Consumers have increasingly turned to online outlets over traditional brick-and-mortar stores for purchasing a variety of goods and services in recent years--and filling prescriptions is no exception. No longer do you have to walk into your local retail pharmacy to get your prescription filled. Consumers are finding more convenient, affordable, customer-focused options online. Amazon RxPass and Mark Cuban Cost Plus Drugs are two of the online options making waves in the pharmacy industry, disrupting traditional pharmacy models.
You may be wondering, should I be looking at online retailers over local pharmacies that are part of my health insurance network? Are these retailers a lower-cost option compared to using my pharmacy benefitt hrough my insurance? Answering these questions aren’t as clear cut as you may think. Let’s talk more about Amazon RxPass and Mark Cuban Cost Plus Drugs, factors to consider when you fill prescriptions outside of your network, and steps to make the most of the available resources.
Amazon RxPass
Amazon RxPass acts like an additional subscription on top of an existing Amazon Prime membership. The cost is $5 per month and includes access to numerous generic medications at no additional cost. Medications are then shipped directly to the customer’s door, just as with any other Amazon purchase.
Amazon advertises this pharmacy prescription service to offer:
- Lower prices. The subscription includes common generic medications for high blood pressure, anxiety, and more. All for no more than $5 per month.
- Simplicity. No more comparing costs at multiple pharmacies or calculating insurance copays.
- Reliability. Prescriptions are refilled and delivered right to your door, with notifications along the way to keep you updated.You can access a current list of the medications available on Amazon RxPass here.
Mark Cuban Cost Plus Drugs
Mark Cuban Cost Plus Drugs is similar to Amazon RxPass, but with more complex medication offerings. This online pharmacy service also allows consumers to completely bypass their insurance carrier, if needed, to access medications. Unlike Amazon, Cost Plus Drugs does not require a $5 monthly subscription fee. The consumer pays for the needed medication, which is then delivered to their door. While Amazon’s RxPass medication list consists of common, generic medications, Cost Plus Drugs offers a more robust list and wider availability.
Cost Plus Drugs founder Mark Cuban says, “Every product we sell is priced exactly the same way: our cost plus 15%, plus the pharmacy fee, if any. When you get your medicine from Cost Plus Drug Co., you’ll always know exactly how we arrived at the price you pay. We started this company as an effort to disrupt the drug industry and to do our best to end ridiculous drug prices.”
Here’s one example of potential savings using Cost Plus Drugs*:
Drug name: Dimethyl Fumarate (commonly used to treat multiple sclerosis, generic Tecfidera®)
Form: 60 capsules
Strength: 240 mg
Supply: 1 month
Cost through Cost Plus Drugs: $54.75
Traditional pharmacy channels: $4,965.52
*This pricing was pulled as of 1-31-23, prices are subject to change.
Should I shop these online pharmacy retailers if I have insurance coverage?
Just as you might compare the price for a new refrigerator at several retailers, so should you price shop your medications! Medication prices go up and down, month to month, so using the resources at your disposal is important to find the best price. Compare the prices at online retailers (Amazon RxPass, Cost Plus Drugs, GoodRx), and also check out pricing tools provided by your health plan. PHP members, for example, have the ‘Price a Medication’ tool available in their member account. Using a mix of pharmacies in your network and/or online retailers may be the best way to get the lowest price for your medications.
Our PHP pharmacy team has assisted members in finding lower costs for certain drugs through these online sources outside of their pharmacy network, which has resulted in significant savings. We will continue to partner with these retailers as they expand their services, as well.
Remember these points when you fill a prescription outside your insurance
The entry of alternative online retailers in the prescription medication industry is a great thing for all of us (members, employers, and insurance companies alike) and they play an important role to helping drive down costs. There are, however, a few points to be aware of when you choose to fill a prescription outside of your insurance coverage.
- Safety. PHP uses Express Scripts, a prescription benefit manager (PBM), to process claims when members use PHP benefits to purchase medications. Express Scripts always screens prescriptions for safety and possible drug interactions when a new order is placed. If members purchase medications through third-party websites such as Amazon RxPass or Cost Plus Drugs, they do not factor in already existing medications that someone may be taking and the potentially dangerous interactions there may be with current medications. Always let your doctor and pharmacy know of any other prescriptions you may be filling outside of your insurance coverage.
- Reimbursement. If you choose to purchase medications through online sources outside of your insurance, reimbursement may be an option. Receipts for these purchases can be submitted, and potentially reimbursed or have the cost applied toward your deductible and out-of-pocket expenses. (Be aware of any time limits for receipt submission.) PHP members do not get credit for any amount over the price they would have paid using PHP’s prescription benefit.
Example: If Sally buys her medication on cost Plus Drugs for $50, and the same medication was available through a PHP network pharmacy for $45, she will only receive credit for $45. PHP does not reimburse or credit the additional $5.
- Prior Authorization. Prior authorization is required for certain medications. Using alternative online services would not circumvent the need to meet prior authorization criteria. This means no credit or reimbursement would be applied toward your insurance deductible or out-of-pocket expenses if a prior authorization wasn't obtained before purchasing one of these medications.
As pharmacy models continue to change and adapt to market demands, remember that being a smart healthcare consumer is vital to making the most of your healthcare dollar. Shop and compare, and consider alternative outlets that can potentially offer you savings. And don’t forget about your health plan pharmacy team that can help you navigate the options and find the best solution for your pharmacy needs.
