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Old 01-23-2012, 08:11 AM
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Medicaid and Walgreens Prescription Drug plan

I'm sticking this here because it's a fact based question, and not in any way an attempt to find out an interpretation of the law. If it has to be moved, fine, but please, non-lawyers, try to keep the opinions to a minimum.

I simply want to know the answer to one question: What law is Walgreens using to claim that they cannot offer their drug plan to people who have government funded insurance? That's what they claim, but I was able to be on the plan as of two years ago.

The law doesn't pass the smell test: why would they care if they got to pay a little bit less for the drugs they cover, and, more importantly, why would they care about the drugs they don't cover? It seems far more likely that Walgreens made a business decision, and is blaming the government to keep people from leaving them over it. Walmart does not seem to make such a claim.

Especially since, as of 2009-2010, I, a Medicaid user, was allowed on their plan. So the law had to have passed in the last couple of years, or they were previously breaking it.
Old 01-23-2012, 08:39 AM
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I am not sure how things are funded, but there is an attempt to make prescription drugs affordable for everybody. Walgreens is one of several plans giving deep discounts to the uninsured. If you have insurance money to cover your drugs, they want it. If not, somehow they will sell them cheaper to you.

Part of it is the cost structure of drugs. It takes fortunes to discover, develop, test, prove safe and effective, and get approval of a drug. Once approved, many drugs can be manfactured quite cheaply. Those with money or insurance must pay for all that to fund new drugs. Those less well off may be allowed to pay closer to the cost of production.

It is kind of like software. The cost of a copy of software is trivial, yet the price can be high.

So no I don't know exactly why the uninsured are allowed to buy drugs cheaper.

I don't even know how to choose the best insurance plan.
Old 01-23-2012, 12:39 PM
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In 2010, Walgreen's stopped accepting prescriptions from Medicaid patients in Washington state, because it said that the reimbursement rate from the state was too low. It may be that the reimbursement rate in Arkansas has similarly been reduced.

It also may be that Arkansas was using stimulus money to bolster its payments to Medicaid providers, and the end of those extra funds has tightened what the state will pay.
Old 01-23-2012, 02:54 PM
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TriCare (military dependents and retirees and their dependents) are contracted to use Express Scripts, a mail-order pharmacy. Express Scripts subcontracts to local pharmacies to provide short-term prescriptions for those covered by TriCare. It's all tied together via computer, and Express Scripts controls the database.

We were recently informed that Walgreens is no longer a provider for TriCare/Express Scripts.

Why? Who knows. The stuff is contracted, and I guess Walgreens didn't want to play by the contracted terms.


~VOW
Old 01-23-2012, 05:16 PM
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Was my post this unclear? I have three different people, answering three different questions, and none of them are the one I'm trying to ask. I'll try again.

Walgreens offers a prescription drug plan that allows you to get your medications for significantly cheaper. However, they will not allow you to go on this plan if you have any government funded insurance. When asked, they claim it's a federal law that prevents them from doing so. It's even on their website.

My question is simply: what is this federal law? The rest of my post is only explaining why I suspect they are lying.
Old 01-23-2012, 06:23 PM
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Sorry; I did misunderstand.

Take a look at this article. I think what Walgreen's is saying is that the government would possibly consider the extra savings of the Prescription Savings Plan to be a kickback to the patient (to induce him or her to come to Walgreen's instead of another pharmacy).

It's not clear to me why Walgreen's couldn't avoid that conclusion by turning around and accepting a lower reimbursement from Medicare/Medicaid for those prescriptions, though (in other words, passing the savings along). Perhaps it thinks it's not permitted to charge two different levels of reimbursement back to Medicare/Medicaid; i.e., a lower one for the PSP patients and a higher one for the non-PSP.

As to why they took you before but not any longer, it might be that there was a court decision between then and now that Walgreen's thinks changed the law, or at least addressed a point that had never been ruled on previously.
Old 01-23-2012, 06:30 PM
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Are yhou asking about Walgreens's Prescription Savings Club link, Big T? I'm not a lawyer, but I do work in Part D insurance and it sounds like this coverage may be considered "creditable coverage" and as so, one cannot have both a Government plan (Part D) and another drug plan at the same time. I'm not aware of your state's rules regarding their State Pharmacy Assistance Program, but often these are similar to Medicare rules. If you have Medicaid, you're probably also eligible for Medicare as well and should find most prescriptions under a Part D plan for Dual-Eligibles (people with both Medicare & Medicaid) have a minimal ($2 or less) co-pay and little or no monthly premium. I'd look into what your options are with Part D plans and go from there. You'll probably find you save more.

I hope this helps.

Bri2k

Last edited by Bri2k; 01-23-2012 at 06:35 PM.
Old 01-23-2012, 06:43 PM
VOW VOW is offline
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Aha, now I understand.

We used to get our prescriptions at Von's, and they were running a promo where you got 10 cents a gallon off the price of gas for every $100 you spent. Then they got really fired up and decided to include any money spent at the pharmacy for prescription drugs as well.

Since at the time, Hubster and I were blowing $100 a month EASY on our co-pays, we thought, "AHA!"

No AHA. Government funded prescription drug coverage is excluded by law from participating in any happy deal like that where you "supposedly" get money back.


~VOW

Last edited by VOW; 01-23-2012 at 06:43 PM.
Old 01-23-2012, 06:44 PM
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P.S. A tip o' the pin to Tom Tildrum for that article. Reimbursement and contract rates with CMS are another piece of the puzzle. It pays to get as much info as possible and shop around when choosing Rx coverage.

Bri2k
Old 01-23-2012, 08:43 PM
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I'm not aware of which law Walgreens cites, but in my opinion it does pass the smell test.

The Walgreens plan is a discount on out of pocket drug costs of clients. Insurance companies (both government and commercial) pay Walgreens the same amount whether or not the client has the discount plan or not. The client having the plan is an incentive for the clients to go someplace expensive for the insurance like Walgreens instead of somewhere cheap for the insurance like Walmart. Unlike the governement commercial insurance can't pass a law saying their clients can't have the discount plan, but they as a cost cutting measure are starting to exclude Walgreens from their networks (like ESI). Walgreens wants to make a lot of money on their drugs.

Walmart by contrast the low price is the same price everyone pays, including insurance. So the law wouldn't apply to them. Walmart is less interested in making a lot of money on drugs than getting people into their store to buy other crap.

Last edited by Mdcastle; 01-23-2012 at 08:44 PM.
Old 01-24-2012, 05:21 AM
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I don't know about Medicaid but one two occasions, I got a drug with my Blue Cross insurance and the copay was higher than the cost if I paid without insurance. Walgreens charged the higher copayment.

I asked them to run it through without the insurance and they said they could not as long as I had valid insurance. I took the prescription to CVS and they had no problem running it through with or without insurance. So it might just be a Walgreens's store policy
Old 01-24-2012, 06:46 AM
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Quote:
Originally Posted by BeaMyra View Post
I don't know about Medicaid but one two occasions, I got a drug with my Blue Cross insurance and the copay was higher than the cost if I paid without insurance. Walgreens charged the higher copayment.

I asked them to run it through without the insurance and they said they could not as long as I had valid insurance. I took the prescription to CVS and they had no problem running it through with or without insurance. So it might just be a Walgreens's store policy
If Walgreens ran the insurance first, and the insurance company okayed the drug, the clerk may not have had a choice about taking cash over insurance. It's happened to me before at different pharmacies. I think it's an insurance company requirement, not a pharmacy requirement.
Old 01-24-2012, 08:56 AM
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Quote:
Originally Posted by Mdcastle View Post
I'm not aware of which law Walgreens cites, but in my opinion it does pass the smell test.

The Walgreens plan is a discount on out of pocket drug costs of clients. Insurance companies (both government and commercial) pay Walgreens the same amount whether or not the client has the discount plan or not. The client having the plan is an incentive for the clients to go someplace expensive for the insurance like Walgreens instead of somewhere cheap for the insurance like Walmart. Unlike the governement commercial insurance can't pass a law saying their clients can't have the discount plan, but they as a cost cutting measure are starting to exclude Walgreens from their networks (like ESI). Walgreens wants to make a lot of money on their drugs.

Walmart by contrast the low price is the same price everyone pays, including insurance. So the law wouldn't apply to them. Walmart is less interested in making a lot of money on drugs than getting people into their store to buy other crap.
That's the exact opposite of passing the smell test, as I meant it. That's exactly what I suspected was the case: they could set up their system so that Medicaid patients could be allowed on the plan, at least on drugs that aren't covered, but they made a business decision not to do so. But then, rather than admit this, they blame the government, when the government regulations actually make sense.

And Bri2k, I'm only 26, so I'm not sure I can get Medicare. I am legally disabled, if that matters. Any more information on that is welcome.

BTW, does anyone else have experience having either Medicaid or Medicare and still being able to use Walmart's $4 prescription plan for medicines the government plans don't cover? I hate to get all embroiled in all this if Walmart is just going to do the same thing.
Old 01-25-2012, 01:56 PM
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The company that I work for has some young disabled subscribers that are entitled to Medicare, but I never dealt with this area so I don't know what the specific rules are. (All I know is that when Medicare and a commercial insurance policy are involved it's a huge complicated mess to figure out what the dates of entitlement are [the thought doesn't occur to our subscribers that we might like to know about it if they have Medicare or another commerical plan] and who should be paying first. I'm friends with a coworker who does nothing but answer allegations from Medicare that we should pay primary.)

As whether you can use Medicare/Medicaid with Walmart, I know you want a second opinion so I won't comment directly, but I will say I don't think it's likely that any drugs the government doesn't cover would be covered by the Walmarts $4.00 plan, which tend to be generic, common drugs prescribed for a months at a time.

Last edited by Mdcastle; 01-25-2012 at 02:01 PM.
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