drug companies be ashamed of themselves? How do they get away with it?

Well, it's simple really. The United States is the only country that doesn't have the government step in and say you're not gouging people. Here's what we're paying, so they really hit us, even while other countries pay 10-20% of that.

The drug companies have also gotten good at avoiding a list of maximum prices by giving out prescription co-pay cards for commercially insured patients that hide most of the pain, or even sending it free in the mail if you're broke. When I started taking Crestor during the "Patrick Stewart years", the drug company was sending it to my 90 days at a time for free under a Patient Assistance Program.

Fortunately, today, over 90% of the drugs filled in America are generic, thanks to the 20 year patent expiration. There are many effective drugs that are now generic and ripe for taking the pharmacy to the mat with drug savings programs without paperwork and ridiculous prices, however if you take brand name drugs, it might suit you to fill everything through Medicare Part D to hit the $2,000 out of pocket cap, or look into Prescription Co-Pay Cards and Patient Assistance Programs like I used to do.

I remember being so terrified ~20 years ago when I was uninsured. Every time I went to the doctor it was $75, but worse than that, if they actually prescribed something, I'd end up shelling out third of a month's income for some antibiotics. In one case, my family doctor prescribed a new drug that was going to be over $400 at Walmart. I asked the pharmacist if anything else would work because I did not have $400.

He said, "If she had written the prescription for [an older generic] it would only cost you $16.", so I had to march right back to the doctor and ask for a different prescription. I was so mad. You know, it seemed like they're driving around in a Mercedes so they forget completely that someone might be working at Walmart.

I was so happy when GoodRX started soon after that. It wasn't a smartphone app, obviously. So I just printed off coupons for the drug and dosage on my computer and handed the printout to the pharmacist. I felt like I finally "won" and there was nothing they could do to prevent me from getting my medicine (most of the time, anyway). With the drug "patent cliff" in the following years, we have a huge bounty.

Re: Negotiating Prescription Prices

AndrewF — Mon, 02 Feb 2026 02:39:56 GMT

I also noticed something funny about GoodRX Gold.

It seems it just routes you to better PBMs that standard GoodRX won't, but that many of those are just a free discount card, so GoodRX Gold is essentially just a way to get routed through to the best PBM for each prescription at that pharmacy.

If you're always using CVS, it might be worth getting a GoodRX Gold free trial, rushing in to fill your prescriptions, then writing down which PBM it's using for each medication so you can go do it yourself later without paying GoodRX.

I suppose you could argue that PBMs are constantly changing their prices and GoodRX is still providing a valuable service by constantly querying them behind the scenes and adapting to always pick the best one, and that may be worth the fee they charge, especially since they *also* comp shop the pharmacies in your area. So even if CVS is always the best Gold pharmacy where you're at and you do write the PBMs down, that information could theoretically become stale next time you have refills.

A guy like me might write down 10 or 11 PBMs and their card details, then tie up the line and make everyone at the pharmacy mad shuffling through cards, then it could all change next month anyway.

Re: Negotiating Prescription Prices

crystal626 — Mon, 02 Feb 2026 06:51:35 GMT

Prescriptions are such a racket. My doctor just put me on a new med. I couldn't believe the price I would have to pay if I didn't have Extra Help from Social Security. It's a good thing my partner and I never got married because we couldn't afford this. It's $12.65 with Extra Help. The cheapest offer from regular GoodRX is $513 a month and GoodRX Gold is $493.

The cheapest standalone PDP would max out the $2100 cap.

The cheapest Advantage plan without Extra Help is $450 for all my meds for the year, which is certainly more manageable, but still ridiculous, and I'd have to give up a few of my doctors that aren't in network. If I didn't want to lose doctors, $1500.

And of course, I'm actually tolerating the med with hardly any side effects, when I don't tolerate many medications well at all (and the older meds for this condition have a very long list of side effects, including serious heart problems, which no thanks), so I would have to figure out how to swing it or just live life with an extremely uncomfortable chronic condition that interferes with all aspects of life.

It's ridiculous to have to pay so much for something that costs pennies to make.

Re: Negotiating Prescription Prices

The_Banker — Mon, 02 Feb 2026 07:21:13 GMT

Support your local pharmacies (which I hope you still have as many no longer have them) by using Mark Cuban's Team Cuban Card program - you can sign up at this link -Member Portal. Its's FREE. The program has over 2300 meds and keeps adding new drugs to their list of covered meds. I actually work for an very Large integrated delivery network (IDN), or health system that uses Express Scripts as the PBM. 2 of the maintenance meds that I take are free (up to 90 day RX's) no matter where I fill them. I take 2 other maintenance meds and I use Team Cuban for those and not my insurance as one of meds would be a $40 copay the other would be a $30 copay. The $40 med is $30 for 90 days and the $30 med is $15 for 90 days using Team Cuban. The local indepedent pharmacy I use is in a very large supermarket chain that I regularly shop and it's 1 mile from my house -so I am not traveling or going out of may to get these meds. Each of the meds is a generic and the pharmacy will not fill more than a 90 supply (which is fine with me). The only downside is that my copays cannot be applied to by overall deductible (which sucks and I have been in an ongoing disussion with the Head of Corp Benefits for my employer trying to get that changed for ALL employees). The $100 I am saving over a year is better in my pocket than paying it to CVS or even to one of the pharmacies that are owned by my employer. The BIG PBM's are all scams/rackets -they pocket manufacturer drug rebates and price generics in way that causes those with health insurance to pay more than the should for generics. The are some challenger PBM's that are trying to change that and break the stanglehold that the BIG PBM's have but it's hard.

Good luck.

Re: Negotiating Prescription Prices

AndrewF — Mon, 02 Feb 2026 23:52:00 GMT

I hate having to take my medicines to different pharmacies and I absolutely will not go to Walgreens no matter what the price says because they almost never honor it and give you a lot of crap and try to sell a plan that only works in their stores then you have to transfer the prescription to someone who actually honors it.

I dislike CVS because their phone system makes you lie and say you're a doctor to talk to a person instead of a chat bot, but to avoid paying double on that one medicine which is truly outrageous, it's worth dealing with them occasionally.

Jewel Osco has better customer service, is usually cheapest or close enough on Gold, and codes as a grocery store for my cards with a grocery cashback category.

I'm not thrilled with the prescription situation. Some generics are still very expensive especially if they're specialty, and there's still occasionally brand only and GoodRX turns an outrage into an outrage that's a few percent less on those.

I do wish that someone would reform these and say cost plus 15% is enough and that's all you're getting no matter how they pay.

CVS and Walgreens overbuilt and are closing about half their stores now leaving pharmacy deserts and they don't care that they stomped the local pharmacy to death and now those people can't even go anywhere.

Yes, a total mess and I have not spoken with a single person who likes it.

I have Original Medicare A and B, but also the $0 premium Part D plan.

On paper, Medicare Part C (Advantage) looks like a smart way to contain costs, but the way they cap out of pocket expenses and offer $0 additional premiums and such is where I draw the line. If I had a Medicare "Advantage" plan, my shoulder surgery would have had to go through insurance company red tape, I could go...wherever they told me to go which may not have been the most qualified surgeon or the best hospital, and sure my costs might have been theoretically contained in the event of an utterly catastrophic year, but that didn't happen either.

Even with over $150,000 in medical bills that went to Parts A and B, I only ended up paying less than a few thousand dollars of it, which is still $5,000 shy of the ceiling on out of pocket on so-called "Advantage" plans.

People surveyed on "Advantage" plans say they like it, but then they report waiting in long lines, being told what they can have or not and where they can go, and most of them never use any of the "extra benefits" like over the counter drug allowances and silver sneakers.

I was talking to my mom about a particular doctor she disliked when she was a hospital nurse back in the 90s. She said, "His patients loved him, while he was watching them die." and this is sort of my impression of Medicare so-called "Advantage".

If you have Original Medicare, you have to either add a Part D plan, or face a penalty of 1% of the premium amount for each month you did not have it, so the only reason to have it is to park it on a $0 monthly premium plan if one exists in your State, take the free cholesterol and blood pressure medicines, and leave it alone on everything else, and that way you are "covered" and avoid any penalties at a future time.

That's my opinion based on my experience with it.

Re: Negotiating Prescription Prices

Jnbmom — Mon, 02 Feb 2026 23:56:27 GMT

My hubby has Medicare part D through WellCare.

Some scripts are zero copays some are outrageous.

he takes one med that's over 100.00 for a 60 days supply, but I use single care It is free and the cost is 29.00 . Another med was 58.00 bucks through well care , single care 12.00 bucks.

The Walgreens pharmacy actually recommended it so we went over every med and use WellCare for some and single care for others . Saved us a lot of money .

Re: Negotiating Prescription Prices

AndrewF — Tue, 03 Feb 2026 03:42:11 GMT

@Jnbmom wrote:
My hubby has Medicare part D through WellCare.

Some scripts are zero copays some are outrageous.

he takes one med that's over 100.00 for a 60 days supply, but I use single care It is free and the cost is 29.00 . Another med was 58.00 bucks through well care , single care 12.00 bucks.

The Walgreens pharmacy actually recommended it so we went over every med and use WellCare for some and single care for others . Saved us a lot of money .

I have a copy of Wellcare's current formulary in my state. Tier 1 is generics that they'll cover for free, but it's very sparsely populated.

The one I do a six month fill on (because there are no QLs when you pay cash!) is on Tier 4(!) under Wellcare, so there's going to be almost no coverage at all on that. I looked at what they would charge me and it would be over $260 per fill. QL 90 day supply. Why would I pay this when I can pay $67 for a six month supply twice a year with GoodRX Gold at CVS?

That doctor has me on 150 mg of something else. It would cost me $154 for 90 with Gold, but if I take a 100 and a 50, then a 90 day supply is $19 for one and $16 for the other for a total of $35.

That's $1040 per year through Part D for one medicine, and $134 through Gold at CVS for the Tier 4 one. For one drug. And the other one, well, a doctor might prescribe the 150s if you don't know any better. It truly is a jungle out there.

That's the most extreme example on the list of medicine I take, but still, whoa. I mean maybe I could get to the $2,000 and get everything else "for free", but why would I do that when I pay $500-600 through Gold and the oddball with BuzzRX? The two I fill with Wellcare because they're free don't count towards OOP, so they're off the board either way.

It's nice that the catastrophic coverage exists for people who need it, but I'm not one of them. My dad, on the other hand, is on a very expensive medicine that he'd die without, and either way he'll overshoot $2,000 so for him, Part D is a good deal.

Re: Negotiating Prescription Prices

crystal626 — Tue, 03 Feb 2026 04:35:41 GMT

@The_Banker wrote:
Support your local pharmacies (which I hope you still have as many no longer have them) by using Mark Cuban's Team Cuban Card program - you can sign up at this link -Member Portal. Its's FREE. The program has over 2300 meds and keeps adding new drugs to their list of covered meds. I actually work for an very Large integrated delivery network (IDN), or health system that uses Express Scripts as the PBM. 2 of the maintenance meds that I take are free (up to 90 day RX's) no matter where I fill them. I take 2 other maintenance meds and I use Team Cuban for those and not my insurance as one of meds would be a $40 copay the other would be a $30 copay. The $40 med is $30 for 90 days and the $30 med is $15 for 90 days using Team Cuban. The local indepedent pharmacy I use is in a very large supermarket chain that I regularly shop and it's 1 mile from my house -so I am not traveling or going out of may to get these meds. Each of the meds is a generic and the pharmacy will not fill more than a 90 supply (which is fine with me). The only downside is that my copays cannot be applied to by overall deductible (which sucks and I have been in an ongoing disussion with the Head of Corp Benefits for my employer trying to get that changed for ALL employees). The $100 I am saving over a year is better in my pocket than paying it to CVS or even to one of the pharmacies that are owned by my employer. The BIG PBM's are all scams/rackets -they pocket manufacturer drug rebates and price generics in way that causes those with health insurance to pay more than the should for generics. The are some challenger PBM's that are trying to change that and break the stanglehold that the BIG PBM's have but it's hard.

Good luck.

Cost Plus Drugs is definitely a great resource for meds that they stock. They only charge like... 15% I think? For their profit margin and it makes the meds crazy cheap.

Re: Negotiating Prescription Prices

crystal626 — Tue, 03 Feb 2026 06:08:22 GMT

@AndrewF wrote:
On paper, Medicare Part C (Advantage) looks like a smart way to contain costs, but the way they cap out of pocket expenses and offer $0 additional premiums and such is where I draw the line. If I had a Medicare "Advantage" plan, my shoulder surgery would have had to go through insurance company red tape, I could go...wherever they told me to go which may not have been the most qualified surgeon or the best hospital, and sure my costs might have been theoretically contained in the event of an utterly catastrophic year, but that didn't happen either.

Even with over $150,000 in medical bills that went to Parts A and B, I only ended up paying less than a few thousand dollars of it, which is still $5,000 shy of the ceiling on out of pocket on so-called "Advantage" plans.

People surveyed on "Advantage" plans say they like it, but then they report waiting in long lines, being told what they can have or not and where they can go, and most of them never use any of the "extra benefits" like over the counter drug allowances and silver sneakers.

Advantage isn't for everyone but I would have been paying massively more money if I didn't have it. Just adding the cheapest high deductible Plan G Medigap to insure I have catastrophic coverage and don't end up being stuck with unlimited 20% cost sharing through Original Medicare would add another $100 a month to the Part B premium and I would have to pay 100% of that 20% cost sharing until I hit $2895 for the year. I've had Medicare since 2014, this would have added up a lot. My typical out of pocket across that time has been less than $500 a year. My Advantage plan over the years has typically been $0 copay for primary care, $20-$30 for specialist, $40 for urgent care. Most bloodwork is typically $0, $30 for xrays, $250-300 or so for CTs... My out of pocket maximum has been between $3500 and $4K, they usually pay $150-$200 for glasses, $1000-$2000 for dental, $30-$70 per quarter for OTC...

My current plan gives me $210 a month to spend on OTC, groceries, and utilities although it's a special needs plan that includes Medicaid for chronic health conditions so it's not really comparable to other Advantage plans but up until last year I had a typical Advantage plan and never had any issues other than prior auths for medications that I would have had to deal with if I had a PDP anyway. It also gives me $2500 for dental and $250 for glasses this year.

The network that I have is actually rather large. I've never had a problem finding care. My plans didn't even have referrals required for years despite always being HMO but unfortunately they've instituted them this year. I considered changing to a PPO but I would lose $99 a month off my OTC, grocery, and utility benefit, which just seemed like a steep price to pay when I can email my doctor any time I need a referral for something and she'll get it done without forcing me to be seen in person and I wouldn't want to pay the extra to see an out of network doctor anyway.

I have Extra Help though as I mentioned, which gives me the unique ability to drop Advantage for Original Medicare and a PDP any time, with the change taking effect the following month, so Advantage isn't really all that risky for me compared to people who can only change during open enrollment. The bottom line though is that all the extra costs I would have been on the hook for with Original Medicare, Medigap, and. a PDP would have been impossible for me to pay back then, so I was in Advantage from day one.

Re: Negotiating Prescription Prices

AndrewF — Tue, 03 Feb 2026 07:06:02 GMT

@crystal626 wrote:
@AndrewF wrote:
On paper, Medicare Part C (Advantage) looks like a smart way to contain costs, but the way they cap out of pocket expenses and offer $0 additional premiums and such is where I draw the line. If I had a Medicare "Advantage" plan, my shoulder surgery would have had to go through insurance company red tape, I could go...wherever they told me to go which may not have been the most qualified surgeon or the best hospital, and sure my costs might have been theoretically contained in the event of an utterly catastrophic year, but that didn't happen either.

Even with over $150,000 in medical bills that went to Parts A and B, I only ended up paying less than a few thousand dollars of it, which is still $5,000 shy of the ceiling on out of pocket on so-called "Advantage" plans.

People surveyed on "Advantage" plans say they like it, but then they report waiting in long lines, being told what they can have or not and where they can go, and most of them never use any of the "extra benefits" like over the counter drug allowances and silver sneakers.

Advantage isn't for everyone but I would have been paying massively more money if I didn't have it. Just adding the cheapest high deductible Plan G Medigap to insure I have catastrophic coverage and don't end up being stuck with unlimited 20% cost sharing through Original Medicare would add another $100 a month to the Part B premium and I would have to pay 100% of that 20% cost sharing until I hit $2895 for the year. I've had Medicare since 2014, this would have added up a lot. My typical out of pocket across that time has been less than $500 a year. My Advantage plan over the years has typically been $0 copay for primary care, $20-$30 for specialist, $40 for urgent care. Most bloodwork is typically $0, $30 for xrays, $250-300 or so for CTs... My out of pocket maximum has been between $3500 and $4K, they usually pay $150-$200 for glasses, $1000-$2000 for dental, $30-$70 per quarter for OTC...

My current plan gives me $210 a month to spend on OTC, groceries, and utilities although it's a special needs plan that includes Medicaid for chronic health conditions so it's not really comparable to other Advantage plans but up until last year I had a typical Advantage plan and never had any issues other than prior auths for medications that I would have had to deal with if I had a PDP anyway. It also gives me $2500 for dental and $250 for glasses this year.

The network that I have is actually rather large. I've never had a problem finding care. My plans didn't even have referrals required for years despite always being HMO but unfortunately they've instituted them this year. I considered changing to a PPO but I would lose $99 a month off my OTC, grocery, and utility benefit, which just seemed like a steep price to pay when I can email my doctor any time I need a referral for something and she'll get it done without forcing me to be seen in person and I wouldn't want to pay the extra to see an out of network doctor anyway.

I have Extra Help though as I mentioned, which gives me the unique ability to drop Advantage for Original Medicare and a PDP any time, with the change taking effect the following month, so Advantage isn't really all that risky for me compared to people who can only change during open enrollment. The bottom line though is that all the extra costs I would have been on the hook for with Original Medicare, Medigap, and. a PDP would have been impossible for me to pay back then, so I was in Advantage from day one.

I had to have parts of my shoulder that broke off removed, a bone graft, a biceps and rotator reattachment, and I was in surgery for 6 hours, and I've been in Physical Therapy since October, and I have paid about $3,000 or so maybe. I'd have to look.

I love Original Medicare and they'd have to pry it out of my cold dead hands. lol

What I don't trust, at all, are insurance companies where people have to beg for their lives over Twitter and you may have to see some crappy doctor in some network that only covers your county, because the guy agreed to work cheap.

I've gotten by most of these years by going to dental hygiene schools and dental colleges. Had I had Medicare so-called "advantage" they'd have paid for some cleanings that I got for $15 at the dental school. The dental school doesn't do scrape scrape your 15 minutes are up get out, they spend the time to do the cleanings right because they're being graded. The dentists are absolutely the wrong place to go if you're uninsured, because they'll hit you for $250 or more for a cleaning and what they call a cleaning and what I call a cleaning are very different.

Also, I have dental insurance now, but that's only been in the past year through my spouse. I am still so impressed with the school I go there, they even sealed eight of my teeth for free, and they give me fluoride treatments, which insurance doesn't cover if you're an adult. I don't have to worry "Uh, is this dentist crooked?" like my ex, when a dentist filled three healthy teeth while he just sat there. If there's a problem, the instructor dentist will advise me with nothing to gain and refer me to a dental college or dentist with my x-rays already done.

Eyeglasses are usually extremely overpriced, especially if it's one of Luxottica's many brands or stores.

The FTC eyeglass rule says you can take your prescription and leave if you paid something for the exam, so don't let them give you a free exam.

They usually don't write down your pupilary distance, but I've asked and they told me (Walmart). You can take the prescription online after measuring yourself for a frame, if you're uninsured. I have VSP, so I use Walmart, but again that's only recent. For 9 of the last 10 years I used Zenni or EyeBuyDirect. American Express often has rebates for both of them on AmEx Offers, so you can get two pair and get a very good rebate if you're paying cash.

Most of my co-pays in Original Medicare are comparable or even lower than yours. It does not say what they are on the Original Medicare card, but if they take Assignment, your costs will be low, and you can go anywhere that takes that. I had to go to Wisconsin for surgery, if I had so-called advantage I would have been stuck with a failing hospital network in my county that's about to go bankrupt, most likely, and is in the news constantly for not paying any of its bills, and patient deaths.

I do not mean to sound combative or anything, but my advice to my mother (who is older and has health problems) was to run screaming away from those so-called Advantage people. Stick with the red, white, and blue card and she got Medigap, which is smart for her.

I can't even get Medigap because you have to be at least 65. Right now it wouldn't even be financially worth it if I could get it. The premiums would be more than I pay for co-pays.

The annual maximum out of pocket on so-called advantage would have never saved me a single penny in any of the 16 plan years I've been on Medicare. So even if that was its only perk, it still wouldn't have saved me anything.

I have looked through the plans that sell policies in my county. If I had been on so-called advantage then I could have seen my doctor while she was at the hospital here, but not after she went a few miles up to Wisconsin. Nor are my orthopedic surgeons that did a fantastic job on my arm in the network those plans I can get here have.

The main reason "advantage" was supposedly created was to save the government money, but it does not even do that. They get a minimum of 11% more than an Original Medicare beneficiary costs on average, but then the Advantage plan companies cheated the government out of billions by looking through patient charts to try to say the patients were sicker, when the patient wasn't complaining of that, and then the government paid them more money to treat patients that were not getting more medical care.

Huge settlement where they paid back half, so they still won.

Re: Negotiating Prescription Prices

crystal626 — Tue, 03 Feb 2026 21:48:21 GMT

@AndrewF wrote:
@crystal626 wrote:
@AndrewF wrote:
On paper, Medicare Part C (Advantage) looks like a smart way to contain costs, but the way they cap out of pocket expenses and offer $0 additional premiums and such is where I draw the line. If I had a Medicare "Advantage" plan, my shoulder surgery would have had to go through insurance company red tape, I could go...wherever they told me to go which may not have been the most qualified surgeon or the best hospital, and sure my costs might have been theoretically contained in the event of an utterly catastrophic year, but that didn't happen either.

Even with over $150,000 in medical bills that went to Parts A and B, I only ended up paying less than a few thousand dollars of it, which is still $5,000 shy of the ceiling on out of pocket on so-called "Advantage" plans.

People surveyed on "Advantage" plans say they like it, but then they report waiting in long lines, being told what they can have or not and where they can go, and most of them never use any of the "extra benefits" like over the counter drug allowances and silver sneakers.

Advantage isn't for everyone but I would have been paying massively more money if I didn't have it. Just adding the cheapest high deductible Plan G Medigap to insure I have catastrophic coverage and don't end up being stuck with unlimited 20% cost sharing through Original Medicare would add another $100 a month to the Part B premium and I would have to pay 100% of that 20% cost sharing until I hit $2895 for the year. I've had Medicare since 2014, this would have added up a lot. My typical out of pocket across that time has been less than $500 a year. My Advantage plan over the years has typically been $0 copay for primary care, $20-$30 for specialist, $40 for urgent care. Most bloodwork is typically $0, $30 for xrays, $250-300 or so for CTs... My out of pocket maximum has been between $3500 and $4K, they usually pay $150-$200 for glasses, $1000-$2000 for dental, $30-$70 per quarter for OTC...

My current plan gives me $210 a month to spend on OTC, groceries, and utilities although it's a special needs plan that includes Medicaid for chronic health conditions so it's not really comparable to other Advantage plans but up until last year I had a typical Advantage plan and never had any issues other than prior auths for medications that I would have had to deal with if I had a PDP anyway. It also gives me $2500 for dental and $250 for glasses this year.

The network that I have is actually rather large. I've never had a problem finding care. My plans didn't even have referrals required for years despite always being HMO but unfortunately they've instituted them this year. I considered changing to a PPO but I would lose $99 a month off my OTC, grocery, and utility benefit, which just seemed like a steep price to pay when I can email my doctor any time I need a referral for something and she'll get it done without forcing me to be seen in person and I wouldn't want to pay the extra to see an out of network doctor anyway.

I have Extra Help though as I mentioned, which gives me the unique ability to drop Advantage for Original Medicare and a PDP any time, with the change taking effect the following month, so Advantage isn't really all that risky for me compared to people who can only change during open enrollment. The bottom line though is that all the extra costs I would have been on the hook for with Original Medicare, Medigap, and. a PDP would have been impossible for me to pay back then, so I was in Advantage from day one.

I had to have parts of my shoulder that broke off removed, a bone graft, a biceps and rotator reattachment, and I was in surgery for 6 hours, and I've been in Physical Therapy since October, and I have paid about $3,000 or so maybe. I'd have to look.

I love Original Medicare and they'd have to pry it out of my cold dead hands. lol

What I don't trust, at all, are insurance companies where people have to beg for their lives over Twitter and you may have to see some crappy doctor in some network that only covers your county, because the guy agreed to work cheap.

I've gotten by most of these years by going to dental hygiene schools and dental colleges. Had I had Medicare so-called "advantage" they'd have paid for some cleanings that I got for $15 at the dental school. The dental school doesn't do scrape scrape your 15 minutes are up get out, they spend the time to do the cleanings right because they're being graded. The dentists are absolutely the wrong place to go if you're uninsured, because they'll hit you for $250 or more for a cleaning and what they call a cleaning and what I call a cleaning are very different.

Also, I have dental insurance now, but that's only been in the past year through my spouse. I am still so impressed with the school I go there, they even sealed eight of my teeth for free, and they give me fluoride treatments, which insurance doesn't cover if you're an adult. I don't have to worry "Uh, is this dentist crooked?" like my ex, when a dentist filled three healthy teeth while he just sat there. If there's a problem, the instructor dentist will advise me with nothing to gain and refer me to a dental college or dentist with my x-rays already done.

Eyeglasses are usually extremely overpriced, especially if it's one of Luxottica's many brands or stores.

The FTC eyeglass rule says you can take your prescription and leave if you paid something for the exam, so don't let them give you a free exam.

They usually don't write down your pupilary distance, but I've asked and they told me (Walmart). You can take the prescription online after measuring yourself for a frame, if you're uninsured. I have VSP, so I use Walmart, but again that's only recent. For 9 of the last 10 years I used Zenni or EyeBuyDirect. American Express often has rebates for both of them on AmEx Offers, so you can get two pair and get a very good rebate if you're paying cash.

Most of my co-pays in Original Medicare are comparable or even lower than yours. It does not say what they are on the Original Medicare card, but if they take Assignment, your costs will be low, and you can go anywhere that takes that. I had to go to Wisconsin for surgery, if I had so-called advantage I would have been stuck with a failing hospital network in my county that's about to go bankrupt, most likely, and is in the news constantly for not paying any of its bills, and patient deaths.

I do not mean to sound combative or anything, but my advice to my mother (who is older and has health problems) was to run screaming away from those so-called Advantage people. Stick with the red, white, and blue card and she got Medigap, which is smart for her.

I can't even get Medigap because you have to be at least 65. Right now it wouldn't even be financially worth it if I could get it. The premiums would be more than I pay for co-pays.

The annual maximum out of pocket on so-called advantage would have never saved me a single penny in any of the 16 plan years I've been on Medicare. So even if that was its only perk, it still wouldn't have saved me anything.

I have looked through the plans that sell policies in my county. If I had been on so-called advantage then I could have seen my doctor while she was at the hospital here, but not after she went a few miles up to Wisconsin. Nor are my orthopedic surgeons that did a fantastic job on my arm in the network those plans I can get here have.

The main reason "advantage" was supposedly created was to save the government money, but it does not even do that. They get a minimum of 11% more than an Original Medicare beneficiary costs on average, but then the Advantage plan companies cheated the government out of billions by looking through patient charts to try to say the patients were sicker, when the patient wasn't complaining of that, and then the government paid them more money to treat patients that were not getting more medical care.

Huge settlement where they paid back half, so they still won.

The issue with having Original Medicare without Medigap is there is no cap on the 20% coinsurance. I wouldn't want to risk that. An unexpected hospital visit can easily reach $100K in a matter of days. That's $20K you would be on the hook for. If you get a serious chronic condition that requires constant visits, your out of pocket can blow past $100K in no time. Lots of stories about this without having to look very far.

Also, under 65s can get Medigap, they just generally pay more for it as they're more risky for the insurer that's required to insure them for the rest of their lives, which is the same situation I would have been facing had I gone with Original Medicare + Medigap.

I've had a lot of dental problems so I wouldn't want to have to come out of pocket for dental care. I'm likely to need more expensive work at some point although for now, things seem to be okay. I also have a fantastic dentist who doesn't do work that doesn't need to be done. We have a spot that's marked on my chart that she's been expecting to turn into a cavity for over a year now and it hasn't happened yet because I've been so diligent with my oral health care.

I also unfortunately have vision problems that require specific frames and lenses so I don't have much choice there either. Last year was the first year in a long time that I didn't have to have repeated visits with ophthalmologists throughout the year so these glasses are definitely doing their job.

At the end of the day you have to do what works for you. Advantage works very well for me right now and if it ever doesn't, I'll drop it. I don't see the point in paying more money and having less benefits when it's been working fine though. Like I said, I'm going on 12 years with Advantage and I've never had any real issues. UHC and Humana both have huge networks in my area, with lots of overlap with doctors (all of mine are generally covered on both although Humana doesn't cover my PCP anymore unless I have their PPO plans but their PPO plans have Part B giveback so I would actually pay less for the plan), so I've jumped between the two of them as my needs have dictated over the years (basically going for the one with the most benefits) but I've stuck with UHC for the past like 5-6 years. It helps that my PCP is actually linked directly with one of the major hospital networks in the area (in fact, she's in one of their buildings) so I can get referrals to anyone in the entire network as they're all required to be in network for UHC.

Re: Negotiating Prescription Prices

AndrewF — Tue, 03 Feb 2026 23:30:47 GMT

Yes — everyone has to figure out what they're doing and hope they did the right thing.

I’m genuinely nervous about dentists. One did an unnecessary root canal on my mom when she was a teenager and ruined her teeth; another filled one cavity and three perfectly healthy teeth on an ex.

We knew he only had one cavity because his dental-school cleaning included x‑rays — you don't get three new cavities in a month.

I remember the dentist walking in — old guy, thick German accent: “Lovely day we are having. Of course, when you are my age every day is lovely.” That was 2005; I’m guessing he’s not around anymore.

Then there’s Aspen Dental. PBS Frontline did a piece on them (https://www.pbs.org/wgbh/frontline/article/patients-pressure-and-profits-at-aspen-dental/).

While my spouse was getting an exam there they quoted benefits plus $8,500 out of pocket. Our regular dentist — who didn’t take insurance but offered a second opinion — said he wouldn’t do half of it if the patient were his. On one item they billed $800 for antibacterial products for teeth they planned to pull. He recommended finding a dentist whose name is on the building.

We did not go with Aspen's treatment plan. The dentist we used afterward helped us stretch treatment across two plan years and I only paid about $2,700 out of pocket.

Some aspects of my spouse's experience also came up on the "plan" from Aspen for the person in the article:

"Aspen Dental charged Ferritto $350 for an antibiotic put next to teeth the dentist was going to pull, a charge other dentists say makes no sense. There were four separate charges for an antibacterial rinse, similar to Listerine, for $129. There was even a $149 charge for an electric toothbrush that Ferritto didn’t even know she had, until she recently retrieved an Aspen Dental bag from her garage and found it inside.

Imagine how many groceries that would buy, she sighed."

PBS noted Aspen likes to toss an electric toothbrush in your bag and bill hundreds for it; you can get a very good electric toothbrush for $56 at Walmart (Oral‑B iO Series 2). I bought one for a friend as a gift. And this was $56 in 2026. What did they stick in this person's bag for $149 in 2012!?

What worries me most is when a dentist has only checked their own work and you don’t come in with a neutral third‑party report. Suddenly you’re cornered with high‑pressure claims that everything must be done now, and they push CareCredit financing so you’re stuck with $11,000 of “necessary” work. It could be true, but the sales tactics and scare language are warning signs.

Some dentists are fantastic; others aren’t. If you walk in for an oil change and they tell you your car — which is running fine — will explode unless you fix nine things immediately, get a second opinion. Same with dental care: verify, compare quotes, and don’t let pressure rush you into big bills.

Re: Negotiating Prescription Prices

crystal626 — Wed, 04 Feb 2026 16:34:59 GMT

I've definitely had some bad dentists in the past too. The first time I went to the dentist as an adult, the guy didn't use fully sterile tools. Both my grandmother and I got a nasty infection and I'm convinced that infection is what killed so many of my teeth because it went from that first tooth to the one across from it to the other side of my mouth. This dentist thankfully has been excellent. I would pay out of pocket rather than lose her if she wasn't in my dental network anymore because she's so good. We do xrays every other visit and they showed me how to tell where cavities are too so we look at the xrays together and one time when I was noticing pain when brushing, I found a cavity that hadn't even showed up on the xray yet. They had to do xrays from another position to see the tiny thing and they fit me in that day to get it filled (they usually fit me in same day for fillings when I have needed them, I think only one time I had to come another day because she wasn't in the office).

I also do check my EOBs and they've never billed for anything they didn't do.

This office has so many happy customers that they're rated 4.9/5 on Google reviews and when my partner called them to try to get a new patient appointment after cracking a tooth the other day, they informed him that they're booked solid until at least June.

Re: Negotiating Prescription Prices

AndrewF — Wed, 04 Feb 2026 22:21:40 GMT

@crystal626 wrote:
I've definitely had some bad dentists in the past too. The first time I went to the dentist as an adult, the guy didn't use fully sterile tools. Both my grandmother and I got a nasty infection and I'm convinced that infection is what killed so many of my teeth because it went from that first tooth to the one across from it to the other side of my mouth. This dentist thankfully has been excellent. I would pay out of pocket rather than lose her if she wasn't in my dental network anymore because she's so good. We do xrays every other visit and they showed me how to tell where cavities are too so we look at the xrays together and one time when I was noticing pain when brushing, I found a cavity that hadn't even showed up on the xray yet. They had to do xrays from another position to see the tiny thing and they fit me in that day to get it filled (they usually fit me in same day for fillings when I have needed them, I think only one time I had to come another day because she wasn't in the office).

I also do check my EOBs and they've never billed for anything they didn't do.

This office has so many happy customers that they're rated 4.9/5 on Google reviews and when my partner called them to try to get a new patient appointment after cracking a tooth the other day, they informed him that they're booked solid until at least June.

I hear you. I always ask the dental school for X-Rays whenever they'll do them because they're cheap there and I want to know right away if I need a filling. Generally the smaller the cavity, the cheaper the filling. When I had to pay a dentist out of pocket in 2007 for some filling, he charged me a lot more for the bigger one than the smaller one. I want to say like $100 something for the small one and over $260 for the bigger one. I know that with inflation you could probably triple those figures now, but it would still hurt a lot less financially I'm sure to catch it early.

Re: Negotiating Prescription Prices

crystal626 — Thu, 05 Feb 2026 18:34:37 GMT

@AndrewF wrote:
@crystal626 wrote:
I've definitely had some bad dentists in the past too. The first time I went to the dentist as an adult, the guy didn't use fully sterile tools. Both my grandmother and I got a nasty infection and I'm convinced that infection is what killed so many of my teeth because it went from that first tooth to the one across from it to the other side of my mouth. This dentist thankfully has been excellent. I would pay out of pocket rather than lose her if she wasn't in my dental network anymore because she's so good. We do xrays every other visit and they showed me how to tell where cavities are too so we look at the xrays together and one time when I was noticing pain when brushing, I found a cavity that hadn't even showed up on the xray yet. They had to do xrays from another position to see the tiny thing and they fit me in that day to get it filled (they usually fit me in same day for fillings when I have needed them, I think only one time I had to come another day because she wasn't in the office).

I also do check my EOBs and they've never billed for anything they didn't do.

This office has so many happy customers that they're rated 4.9/5 on Google reviews and when my partner called them to try to get a new patient appointment after cracking a tooth the other day, they informed him that they're booked solid until at least June.
I hear you. I always ask the dental school for X-Rays whenever they'll do them because they're cheap there and I want to know right away if I need a filling. Generally the smaller the cavity, the cheaper the filling. When I had to pay a dentist out of pocket in 2007 for some filling, he charged me a lot more for the bigger one than the smaller one. I want to say like $100 something for the small one and over $260 for the bigger one. I know that with inflation you could probably triple those figures now, but it would still hurt a lot less financially I'm sure to catch it early.

Yeah I just looked and the molar she filled in May that unfortunately was in the side of the tooth where it was right next to another tooth surface and was closer to the gum line so it took a lot of drilling and ended up being a three surface filling, she billed the insurance $409 for, and got $173.

Re: Negotiating Prescription Prices

AndrewF — Thu, 12 Feb 2026 19:13:19 GMT

Additional:

One of my regular meds is the cheapest at Meijer on GoodRX Gold. I don't have a Meijer near me. The closest one is 10.5 miles away, but my spouse has a dentist appointment today. Asked my doctor for a 6 month fill after verifying the price at Meijer with the pharmacist and that they would have enough to fill it today.

I am in that town due to my spouse's dental appointment and drive past the Meijer anyway. Their price saves me $20 over 6 months on 180 tablets of this medicine vs. the Gold price on CVS, and $40 vs. the Gold Price at Jewel-Osco.

I looked at alternative medicines. There's another drug in the same class, but it's slightly less effective and costs more money, and there's the non-prodrug version of the one I am filling which you have to take twice a day, not once, and it would be about the same price and not worth fussing with for the added dosing inconvenience.

Amusingly, my cat has the feline version of the same condition and I use a GoodRX coupon on the other drug of the same class (with lower efficacy than the one I take, in humans). This is because that drug can be used off label for cats and my vet calls it in for the cat and you can't use either version of what I take for the cat.'

I love her but she's an expensive kitty. Thankfully, GoodRX is helping me to contain some of her medicine costs too.

Re: Negotiating Prescription Prices

AndrewF — Fri, 13 Feb 2026 21:48:49 GMT

I ended up having to go to CVS because Meijer said they did not have 180 of those in stock and would require a separate trip.

While I was playing with the Gold prices on all my medicine at CVS, I noticed that it is 37% less expensive, over all, to fill 180 days at a time, and since GoodRX isn't insurance and has no quantity limits, they can just fill two 90 day supplies in one go and convert it into a 180 even if that's not how the doctor wrote it.

So I found out that I should go to CVS and do 180 day fills on everything. I ran the numbers both ways for my routine fills.

Doing four 90 day fills on everything I fill routinely will cost $723.52 at current GoodRX Gold prices at CVS, but doing two 180 day fills of everything is only $455.50, a savings of $268.02 throughout the year, approximately.

Gold prices change sometimes, but over all converting your two 90s to one 180 seems to make the most sense, at least at CVS.

The pharmacist told me it eliminates one of the flat fill fees, and it also gets me a lower contractual price per pill.

State law says your doctor can give you up to 360 days on anything that's not a narcotic, but most doctors want to see you back at least every 3-6 months. Also, I played with GoodRX Gold looking to see if there's additional savings if you could convince a doctor to do 360 day fills, and the answer seems to be...sometimes, but the savings really level off at 180 days for most drugs anyway.

Sometimes we have pharmaceutical shortages on something. 180 day fills are also risk management for that as well as cost savings. They reduce the odds that you won't be able to get a refill.

Re: Negotiating Prescription Prices

crystal626 — Sun, 15 Feb 2026 06:16:58 GMT

That's awesome that you have a doctor willing to give you so many months of meds at once. My doctors want to see me every 3 months, even if it's a quick telehealth checkup.

Re: Negotiating Prescription Prices

AndrewF — Sun, 15 Feb 2026 21:54:40 GMT

@crystal626 wrote:
That's awesome that you have a doctor willing to give you so many months of meds at once. My doctors want to see me every 3 months, even if it's a quick telehealth checkup.

Yeah, that's why the lines at the pharmacy are backed up. They have more and more prescriptions to fill and less pharmacists and techs now compared to the people needing fills.

If doctors would write 180 day fills instead of 90 or 90 with a refill (like what's even the point?) then we'd have about half as many trips to the pharmacy and more people who have crummy insurance, like I do, would be laying out beaucoup bucks for the same number of pills, over more *fills*, and missing out on the operational efficiency of getting a better price _over time_.

Most of my medications have not changed dosages in years. If they're that stable, I don't know why I shouldn't be able to take advantage of bulk buying power to get my costs down to something more manageable.

Last year, it only cost me $8.80 per 90 day fill, so even if I had many medications to fill, my out of pocket costs I don't think even reached $200.

Even with 180 day fills using drug discount codes, the best I can do is pay double that, and without 180 day fills I will pay more than triple.

I think people should really lean on their doctor to do a 180 day fill if they're cash pay, at least on the medicines they're stable on.

CVS closed down half the pharmacies in my area. If it wasn't for Dollar Tree coming in and buying most of them, we would have yet more empty buildings that are not employing anyone, at any wage. They'd be rife with people vandalizing them, because that's what tends to happen to empty buildings. We even had an empty hotel that the city was going to turn into low income senior apartments, but it just sat there for years, attracting the homeless. The police were out there constantly and eventually some of the squatters set a fire and the whole building had to be razed and now it will be good for nothing.

CVS and Walgreens took advantage of economic booms in the United States economy to reach an incredibly overbuilt situation. For about 20 years, where one opened, the other would move in across the street, but now they're closing half their stores and firing people because the good times are over, the high inflation and high unemployment and low growth economy has become extremely sticky, and now we're dealing with pharmacy deserts and overworked pharmacists.

The 180 day fills makes for a good solution to that. People need economic relief probably now more than ever even if it is only $200-300 over the course of a year. If that's a $200-300 annual savings with no cutbacks then that's the best kind of savings, and that's money that goes right in your pocket for gas, or food, or rent, or shoes and clothing.