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rated:
I never understood this

With Medicare Part D, seniors get drug coverage but the drug prices they have to pay is based on their income. Why dont they simply buy it online from Canada for 1/10th of the price.

Is this illegal?

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rated:
Several bad assumptions:

1) All drugs cost 10x more in the U.S.
None of the high-profile, on-patent drugs are 10x more expensive -- https://www.fool.com/investing/2017/01/21/5-drugs-that-are-way-c...

2) Drugs are always cheaper in Canada.
Generics can actually be more expensive -- http://news.nationalpost.com/news/canada/this-is-why-canada-has-...

3) Importing drugs from Canada will be cheaper than Part D coverage.

rated:
I assume many don't because they have trouble ordering Depends from Amazon.com. You need to be tech savvy and be smart enough to avoid scams and imitations.

rated:
It will be almost impossible to detect fake drugs by most seniors. Most people do not have access to instrumentation needed for a quality check. That perhaps scares a lot of seniors to buy drugs across the border.

rated:
Around 10% of drugs sold by pharmacies in USA are either counterfeit or expired. The FDA spends most of its resources approving drugs based on efficacy and safety, and not much on making sure pharmacies only sell genuine drugs. The FDA recently has forced drug manufacturers to use a forgery-proof way of labeling their drug bottles so any pharmacy can verify the drugs came from the correct manufacturer, but most pharmacies are regulated by state agencies and are not required to use the FDA's method to verify that every bottle of drug they buy from distributors is genuine. Pharmacies rarely buy from the manufacturer directly (which would eliminate most problems) but through distributors : these middlemen protect their profits by lobbying states to NOT require pharmacy's to buy direct from the manufacturer and then offer discounts to pharmacies that would not be available if they bought directly from the manufacturer. As a result pharmacy chains are constantly shopping around for the cheapest distributor. There are literally thousands of drug distributors in USA, more than there are pharmacy chains, and a few of them are shady fly-by-night black market resellers of drugs stolen from hospitals (or discarded by hospitals due to expiration). Guess which distributors tend to have the cheapest prices ..

 

rated:
ananthar said:   Around 10% of drugs sold by pharmacies in USA are either counterfeit or expired. The FDA spends most of its resources approving drugs based on efficacy and safety, and not much on making sure pharmacies only sell genuine drugs. The FDA recently has forced drug manufacturers to use a forgery-proof way of labeling their drug bottles so any pharmacy can verify the drugs came from the correct manufacturer, but most pharmacies are regulated by state agencies and are not required to use the FDA's method to verify that every bottle of drug they buy from distributors is genuine. Pharmacies rarely buy from the manufacturer directly (which would eliminate most problems) but through distributors : these middlemen protect their profits by lobbying states to NOT require pharmacy's to buy direct from the manufacturer and then offer discounts to pharmacies that would not be available if they bought directly from the manufacturer. As a result pharmacy chains are constantly shopping around for the cheapest distributor. There are literally thousands of drug distributors in USA, more than there are pharmacy chains, and a few of them are shady fly-by-night black market resellers of drugs stolen from hospitals (or discarded by hospitals due to expiration). Guess which distributors tend to have the cheapest prices ..

 

  
Every major pharmacy in the country uses Mckesson, Cardinal, or Amerisource.  These are companies with tens of billions of dollars in revenue.  You make it sound like pharmacies are cutting deals with a guy under a bridge in a trenchcoat.

These distributors have massive price bargaining power and sophisticated logistics and replenishment capabilities that neither drug manufacturers or pharmacies can even dream of.  "Middlemen" is dishonest, they add significant value to both parties.

rated:
Hecho en Mexico. Same exact formula as US, but no Rx is required - except for controlled substances. Abbott, Novartis, Roche, Astra Zeneca and many many more operate in both countries. Mexico is the eleventh global market for pharma with a net worth of 13.2B usd. Thousands of Winter Texans and Snowbird Seniors obtain their prescriptions in Mexico saving themselves from having to pay the exorbitant prices of prescription meds here in the US.

rated:
I was looking at filling a script in Mexico last time I was there, but got cold feet due to how difficult Immigration and Customs has been lately. Anyone have experience with this?

rated:
Another point - both my doctors insist on sending prescriptions to my pharmacy electronically. I was having issues with a certain pharmacy not receiving the prescriptions he was sending and asked for a written one. He said he can only do that under certain circumstances - told me because of Obamacare (he obviously is not a fan) he has to send 90% of his prescriptions electronically or he looses some of the fees he collects from Medicare.

True or not - I don't know.

rated:
fleetwoodmac said:   I never understood this

With Medicare Part D, seniors get drug coverage but the drug prices they have to pay is based on their income. Why dont they simply buy it online from Canada for 1/10th of the price.

Is this illegal?

Part D drug cost is NOT based on income, with one exception. those individuals meeting certain criteria to qualify for Extra Help based on low income or other qualification (i.e., dual enrollment in Medicaid) do get subsidies to reduce or eliminate cost- sharing for covered drugs.

Part D premium cost is to some extent based on income. Individuals considered high earners pay a income-related monthly adjustment amount in addition to the standard premium. Currently if your modified adfjusted AGI is > $85k as a individual filer or 170k as joint, you are subject to D-IRMAA. You would also have a higher than base Part B premium, so nothing new there. Most part D enrollees do not pay D-IRMAA.

rated:
tlaxson said:   
fleetwoodmac said:   I never understood this

With Medicare Part D, seniors get drug coverage but the drug prices they have to pay is based on their income. Why dont they simply buy it online from Canada for 1/10th of the price.

Is this illegal?

Part D drug cost is NOT based on income, with one exception. those individuals meeting certain criteria to qualify for Extra Help based on low income or other qualification (i.e., dual enrollment in Medicaid) do get subsidies to reduce or eliminate cost- sharing for covered drugs.

Part D premium cost is to some extent based on income. Individuals considered high earners pay a income-related monthly adjustment amount in addition to the standard premium. Currently if your modified adfjusted AGI is > $85k as a individual filer or 170k as joint, you are subject to D-IRMAA. You would also have a higher than base Part B premium, so nothing new there. Most part D enrollees do not pay D-IRMAA.

  wow I did not know you can enroll to Medicare and Medicaid at the same time

I think the answer to my question is most seniors are not tech savy and do not trust shipped drugs from Canada. I have seen seniors paying north of $200 for drugs in CVS and Walgreens and that was a shocker to me. I am sure those drugs cost no more than 10 bucks in Canadian pharmacies online but only would they know.

rated:
fleetwoodmac said:   
tlaxson said:   
fleetwoodmac said:   I never understood this

With Medicare Part D, seniors get drug coverage but the drug prices they have to pay is based on their income. Why dont they simply buy it online from Canada for 1/10th of the price.

Is this illegal?

Part D drug cost is NOT based on income, with one exception. those individuals meeting certain criteria to qualify for Extra Help based on low income or other qualification (i.e., dual enrollment in Medicaid) do get subsidies to reduce or eliminate cost- sharing for covered drugs.

Part D premium cost is to some extent based on income. Individuals considered high earners pay a income-related monthly adjustment amount in addition to the standard premium. Currently if your modified adfjusted AGI is > $85k as a individual filer or 170k as joint, you are subject to D-IRMAA. You would also have a higher than base Part B premium, so nothing new there. Most part D enrollees do not pay D-IRMAA.

  wow I did not know you can enroll to Medicare and Medicaid at the same time

I think the answer to my question is most seniors are not tech savy and do not trust shipped drugs from Canada. I have seen seniors paying north of $200 for drugs in CVS and Walgreens and that was a shocker to me. I am sure those drugs cost no more than 10 bucks in Canadian pharmacies online but only would they know.

  So, now it's 20x? And there's no cost for shipping, right?

rated:
10x... 20x... Do I hear 50x?

rated:
JonnyRock said:   I was looking at filling a script in Mexico last time I was there, but got cold feet due to how difficult Immigration and Customs has been lately. Anyone have experience with this?
  
No experience, but if you had empty RX labeled containers and put the Mexican sourced drugs in them, crossing the border should be no worse than coming home with RX you'd bought here.

rated:
Walmart and Costco have been a godsend for drug pricing. More than Canada, but much cheaper than CVS/Walgreens on a cash basis for many drugs.

rated:
It's not illegal to import small quantities of prescription drugs for your own use, assuming you have a prescription. You'll only get heat if you're bringing thousands of pills or DEA controlled drugs like painkillers.

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Hecho en Mexico for Rx. While visiting Mexico, have your dental work done. Think of a medical vacation - go to Nuevo Progreso - Winter Texan haven. You will save hundreds of dollars. High quality dental and medicines.

rated:
If there is one drug our seniors are not overpaying for, it's weed. The semi-legalization of cannabis for medical consumption (and now recreation in some places) has destroyed the market for Mexican grown weed. Why consume their crap when US grown grass is of much higher quality?

rated:
When thinking about how chains might price drugs, think about how they price non- drug goods. CVS/Walgreens generally don't position as low-cost at from of the store, no reason to expect they will at back of the store either. From a cash perspective, you'll generally find lower costs at large grocers or warehouse clubs (which require no membership to use, FYI). CVS//Walgreens or an independent may be super competitive for cash on specific drugs, but on average they won't be competitive.

As far as Canada pricing, i work for a pbm and have seen claims filed to us for reimbursement for drugs purchased from Canada and other countries. Sometimes the equivalent in the US is higher cost, sometimes lower, sometimes there is no equivalent. If you are thinking of going this route to save money and actually have insurance, check with your benefits and see if foreign claims are covered. You might be able to get some reimbursement.

rated:
TravelerMSY said:   Walmart and Costco have been a godsend for drug pricing. More than Canada, but much cheaper than CVS /Walgreens on a cash basis for many drugs.
  
The problem IMO is our insurance system as far as drug prices.

Because of how our insurance works, price is not a concern of most people. They take whatever drug the doctor prescribes (regardless of if a generic or cheaper alternative would work just as well) and they take it to the pharmacy with no thoughts of how much it costs, how much it's worth, and how effective it is vs. other treatments.

So when someone has a PPO plan and pays a co-pay regardless of the cost of the prescription - that is a part of the problem.

To be fair, I think High-deductible plans (and more people utilizing them) are helping to curve things a bit - because people don't want to have to have to pay $3,500 in up-front costs just to get their prescription. When they get a huge bill at the pharmacy because of high-deductible they are more likely to go back to their doctor and ask if there are any other options. The only exception to this rule is if someone is stuck on a certain medical for life (diabetes, cancer drugs, etc...) that are still under patent with no alternatives... then it's just a matter of them spending the max oop and then not caring about the costs since it will be $0 thereafter.

rated:
wilesmt said:   If there is one drug our seniors are not overpaying for, it's weed. The semi-legalization of cannabis for medical consumption (and now recreation in some places) has destroyed the market for Mexican grown weed. Why consume their crap when US grown grass is of much higher quality?
  The Mexican grown weed is still flowing/floating in some places over our southern border.  Every week in the South Texas newspapers are pictures of the weed busts that occur on a weekly basis.

rated:
TravelerMSY said:   Walmart and Costco have been a godsend for drug pricing. More than Canada, but much cheaper than CVS /Walgreens on a cash basis for many drugs.
  
That depends on the drug that you need.  For one prescription that we need, CVS is $100 less than everyone else. 

rated:
nm 

rated:
Medicare part D is based on Income?
Oo, I didn't know that.

I thought everyone picked a plan that they wanted based on the drugs they used.

rated:
justignoredem said:   
TravelerMSY said:   Walmart and Costco have been a godsend for drug pricing. More than Canada, but much cheaper than CVS /Walgreens on a cash basis for many drugs.
  
The problem IMO is our insurance system as far as drug prices.

Because of how our insurance works, price is not a concern of most people. They take whatever drug the doctor prescribes (regardless of if a generic or cheaper alternative would work just as well) and they take it to the pharmacy with no thoughts of how much it costs, how much it's worth, and how effective it is vs. other treatments.

So when someone has a PPO plan and pays a co-pay regardless of the cost of the prescription - that is a part of the problem.

To be fair, I think High-deductible plans (and more people utilizing them) are helping to curve things a bit - because people don't want to have to have to pay $3,500 in up-front costs just to get their prescription. When they get a huge bill at the pharmacy because of high-deductible they are more likely to go back to their doctor and ask if there are any other options. The only exception to this rule is if someone is stuck on a certain medical for life (diabetes, cancer drugs, etc...) that are still under patent with no alternatives... then it's just a matter of them spending the max oop and then not caring about the costs since it will be $0 thereafter.

What you described is part of the problem. However, prices for certain generics have also gone through the roof as competition has decreased and pharma companies have increased the price of generics by huge amounts.

http://www.cbsnews.com/news/5-reasons-why-generic-drugs-cost-so-...
https://vineyardgazette.com/news/2015/09/24/cost-doxycycline-sky...

rated:
It makes me a little crazy that everyone pays a different price for the same product, based on varying discounts from an absurd rack rate. That's fine for me with airline tickets, but not for lifesaving medicines. Especially for something like Truvada, which could eradicate hiv in a generation if it were close to free.

rated:
Also, obligatory GoodRx mention. I have found some pretty good deals on there over time, though recent searches I haven't found deals as good as in the past.

rated:
 TravelerMSY  said
No experience, but if you had empty RX labeled containers and put the Mexican sourced drugs in them, crossing the border should be no worse than coming home with RX you'd bought here.

No need to take empty Rx bottles to Mexico.  Bringing into the US is 100% legal a 90-day supply of medicine from Mexico.  You do not even need an Rx except for controlled substances.  And you can bring those back with a written Rx from a physician.  That's the only time you need an Rx.  All medicines are blister-packed much like allergy and the runny nose medicines you buy at Walgreen's.  You buy medicines in Mexico by the 10, 25, 100 blister-pack.   No pharmacists counting out pills & filling/labeling bottles like in the US.  15+ yrs of wintering in the Rio Grande Valley of Texas.  While in Mexico, get your dental work done.  Had a friend from Virginia that needed $3,000+ of dental work (US price) - talked him into to spending the winter in South Texas - bottom line he spent slightly less than $1,500 and he is still thanking me today.  I am not saying that every dentist is of equal quality - you need to choose your provider of medical service just like you do here in the US - ask around.  Think about a medical vacation to McAllen, TX (the heart of the Rio Grande Valley) - cross over to Nuevo Progreso or Matamoros or Reynosa - thousands of Americans do this every year.  

rated:
busnut said:   
  
No experience, but if you had empty RX labeled containers and put the Mexican sourced drugs in them, crossing the border should be no worse than coming home with RX you'd bought here.

No need to take empty Rx bottles to Mexico.  Bringing into the US is 100% legal a 90-day supply of medicine from Mexico.  You do not even need an Rx except for controlled substances.  And you can bring those back with a written Rx from a physician.  That's the only time you need an Rx.  All medicines are blister-packed much like allergy and the runny nose medicines you buy at Walgreens.  So you buy medicines by the 10, 25, 100 blister pack.   No pharmacists counting out pills & filling bottles like in the US.  15+ yrs of wintering in the Rio Grande Valley of Texas.  While in Mexico, get your dental work done.  Had a friend from Virginia that needed $3,000 of dental work done - talked him into to spending the winter in South Texas - bottom line he spent slightly less than $1,500 and he is still thanking me today for telling him about Mexico Dentists.  I am not saying that every dentist is of equal quality - you need to choose your provider of medical service just like you do here in the US - ask around.  Think about a medical vacation to McAllen, TX (the heart of the Rio Grande Valley) - cross over to Nuevo Progreso or Matamoros or Reynosa - thousands of americans do this every year.  

  
I understand Canada but I can not believe any American would trust the safety not to mention the effectiveness of drugs manufactured in Mexico

rated:
fleetwoodmac said:   
busnut said:   
  
No experience, but if you had empty RX labeled containers and put the Mexican sourced drugs in them, crossing the border should be no worse than coming home with RX you'd bought here.

No need to take empty Rx bottles to Mexico.  Bringing into the US is 100% legal a 90-day supply of medicine from Mexico.  You do not even need an Rx except for controlled substances.  And you can bring those back with a written Rx from a physician.  That's the only time you need an Rx.  All medicines are blister-packed much like allergy and the runny nose medicines you buy at Walgreens.  So you buy medicines by the 10, 25, 100 blister pack.   No pharmacists counting out pills & filling bottles like in the US.  15+ yrs of wintering in the Rio Grande Valley of Texas.  While in Mexico, get your dental work done.  Had a friend from Virginia that needed $3,000 of dental work done - talked him into to spending the winter in South Texas - bottom line he spent slightly less than $1,500 and he is still thanking me today for telling him about Mexico Dentists.  I am not saying that every dentist is of equal quality - you need to choose your provider of medical service just like you do here in the US - ask around.  Think about a medical vacation to McAllen, TX (the heart of the Rio Grande Valley) - cross over to Nuevo Progreso or Matamoros or Reynosa - thousands of americans do this every year.  

  
I understand Canada but I can not believe any American would trust the safety not to mention the effectiveness of drugs manufactured in Mexico

  Just because you buy them in Mexico does not mean they are manufactured in Mexico.

rated:
fleetwoodmac said:   
busnut said:   
  
No experience, but if you had empty RX labeled containers and put the Mexican sourced drugs in them, crossing the border should be no worse than coming home with RX you'd bought here.

No need to take empty Rx bottles to Mexico.  Bringing into the US is 100% legal a 90-day supply of medicine from Mexico.  You do not even need an Rx except for controlled substances.  And you can bring those back with a written Rx from a physician.  That's the only time you need an Rx.  All medicines are blister-packed much like allergy and the runny nose medicines you buy at Walgreens.  So you buy medicines by the 10, 25, 100 blister pack.   No pharmacists counting out pills & filling bottles like in the US.  15+ yrs of wintering in the Rio Grande Valley of Texas.  While in Mexico, get your dental work done.  Had a friend from Virginia that needed $3,000 of dental work done - talked him into to spending the winter in South Texas - bottom line he spent slightly less than $1,500 and he is still thanking me today for telling him about Mexico Dentists.  I am not saying that every dentist is of equal quality - you need to choose your provider of medical service just like you do here in the US - ask around.  Think about a medical vacation to McAllen, TX (the heart of the Rio Grande Valley) - cross over to Nuevo Progreso or Matamoros or Reynosa - thousands of americans do this every year.  

  
I understand Canada but I can not believe any American would trust the safety not to mention the effectiveness of drugs manufactured in Mexico

  

Versus drugs made in India and China ? 
 

rated:
dannon35 said:   
fleetwoodmac said:   
busnut said:   
  
No experience, but if you had empty RX labeled containers and put the Mexican sourced drugs in them, crossing the border should be no worse than coming home with RX you'd bought here.

No need to take empty Rx bottles to Mexico.  Bringing into the US is 100% legal a 90-day supply of medicine from Mexico.  You do not even need an Rx except for controlled substances.  And you can bring those back with a written Rx from a physician.  That's the only time you need an Rx.  All medicines are blister-packed much like allergy and the runny nose medicines you buy at Walgreens.  So you buy medicines by the 10, 25, 100 blister pack.   No pharmacists counting out pills & filling bottles like in the US.  15+ yrs of wintering in the Rio Grande Valley of Texas.  While in Mexico, get your dental work done.  Had a friend from Virginia that needed $3,000 of dental work done - talked him into to spending the winter in South Texas - bottom line he spent slightly less than $1,500 and he is still thanking me today for telling him about Mexico Dentists.  I am not saying that every dentist is of equal quality - you need to choose your provider of medical service just like you do here in the US - ask around.  Think about a medical vacation to McAllen, TX (the heart of the Rio Grande Valley) - cross over to Nuevo Progreso or Matamoros or Reynosa - thousands of americans do this every year.  

  
I understand Canada but I can not believe any American would trust the safety not to mention the effectiveness of drugs manufactured in Mexico

  Just because you buy them in Mexico does not mean they are manufactured in Mexico.

  wait a minute

so there are drugs made in USA and sold in Mexico cheaper than USA?

rated:

 
  wait a minute

so there are drugs made in USA and sold in Mexico cheaper than USA?

  You got it!  You are starting to see the light now.  And vice versa - drugs made in Mexico sold here in the USA.  

rated:
fleetwoodmac said:   
...
so there are drugs made in USA and sold in Mexico cheaper than USA?


  
Yes.


Most of the retail price of drugs often has little to do with the manufacturing costs.
They can make a drug in the USA for $1 per pill then sell it in Mexico for $1.20 and $5 in the US.

But its probably just as likely that the drugs are made in China or India for 75 cents a pill.

rated:
busnut said:   

 
  wait a minute

so there are drugs made in USA and sold in Mexico cheaper than USA?

  You got it!  You are starting to see the light now.  And vice versa - drugs made in Mexico sold here in the USA.  

  how do I avoid drugs made in Mexico in USA?

I never asked these questions to my local CVS. Maybe I should

rated:
fleetwoodmac said:   
busnut said:   

 


...  how do I avoid drugs made in Mexico in USA?


 

  
 
Build a wall ? 


 

rated:
fleetwoodmac said:   
busnut said:   

 
  wait a minute

so there are drugs made in USA and sold in Mexico cheaper than USA?

  You got it!  You are starting to see the light now.  And vice versa - drugs made in Mexico sold here in the USA.  

  how do I avoid drugs made in Mexico in USA?

I never asked these questions to my local CVS. Maybe I should

  
Do you avoid consuming anything made in Mexico? Do you not eat bananas, avocados, drink cervezas, etc?

rated:
meade18 said:   
fleetwoodmac said:   
busnut said:   

 
  wait a minute

so there are drugs made in USA and sold in Mexico cheaper than USA?

  You got it!  You are starting to see the light now.  And vice versa - drugs made in Mexico sold here in the USA.  

  how do I avoid drugs made in Mexico in USA?

I never asked these questions to my local CVS. Maybe I should

  
Do you avoid consuming anything made in Mexico? Do you not eat bananas, avocados, drink cervezas, etc?
 

  Growing avocados is easy

manufacturing drugs?

rated:

Skipping 21 Messages...
rated:
justignoredem said:   
To be fair, I think High-deductible plans (and more people utilizing them) are helping to curve things a bit - because people don't want to have to have to pay $3,500 in up-front costs just to get their prescription. When they get a huge bill at the pharmacy because of high-deductible they are more likely to go back to their doctor and ask if there are any other options. The only exception to this rule is if someone is stuck on a certain medical for life (diabetes, cancer drugs, etc...) that are still under patent with no alternatives... then it's just a matter of them spending the max oop and then not caring about the costs since it will be $0 thereafter.

That's the case with a coworker. His wife requires daily injections for life. He reaches the max OOP deductible in 2-3 months so he couldn't care less if the price doubled or tripled (or dropped by 2-3 times either) and he reached it in a month.  

The PPO plans are no better for people ignoring the underlying costs of prescriptions. Unless the Rx insurance gives much different copays for generic vs. brand, who would pick a generic if your copay is the same than for the brand drug that retails 5x as much? You never check the sticker price, only what it costs you.

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