Cost Plus
St. Paul Corner Drug’s self-pay program
Did you know that you don’t need insurance to fill prescriptions at our pharmacy?
Health insurance won’t always make your prescriptions cheaper, and it certainly doesn’t make filling them a smoother experience.
Additionally, the inner workings of the insurance industry make it so that independent pharmacies like us currently lose money dispensing prescriptions.
Our Cost Plus program is exactly as it sounds: rather than using your health insurance to bill and fill prescriptions, we charge you the cost of your medication plus a flat-rate dispensing fee that accurately reflects our true operating costs as compared to the increasingly low or complete lack of dispensing fees currently paid by Pharmacy Benefit Managers (PBMs) on behalf of payers (insurance companies, government entities, and large employers).
This kind of self-pay model is becoming more popular as independent pharmacies across our nation face the financial and logistical challenges of working within the pharmaceutical and insurance industries.
Benefits
You may be able to get your medications cheaper than if billed through insurance (because insurance doesn't always make healthcare more affordable!). See our example from a real life SPCD patient below.
Prescriptions that are paid for out-of-pocket are able to be refilled whenever and for as much as you like (e.g., at 3- or 6-month intervals instead of monthly), within the constraints of the written prescription and depending upon whether the medication is a controlled substance. This makes it possible for you to fill your medications at more convenient intervals and easily stock up when you're planning to go out of town. No more vacation or lost medication overrides, and syncing up your medications becomes a piece of cake. You simply order as much medication as you need, when you need it.
Bypassing the billing of prescriptions to insurance means no more hoop jumping (e.g., prior authorizations (PAs)). Additionally, even if your insurance isn't accepted at our pharmacy, you can continue to have your cheap generic medications filled by us.
Bypassing the billing of prescriptions to insurance ensures that we're being compensated fairly for the work we do filling your prescriptions and remain a viable business and healthcare provider in your community. Currently, we are reimbursed at extremely low rates (or not at all) by insurance companies and the PBMs they work with or own. In most cases, the professional dispensing fee we receive—which is supposed to cover our operating costs—is less than 25 cents per fill (in the late 1980s, this fee ranged from $7 - $10). Years of being underpaid or outright not paid for our work has, unsurprisingly, put us in a difficult financial situation, surviving on the revenue from other services we offer and OTC products sold to stay afloat while we wait for legislative efforts addressing PBM abuse to hopefully pass and take hold.
A real life example of how Cost Plus can cost less…
An actual SPCD patient takes 5 maintenance medications:
Amlodipine (for high blood pressure)
Ezetimibe (for high cholesterol)
Fluticasone nasal spray (for rhinitis symptoms like sneezing and nasal congestion)
Lisinopril (for high blood pressure)
Metoprolol (for high blood pressure)
Upon a recent visit, our Pharmacy Technician noticed that the patient’s copays seemed higher than would be expected for cheap, generic medications like this. If the patient had used insurance to help cover the cost of his prescriptions during this visit, their total out-of-pocket cost would have been $271.88. After applying our Cost Plus pricing model [raw cost of the drug plus a dispensing fee based on days’ supply], their total was $141.66, over $100 less than if the patient had used their health insurance.
This patient now uses Cost Plus to fill all of their maintenance medications.
Pricing
There is no set price for medications (e.g., $30 per month) filled through our Cost Plus program and no subscription fee to participate. Rather, we charge you the cost of your medication based on its average market value plus a flat-rate dispensing fee that accurately reflects our operating costs and depends on the days’ supply we’re dispensing. See below for some example prices of generic medications commonly filled through our Cost Plus program.
A 30-day supply (quantity 30) of Sertraline [Zoloft], an antidepressant, costs around $14.
A 90-day supply (quantity 180) of Metformin, a common diabetes medication, costs around $30.
A 180-day supply (quantity of 180) of Lisinopril, a common blood pressure medication, costs around $33.
note: All prices are subject to change without notice and based on the market value of individual medications.
Is Cost Plus the right fit for me?
Patients who take generic medications are great candidates for our Cost Plus program. This is due to the fact that the wholesale cost of these medications in many cases is less than $5.00 for a 3-month supply. Unfortunately, most brand-name medications are too expensive for patients to afford out-of-pocket; however, there may be a generic alternative to the expensive brand-name medication your prescriber has ordered for you.
note: Just because a medication is “new” doesn’t necessarily mean that it’s better than what we have been using for years; it does, however, mean that it will be significantly more expensive. These new medications (the ones you probably see advertised on cable television) are considerably less tried and true, and in many cases come with significant side effect profiles not seen with older medications.
In particular, Cost Plus can be especially beneficial for those with high-deductible insurance plans, since generic medications are usually inexpensive and don’t contribute much to such a deductible.
This program is also a great fit for patients who either don’t have health insurance with prescription drug coverage OR whose insurance isn’t accepted at our pharmacy.
A note re: Minnesota Health Care Program (MHCP) recipients
Unfortunately, in most cases, patients with a state-sponsored health insurance plan are NOT eligible to pay out-of-pocket for their prescriptions per Minnesota state law, and are therefore not eligible for our Cost Plus program. This includes patients who are dual-eligible and covered by both Medicaid and Medicare. Please contact MHCP for more information.
Cost Plus & Medicare
If you’re a Medicare patient participating in Cost Plus because your Medicare plan is NOT accepted at our pharmacy, please be aware that we will only be able to bill your COVID, flu, and pneumonia vaccinations to insurance IF you have a traditional Medicare Part D plan (vs. Medicare Advantage). This is because these vaccines, specifically, are the only ones currently covered by Medicare Part B, which is actually the medical portion of your Medicare coverage instead of your drug coverage (as a pharmacy, we usually bill vaccines to patients’ drug coverage, but when you have a Medicare Advantage plan, your hospital, medical, and drug coverage are bundled together, so we’re unable to bill any care for you if we’re not in-network with your plan).
All other vaccines—such as RSV and Tdap (tetanus)—will need to be paid for out of pocket, which would include the raw cost of the vaccine plus and administration fee; this can range from tens to hundreds of dollars, depending on the vaccine. As mentioned above, unfortunately, patients with a Medicare Advantage (Part C) are unable to have ANY vaccines billed to insurance if their plan isn’t accepted at our pharmacy. Click here to learn more about Medicare at St. Paul Corner Drug.
Getting started
If you’re considering or decide that you’d like to participate in our Cost Plus self-pay program, please give us a call and ask to speak with one of our Pharmacists, Pharmacy Technicians, or our Nurse about Cost Plus (alternatively, you can send us a message here). If they don’t have time to chat with you in the moment, they’ll give you a call back when they’re able. When you connect with a staff member, they’ll answer any remaining questions you have and educate you about next steps for participating in the program, including completing our Patient Authorization for Self-Pay (HITECH) form, which is required for ALL Cost Plus participants.
Thoughts from actual Cost Plus patients
“When our insurance company told us we ‘must’ use a mail order prescription plan for our maintenance medications, we asked our Pharmacist, John Hoeschen, what to do. He provided us with a reasonable out-of-pocket alternative, which allows us to continue to have 90-day supplies of our medications delivered from St. Paul Corner Drug to our home.
Having a local Pharmacist that we trust is very important to us. We are grateful for St. Paul Corner Drug and everything they have done for our community, especially during the pandemic. We would not fill our prescriptions anywhere else.”
— Gretchen & Chris C.
“Even though our prescription copays would be $0 if using our insurance, after hearing about the Cost Plus program we signed on. We want St. Paul Corner Drug to continue in business and with low insurance payments they may not be able to do that.
We appreciate having a local, neighborhood pharmacy. We like the fact that they know us, are very knowledgeable, and we trust them with our business. We believe small businesses are good for our community. We are grateful we can do something to help St. Paul Corner Drug be here to serve its patients and the community.”
— Ron & Mary R.
We’re committed to helping our patients get their prescriptions filled efficiently and cost-effectively.
Questions about our Cost Plus program?
Send us a message here.