Whenever I visit the states and pop into CVS I am frequently amazed at the sticker prices on some of the dugs there. Things that literally cost pennies per tablet in the UK (generic hayfever tablets, pain killers etc) were absurd prices. 20USD for 7 hayfever tablets? 15 USD for 12 ibuprofen tablets? WTF?! Do not forget to get 12 hayfever tablets for £1.80 (~2USD) from a supermarket before your flight otherwise you'll need to spend 45USD (+tax) at the CVS a block from your hotel.
Do you guys actually pay these prices for this stuff, or is it only forgetful travellers who fall for it and end up paying through the nose because they have no other choice?
Surely you won't be claiming for pain killers for a headache etc on your health insurance? (...although at those prices maybe you should??!)
It feels to me that is pretty criminal to charge those prices at retail - to inflate even more to insurers just seems pretty outrageous.
> Do you guys actually pay these prices for this stuff, or is it only forgetful travellers who fall for it and end up paying through the nose because they have no other choice?
Usually you can get those cheaper in bulk, like at Costco, or at a pharmacy that your doctor works with, or you can get a discount by showing your insurance card.
But yes, sometimes when desperate, we pay that much too.
We also have these health savings plans where we get a debit card and can buy that stuff with pre-tax money, which is sort of like saving 10-40% depending on your tax bracket.
But yes, it sucks. When I go to other countries I try to stock up. You have better prices and stuff that we can't get here.
> health savings plans where we get a debit card and can buy that stuff with pre-tax money,
These are stupid, and I wish they'd die, for multiple reasons.
First, the list of things that are allowed and not allowed is completely arbitrary and random. Feminine hygiene products are allowed, but baby formula isn't. Wtf why? And now someone's gotta maintain this list of items and enforce it (Wageworks et al), and process claims made manually. So now we've just added another actor in the whole system that can add their own profit margin on top. All so we can save a few bucks in paying taxes.
Second, these aren't available to everyone (just like 401k plans, the other symbol of taxation inequality). It's a benefit that has to be offered by your employer, and there are plenty of shitty employers out there. The people who could most use a tax break on a $10 bottle of aspirin are the least likely to get it.
Third, the use-it-or-lose-it nature of FSA money. And if you lose it, the money goes back to the employer. Again, wtf why? You're basically placing a wager against your expected healthcare expenses every year at open enrollment time. For really no clear benefit. Why can't the "debit card" work like a "credit card" instead, with payments made directly from your paycheck? There's no guessing involved, and no one ever over- or under-contributes.
There are also HSA plans, which are not "use it or lose it", but require high deductible insurance plans. I consider the two options targeting two entirely different audiences. If you have high or very predictable medical costs, you only contribute to an FSA what you will use in a year. If you are young, with no pre existing conditions, and generally take care of your own health, you can save some money on premiums with the high deductible plan and HSA, you are unlikely to need to make any claims so the high deductible never comes into play, and you get to keep the HSA through retirement when you are sure to have more medical costs and you get to benefit from the triple tax advantage.
This is side stepping the issue. The solution is very simple and straight forward: you simply buy whatever is "FSA approved", and submit a claim. Can't be any more straight forward. Or as OP presented, you use the same card, but then it gets deducted from your paycheck minus tax.
We have to see who's benefitting from this elaborate gambling scam that steals money from people.
> It's a benefit that has to be offered by your employer, and there are plenty of shitty employers out there.
This seems like a weird indictment of health savings accounts, because it has nothing to do with the type of benefit, and has everything to do with the coupling of healthcare to employment. If that's your issue, solve that — don't drag down everything else. Decoupling it from employment has the added benefit of essentially killing the FSA because, you're right, it's dumb that it belongs to the employer.
Health savings accounts are exactly how most people pay for their healthcare in Singapore, and it enjoys some of the best health outcomes with some of the lowest costs. I think that there's a lot of room to improve the experience in the US, but you don't have to throw the baby out with the bathwater.
But HSAs are kind of weird too. Why pre-allocate money specifically for healthcare expenses to a separate account? Instead, why not bump up IRA contribution limits and allow penalty-free distributions for qualified medical expenses?
Why restrict HSAs to high-deductible health plans?
Why are we asking people to deal with investment stuff in order to pay for their healthcare? Isn't that the point of an insurance company? You pay them premiums, they invest the money and pay for all your healthcare needs - none of that co-pay, coinsurance, deductible shit.
The whole thing is a hack on top of a hack on top of a hack. One kludge after another.
> Instead, why not bump up IRA contribution limits and allow penalty-free distributions for qualified medical expenses?
Seems indistinguishable from a higher limit HSA, but I'm on board with that.
> Why restrict HSAs to high-deductible health plans?
Removing this restriction is a great idea! I agree.
> Why are we asking people to deal with investment stuff in order to pay for their healthcare?
Most HSA providers use robo-investment. Where active investment is an option, it's usually only used by the most savvy users. Half the value add of most off your HSA providers is this investment management, which 100% beats having it sit around in cash.
> Isn't that the point of an insurance company? You pay them premiums, they invest the money and pay for all your healthcare needs - none of that co-pay, coinsurance, deductible shit.
This is really debatable, because the concept of "insurance", traditionally, is tail risk mitigation. Having insurance pay for everything from flu shots to regular check-ups makes it something else entirely, that's no longer insurance, it's a glorified health payment plan with all of the price information removed.
Indiana has a very interesting program for their government employees, where they offer "deductible security", in which the state provides a health savings account into which it deposits an amount equal to the annual deductible every year. Another potential policy avenue to incorporate with HSA's.
> Having insurance pay for everything from flu shots to regular check-ups makes it something else entirely, that's no longer insurance,
I don't disagree with that sentiment. However, it's my understanding that traditional health insurance in the US pays for those things (often without co-pay) because preventative treatments are cheaper. If you add a co-pay for getting a flu shot, or even worse don't cover it, many more people might skip it and some of them will inevitably develop the flu. Treating those cases will likely end up costing way more than paying for flu shots for all the insureds.
I get that HSAs are an attempt to give patients more pricing information and agency, and encourage them to shop around for their healthcare. But (to me) it comes off as a self-managed insurance plan that you use to pay for your actual health insurance. It's insurance for insurance. Which is slightly bananas.
> However, it's my understanding that traditional health insurance in the US pays for those things (often without co-pay) because preventative treatments are cheaper. If you add a co-pay for getting a flu shot, or even worse don't cover it, many more people might skip it and some of them will inevitably develop the flu. Treating those cases will likely end up costing way more than paying for flu shots for all the insureds.
So full disclosure: I work in insurance and adjust claims myself.
This is certainly a reasonable cost-reduction strategy, but it isn't necessarily the most cost effective strategy, nor is it the only strategy. Indeed, Singapore has shown us that you can achieve more efficient per capita health spending WITHOUT covering flu shot co-pays, etc for everyone.
> But (to me) it comes off as a self-managed insurance plan that you use to pay for your actual health insurance. It's insurance for insurance. Which is slightly bananas.
I recommend listening to 3 or so minutes of this Reuters podcast (starting at 12:30)[1] that talks about Singapore's healthcare system, its journey trying different systems out, and some of its learnings. One key insight that they picked up on was that for the vast majority of people, the bulk of one's healthcare expenditure in life occurs at older ages once health starts to deteriorate. In that regard, it's almost like social security, where you save up over the course of your lifetime and build up this trust fund that you would eventually expect to use once you're older...which is largely what HSA's are: a savings account in a wealth fund that grows over time.
Formula is literally the only thing some babies can eat particularly less than 6 months old. You cant just give them cow milk, or chocolate or bread or whatever. Has to be formula if it cant be breast milk.
Not all parents breast feed their babies for myriad reasons - some by choice, some not by choice.
Formula is quite expensive in the UK - no idea how expensive it is in the states, but a 800g tin of powder might cost about £12/15USD. That makes about 4 litres of milk which might last a 100% formula-fed baby 2-7 days depending on how old/hungry they are. By comparison 4.54L (i.e. 8 imperial pints ... we still seem to sell milk in imperial sized bottles for unknown reasons) of cow milk is £2.18, so formula is roughly 5x or 6x as expensive.
Is £12 for 2-7 days worth of food for your kid expensive? For people on HN probably not, but I do know that the formula in the supermarkets often have security tags on them (along with razors etc) so I am guessing a lot of people cannot easily afford the formula/can't afford to feed their kid literally the only thing they can eat. Sad stuff really - this is why I would expect it to be on these sort of discount schemes.
> Formula is literally the only thing some babies can eat particularly less than 6 months old. You cant just give them cow milk, or chocolate or bread or whatever. Has to be formula if it cant be breast milk.
I think the ideal compromise for this situation is that if this describes your situation you get a doc to sign off on it and then your FSA/Insurance should cover it as medical expense. Like it wont and it makes little sense for it to be excluded in the first place but I think we could find a compromise that satisfies everyone.
I think the point was more that whomever makes the list of acceptable items for the HSA is clearly out of touch and missing important things, and there shouldn't be a person in that role anyway.
> if this describes your situation you get a doc to sign off on it
That's how it works for a lot of items. But still...why? Now you definitely need an FSA administrator to examine the letter of necessity - all this to save again, a measly few hundred bucks in taxes.
> if this describes your situation you get a doc to sign off on it
For those with feeding tubes, this is possible - insurance will often cover the special enteral formulas. But it seems (based on various Facebook group discussions) that the individual must be 100% tube fed to qualify.
To a baby, baby formula is a life saving drug. Many women can't produce enough breast milk for their child, or have to work, or can't breast feed at all, or myriad other reasons that they need to supplement or completely replace their supply with formula.
It's baby formula not protein powder. It's literally life-sustaining. Calling it merely "a food" misses the point because, other than breast milk, it's the only food very young infants can consume.
I'm not arguing that tampons and sanitary napkins shouldn't be FSA-eligible; I think it's 100% correct that they are. I'm just pointing out the randomness of what is considered eligible.
> Whether something is necessary to sustain life is not the criteria used to decide if an HSA covers it or not.
And I'm arguing that the criteria, whatever they are, are arbitrary and stupid and need to die in a fire. Along with the the whole concept of FSAs. Yeah food and water are essential, but baby formula isn't ham sandwiches or avocado toast. It's the only food that a baby can have - it's an essential health item. That an account meant to pay for health expenses doesn't allow it is downright dumb.
Calling it a "flexible" spending account is downright Orwellian language. It's the opposite of flexible.
Depends on the pharmacy. Some have negotiated prices for OTC. If you already use that pharmacy for your prescriptions they can give you the discount, and sometimes by contract they have to give you the discount.
Like all things insurance, it's very specific to you and takes more work to find the discount than it's worth. Usually it's just something that is surprising when it happens.
I've never gotten a discount on OTC with any of my insurance cards. However, my OTC allergy meds are available as a prescription, which the insurance happily covers. Thank goodness because I otherwise couldn't afford the $400/yr.
Generic OTC allergy meds are cheap when you don't buy boutique retail. I pay less than $11/year for daily generic Claritin (365 doses) at Costco. Allegra is a touch more.
CVS and corner stores generally inflate prices outrageously. For example, for 24 pills of Aceteminophen (Paracetamol), you'll pay $4.59 at CVS [1] vs $1.19 for 50 pills at Target [2]. It's even cheaper if you buy in bulk. CVS is just a ripoff and primarily caters to people who need something right now or at some odd hour.
Generally, generic drugs aren't too expensive in the US. But we pay more for many brand drugs.
It could be argued CSV and the like are taking advantage of uninformed people or charging more for people who need medicine now, perhaps because they didn't build a good medicine cabinet. The same medicines can be bought on Amazon or at CostCo for 10x cheaper than the generics at CSV or Walgreen, but you need to know about that option and plan for it.
Some price comparison:
- 30 400mg guaifenesin tablets cost $10.50 ($0.35 each) at a Walgreens in San Francisco
all of my local cvs drugs store mark that as "out of stock" according to the link you posted.
the closest that Walgreens offers, according to their website, actually in store (97201 if you want to look) appears too be around $50 for 500 200mg ibuprofen.
when I first lost insurance, I asked my local (rite aid) pharmacy about the generic price of what I was taking hoping to buy 90 days worth - they quoted me ~$10/pill (one per day).
I can order it from aliexpress for ~$0.24/pill, and from alibaba for ~0.002/pill (in powdered form). since it's a fairly common chemical that was patented in 1957, and is listed by wikipedia as costing between $0.01/pill and 0.04/pill wholesale, I really started to question the prices.
of course, now my insurance pays for it, and marks it at ~$1/pill in their "invoice".
still, somehow the math doesn't add up. no cvs near me to compare to, but Walgreens was similar prices. it really feels like a scam, but who can you really complain to? I'm in no way sympathetic of for-profit health insurance companies, but I have to hope that someone can push legislation to help curtail this.
of course, this is just one point of anecdata, but looking at similar costs of things like omeprazole over time seem to corroborate these findings.
Compare prices between Boots in the UK and Walgreens in the US. They're the same company, Walgreens Boots Alliance. Many items come from the same sources. But the price difference is huge.
Personally I find boots in the UK to be an absolute scam anyway. Their prices on everything are almost always more expensive than supermarkets - not just by a few pennies but often in the 25+% range.
I think they survive solely on makeup sales, and small stores in airports and stations where there is a captive audience? No one can seriously shop there for everyday stuff.
In the UK (and most other countries), a 25% markup is outrageous. In the US, a 500% markup is pretty common. I don’t understand how this is not competed away. Yes, CVS offers convenience, but not more convenience than offered by a corner Tesco in the UK, which has very competitive prices.
Where were you shopping, and were you looking at "Generics" or fancy name brands? You also pay a premium if you don't buy in bulk. Getting 10x more drugs sometimes only costs 50% more.
The prices you listed are definitely not normal— last time I bought Ibuprofen I think it was 2¢ per pill, although that was on sale. According to their website, the CVS by me is charging 5¢ per pill right now.
If it's prescribed, you can try to get insurance to pay for OTC meds. You can also pay for them with pre-tax dollars. Sometimes there's also prescription versions of OTC meds. I've been offered a prescription for 800mg ibuprofen but didn't bother.
A lot of stuff in CVS are overpriced. I guess they are charging for "convenience". You are better off going to Walmart, Costco, Target to name a few. Even my local hospital pharmacy has OTC medicines at lower prices.
It's totally legal to pay the cash price if it's lower. It's not against the law to have insurance and not use it.
But if you try to make a claim later, I've never heard of that working. They'd either require that you pay the difference towards the price with insurance first, reject it entirely for not following in-network procedures (most likely), or else reimburse you according to out-of-network rates, which will be far lower. I can't imagine any scenario where you'd save money in the end.
If you haven't reached your deductible and don't think you'll reach it, then it can make sense to pay in cash and just not report it to your insurance company at all. That's fine (though it doesn't count toward your deductible of course).
But also note it's not a universal that insurance prices are higher than cash. At every doctor and dentist I've ever seen in New York City, insurance prices have always been lower than not having insurance. I ask every time, since I have a HDHP. One of the benefits of health insurance is often precisely that they negotiate lower rates with doctors, because (in theory) they bring in more patients to make up for it.
Of course, if you're paying cash the doctor can give you a discount if they choose to, if you tell a sob story... which I've never heard of happening with insurance.
> But if you try to make a claim later, I've never heard of that working. They'd either require that you pay the difference towards the price with insurance first, reject it entirely for not following in-network procedures, or else reimburse you according to out-of-network rates, which will be far lower. I can't imagine any scenario where you'd save money in the end.
Unless you're the provider, in which case there are many cases of providers billing insurance after taking a cash patient. Effectively "reverse balance billing", aka fraud.
If you see instances where providers "accidentally" process your care through your insurer after paying cash, tell your insurer. While it may seem like a non-issue, and that the provider will claim accident, I assure you that for all their (many, many) faults, insurance companies dislike provider fraud too, and similar to credit card chargebacks, too many "accidental" billings will become problematic to the provider.
Many doctors discount their care when providing it to people who don't have insurance to help them afford medical care. It's probably legal to make a claim later, but you're effectively lying to the doctor so you can receive a charitable contribution. It's ok to do it if you don't mind feeling like a welfare fraudster.
They may also discount their care if they get paid upfront and don't have to submit the claim and wait for reimbursement. But it might also violate their network agreement with the insurer to not do the submital?
You are paying more for your insurance because the doctors offer different prices to different people (since insurance prices follow cost). This likely locks some people out of insurance altogether.
It’s viewed as unethical to some because when you flip the script, it’s: “charge rich people more simply cause they’re rich”. Which isn’t a good argument, but it’s what I’ve heard.
But rich people are not charged because they are rich. They are charged because they have insurance. And it is insurance that has led to this bizarre situation where the free market is completely broken and you can't confidently put a price number to a medical product or service.
If almost everyone was paying for their medical care out of their own pocket we would not be in this situation. And there are plenty of other countries where this is the case. In India for example, individual doctors literally have a board with a list of what they charge for various services, and if you visit a hospital, someone at the reception would be happy to help you with these.
You want a general ward? Here's the price. You want a private air-conditioned room with five-star catered meals, here is the price.
When I was between jobs I had about a 2 week period where I was technically without coverage, but the new company reimbursed me once I was on their plan. I went to fill a prescription for a very common generic drug that has been around for decades at the chain pharmacy I always use.
I was expecting to pay the same price I generally did, about $3.00. I was shocked when they charged me $150.00. I can understand the pharmacy needing to charge a bit more to cover costs, but this seemed like highway robbery.
The real question here isn't how much you generally pay, but how much insurance generally pays. It was almost certainly less than $150, but it isn't at all unusual for even generic drugs to cost insurance hundreds of dollars, even when you have only a small copay.
As the number of pharmacy companies has declined, there's been a huge creep upwards in the price of generic drugs. Even for non-prescription drugs. Price is no longer even vaguely related to production cost. Look at the price of antacid tablets (which are chalk, calcium carbonate) and cranberry pills (a very cheap product.)
Price discrimination in healthcare is out of control. Simple addition to Medicare regulation that requires any provider (including Pharma resellers) to have a public price and not charge anyone more than they charge Medicare solves a lot of problems.
I've done price comparisons and CVS is hands down the worst price for anything.
The only reason you go to CVS, is if you have 0 other options.
While I blame the various medical cartels for making healthcare unaffordable by bribing (Lobbying) hundreds of millions of dollars to politicians- can the customer be blamed for negligence?
Just switched from CVS to Walgreens for this exact reason. They were charging the insurance (and us for the uncovered amount) full prices for generic versions.
And let me just clarify, the prescription bottle had the generic version on the label, our receipt was for the non-generic!
We complained to the CVS pharmacist about this and their response was brazen and they wouldn't budge even when we said we will escalate this to our insurance company. We did escalate it to our insurance company (not Blue Cross Blue Shield), but never heard anything more about it... perhaps more will sue in the weeks to come.
Edit: This was in SoCal, not one of the states mentioned. Also, we weren't part of this plan that they talk about in the article.
I had to fail 4 medications WITH insurance and I had BCBS, to get my medication for free, thay was already free through the insurance, that just fucked me up even more mentally than I started.
From some perspectives charging everyone the same amount is wrong. In fact I'd say my intuitive notion of what a "fair" price was was closer to that when I was young, even being American. If a shopkeeper makes little or nothing selling an apple for $.25 to poor locals but does it anyway, but then successfully charges more of people she judges richer, she is any of remarkably charitable, grossly unfair, or simply doing what's right and expected, depending on one's culture or perspective. Similarly, the mechanic who could charge more but instead charges a smaller amount at what seems to them a fair markup is either an idiot or a good citizen, depending on one's perspective.
Anyhoo, is it fair to charge me $10 and you $200 for the exact same burger? I thought there were rules against this. Why don't the laws prohibiting price discrimination apply to pills?
Further, upthread someone said something about prices doctors charge.
I have no problem with that. Of course different doctors have different prices. Rent, servicing debt, skill/merit.
But I have a problem with that doctor (or more likely her hospital or managed healthcare org) charging different prices to different patients.
I know there's some history here (in the USA), and path dependence. But it is conceptually so simple to make the system transparent, fair, accountable.
> Merely charging different prices to different customers is not illegal, when there is no intent to harm competitors.
So if CVS uses price discrimination to screw-over Walgreens, it's illegal, but if they use it to screw over their customers, it's not (with the expectation that if they screw over their customers, the customers will go to Walgreens).
Thanks. That's an embarrassing oversight on my part.
Pharma definitely has done anti-competitive stuff. But I'm not seeing a connection to the customer pricing we're talking about.
Even so, I vaguely remember something about price discrimination, so care has to be taken when doing market segmentation. Or I could just be making it all up.
Providing something for free is not exactly charging a price, but it is also not something they do. At least I seldom see a restaurant have people in need come into the restaurant and eat for free next to people that are paying. However, to bend your analogy to the current situation, you come into the restaurant, there is no menu, the chef decides what you need, you find out how much it cost weeks later, the price can vary 500% based on which "hunger insurance" plan you have selected. If the restaurant decides to give you the meal for free, they come up with the highest possible price for tax purposes.
Sure and an argument could be made that the specific things happening in this situation are wrong. That's not the argument that I replied to. I replied to a flippant argument that it is always wrong to charge different people different amounts.
I just went to what I considered a clear counterexample, though it does have problems that it is rare (though local coffee shops and bakeries, for example, fairly regularly will provide things for free to those in need within the store exactly like they would for regular customers).
Is it wrong for universities to provide financial aid to those in need?
Would it be wrong for a city to provide subsidized public transportation? subsidized school lunches?
You can come up with other harder to decide examples. A really good one would be whether it's wrong to charge tourists and locals different amounts. On the one side, this feels unfair to the tourists, why should they have to pay more? Generally, I lean to unfair things being wrong. But, the consequences of charging them the same are, to me, much worse, especially as the means of the two become further and further apart.
Do you guys actually pay these prices for this stuff, or is it only forgetful travellers who fall for it and end up paying through the nose because they have no other choice?
Surely you won't be claiming for pain killers for a headache etc on your health insurance? (...although at those prices maybe you should??!)
It feels to me that is pretty criminal to charge those prices at retail - to inflate even more to insurers just seems pretty outrageous.