/>>>>>I should have the ability to pay cash out of my own pocket while using the benefits of the discount club instead of using my Part D Medicare prescription if the former is cheaper.<<<<< I do that all the time when purchasing my mother's medications if the discount is cheaper, I buy it that way - actually the pharmacy clerk gives me the lowest price be that a special retailer generic cost or the Med D plan price. />>>>>> I have used the discount program and Medicare has not paid anything. <<<<<<< That is the way that it has to work because when they aren't putting it through the Medicare D system (whomever your plan is with), your plan D will not pay.  My mother has one Rx that Med D does not cover at all but I get a discounted price for it under her Medicare supplemental insurance.  This one never shows up on the Med D plan because it is put through under another insurer. >>>>>>Taking it one step further if my prescription plan has a 10 copay, why should I not be able to use the discount card which would reduce my copay since I have paid for both medicare and a prescription club.  If a pharmacy wants to offer an incentive to get my prescriptions there why should I not be able to join the club and let the reduced price benefit both medicare with lower expenses and the medicare recipient.>>>>>>>>>>>>>>> Because of the above reason - the pharmacy can only process your medication under one program or another, not both. >>>>>We still have the case of Lipitor where we are automatically excluded just because we are on Medicare. Would it not makes sense for medicare recipients to get the $4 copay instead of using their insurance. My understanding it is something with the government that does not allow you to even join some of these clubs and use them if you are on medicare. The Lipitor program says this about the Lipitor for You Program: Lipitor For You $4 Card Program FAQ " This Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico ([formerly known as "La Reforma de Salud"]). The Card is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs which reimburse you for the entire cost of your prescription drugs." The term "eligible to be reimbursed" is the key since the insurance companies in Med D have already set a price for the drug, know the estimated usage and this is part of their business plan to work within the Medicare D framework. However, if you wanted to buy the Lipitor at whatever the pharmacy price out of your own pocket and not have it filed through Medicare D, it seems you could get the card  - there are other terms and conditions on the Pfizer website: " To qualify for this offer, your out-of-pocket expense must be greater than $4 per prescription. If your out-of-pocket expenses for a 1-month supply (30 tablets) are $54 or less, you will pay $4 for a 1-month supply. If your out-of-pocket expenses for a 1-month supply (30 tablets) exceed $54, you qualify for up to $50 in savings for a 1-month supply. In either case, you can only qualify for up to $600 of savings per calendar year. After maximum of $600, you will pay usual monthly out-of-pocket costs. You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf. The Card is not valid for Massachusetts residents whose prescriptions are covered in whole or in part by third-party insurance, or where otherwise prohibited by law. This Card cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription. The Card will be accepted only at participating pharmacies. This Card is not health insurance. Offer good only in the U.S. and Puerto Rico. The Card is limited to 1 per person during this offering period and is not transferable. Offer limited to 1 use per month. Pfizer reserves the right to rescind, revoke or amend the program without notice at any time. Card and Program expires 12/31/2012. No membership fees." >>>>>At Costco there is no charge for the prescription discount if you have a membership and my feeling is that at a minimum you should be able to use the discount club or medicare depending on what is cheaper. All because you are on medicare you should not be restricted from this selection which is also partially to avoid the donut hole which is a nonsensical item also.>>>>>> All these companies - insurance, retailers - deal with their suppliers/maufacturers on a pricing basis - they buy so much/ they get it wholesale for so much - not too much different than any other business.  If you buy at pure retail, you pay higher.  If you go with this insurance, you pay their pricing.  If you go with another insurer, you pay their pricing.  If you go with a pharmacy discount card, you pay tbheir pricing. The only decision that you have to make is IF you want to participate and receive the cost break that they are providing you via their business plan.  If you want to buy a Rx through some other program and not have it go through their system of reimbursement - you are free to do it.  They only set the rules when you are using their system be that Med D, regular health insurance with a prescription drug plan, a pharmacy chain discount program, etc.  The decision of how you want to get the best price is yours - but if you participate in their reimbursement plan by putting the Rx that you got through their system, that is the choice that you have made.
Posted by GailL1