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ooky

(10,593 posts)
13. The patients don't negotiate better prices, but they do get the better price the insurance
Thu Sep 19, 2019, 08:57 PM
Sep 2019

company negotiates with the insulin supplier. The last time I checked with my son's insurance company, this is how it was explained to me and him. The retail price of his insulin was $890 for a 90 day supply from the insulin supplier. The insurance company negotiated the price to $552. Until he met his deductible, he had to pay the $552 price with the insurance. Without insurance the price would be the full $890. Once he met his deductible the insurance would kick in and he would have a copay of 20%, making his cost around $100. But the annual deductible he had to meet on that employee insurance plan was $3000, so he would never get to $100 price.

This was two employers ago, and his new employer has a better plan for the insulin price. So now he is getting gouged for the infusion sets for his $5000 insulin pump. Without the pump his diabetes management is much worse, and would likely take years off his life and cause earlier onset of complications. Government policies on this disease are a nightmare for those who have it.

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