Some prescriptions may be cheaper out of pocket than through health insurance

Posted at 12:49 PM, Oct 20, 2017
and last updated 2017-10-20 17:53:17-04

INDEPENDENCE, Mo. -- Earlier this week, NBC Nightly News investigated some prescriptions may be cheaper out of pocket than through your insurance co-pay.

James Lowman from Independence, Missouri says that’s exactly what happened to him.

“My mind was blown, I couldn't fathom that we were paying this much to an industry that's supposed to be helping us,” Lowman said.

For years, Lowman has paid for prescriptions through his health insurance.

“I have two standing prescriptions that cost with insurance copay $15 each. That's $30 a month,” he said.

But last year, he decided to pay out of pocket.

“When I was in between insurance and did not have prescription insurance, I figured OK, I'll take $60 to pay out of pocket and you know eat the cost until my new insurance kicks in,” Lowman said. “And it was a huge drastic change in cost."

That drastic cost was more than a $27 difference. Lowman says he paid $2.48 for both prescriptions out of pocket.

“It just blew my mind when I started comparing the numbers,” he said. “For years, I've been paying like everybody else does. They just go with the system, they get their insurance, they get their insurance card, they get their copay, they pay it, and they just go on with their life.”

“My immediate thought is that does happen,” Pharmacist Pete Spallito said.

Spaillto has been a pharmacist for 30 years.

“Most of our people are on what we call Missouri Medicaid, which is for people who really don't have healthcare so they don't pay really more than $1 on their copay prescriptions,” Spaillto said. “The other basic people I have are Medicare, 65 and over. They don't pay much for their prescriptions either.”

While he doesn’t see it happen often in his pharmacy, he said he isn’t surprised this happens.

“At some point you need to make some revenue to keep your doors open,” Spaillto said. “So maybe that may be why this goes on.”

Spaillto suggested talking with your pharmacist on what the cheapest option would be.

“Find out from several pharmacies what the cash price is and compare that with what your insurance copay is and you'll be in a better position to determine what's best for you,” he said.

Lowman said he always asks now.

“Always question,” Lowman said. “Just because plan A and B are there, doesn’t mean plan C isn’t an option.”