A Personal (Russ Swallow) Case Study ... Prescription Coverage

I'm scheduled for Cataract Surgery on October 12th and October 26th (one eye at a time).

The cataract surgeon's office sends three prescriptions to my local pharmacy for three types of eyes drops to prevent infections after the surgery.  I go to pick up the prescriptions and find the costs are $12.35 (Diclofenac), $16.10 (Ofloxacin) and $156.80 (Durezol).  

I picked up the $12.35 and the $16.10 and then called the surgeon's office and asked for a Durezol generic which was then phoned in to the pharmacy.  The generic was Prednisolone Acetate and the quoted cost was $80.50.  Again, no way.

My particular Part D drug plan has …
1.   NO deductible and NO copays for Tier 1 and 2 drugs
​​​​​​​2.   $360 deductible and then copays for Tier 3, 4 and 5 drugs

The $12.35 and $16.10 were obviously Tier 3s while the $156.80 was a Tier 5.  These costs would count toward the $360 deductible, after which copays would then apply.

My next move was finding a better price for the Prednisolone Acetate.

I then went to www.goodrx.com and found a discount coupon.  The coupon information was entered into the pharmacy's computer which produced a price of $27.53.  Even though I've been out of school for a long time, I still think $27.53 is less than $156.80 or $80.50.  

In this instance, it made sense to make the purchase outside of the insurance plan.