Cost Plus Drugs is great...until it isn't

Once again, my apologies for being late with the blog. I do have a good excuse this time; my sister's family was visiting from Sunday through Tuesday, and I spent more or less the whole time with them at my parents' house in Hopewell. So I didn't get a chance to finish up this post until Wednesday. Now, on to a few words about health care costs.

When Brian retired last February, I did a lot of number crunching to find the best prices on the health coverage his job would no longer provide. The state's Get Covered NJ website helped me compare basic health plans quite easily, and a little online searching helped me find a separate plan for vision care. (Side note: the dental discount plan I chose turned out to be a complete bust. The dentist we'd been going to for years wasn't in the plan's network, and the local dentist we decided to try instead charges way, WAY more than the estimates Aetna provided for "average costs" under the plan. Unfortunately, we didn't learn this until we showed up for our appointments, so we ended up paying $100 in cancellation fees and going back to our old dentist. Add in the $145 we paid for the discount card itself—counting the extra $20 I decided to pay for prescription drug discounts that turned out to be worthless—and that's $245 wasted instead of saved.) 

Then, since our new plan had a high deductible, I also used its website to help me check out-of-pocket prices for all our prescription drugs. For most of them, I found that it would be significantly cheaper to buy from Cost Plus Drugs, a Mark Cuban venture that offers generic drugs at rock-bottom prices. The way it works is right there in the name: They charge you the wholesale cost of the drugs from the manufacturer, plus a 15% markup to pay for their overhead, plus a $5 dispensing fee for the pharmacy that makes up the prescriptions, plus shipping, which is a flat $5.25 for most orders. 

All that can add up to a substantially lower price than you'd pay at a retail pharmacy. For example, one of my rosacea medications, a 15% azelaic acid gel, would cost $81 a tube if I bought it from the nearest in-network pharmacy. If I bought it through my health plan's mail-order pharmacy, that would drop the price to just $26.14 per tube plus shipping—but that pharmacy is Amazon, which I don't want to use unless it's the only option. If I used a free discount card from GoodRx, I could get the medicine from a local chain pharmacy (which isn't in our plan's network) for around $36 a tube. But at Cost Plus, the total price including shipping is just $24.27.

This sounds great, and it is, but there are a few downsides. One is that Cost Plus only offers a limited selection of medicines. However, all of ours are on this list, so that wasn't a problem for us. The second is that they aren't in the networks of most health insurers, including ours, so we have to pay the full costs out of pocket. But I didn't consider that a deal breaker because, in the first place, our plan's high deductible meant we'd be paying for most of our meds out of pocket anyway. And even if we happened to hit our deductible in a given year, the plan would only cover 60 percent of medication costs after that. At our local, in-network pharmacy, just our 40 percent copay on the azelaic acid would come to $32.40, which is still higher than the total price from Cost Plus.

The third problem is the difficulty of transferring prescriptions to Cost Plus. Most pharmacies will happily transfer a prescription from another pharmacy for you. So, if I'd been using Amazon or another in-network pharmacy, I could have simply transferred over the prescriptions I had at OptumRx, our old plan's mail-order pharmacy, and used the refills I had remaining. But Cost Plus doesn't do this. You have to ask your doctor to send them a new prescription for each medication you use—and if the meds were prescribed by different doctors, you have to do this multiple times. It took several attempts to get in touch with my new doctor, as well as my dermatologist, and get them to send in my prescriptions to Cost Plus, but I managed it in the end for most of my meds. And once Cost Plus had the prescriptions, it was perfectly straightforward to use. They sent me a notice to say the prescriptions were ready to fill, I went on the site and placed the order in a few minutes, and the meds arrived in about a week.

The fourth problem came up with the last remaining medication I hadn't transferred over yet. This was partly my fault; I thought I had an extra tube of the azelaic acid on hand, which would have been enough to get me through to my next appointment with the dermatologist, so I was planning to ask for a new prescription then. But that extra tube in the drawer was actually a different medication, something we were no longer using. So, with just a few weeks' worth left, I reached out to the dermatologist last month and said, "Hey, I don't have enough of my meds, can you send a new prescription to Cost Plus?" and they obligingly did so. Within a day, I received a message from Cost Plus saying they had the new prescription...but unfortunately, the medication was out of stock. They promised to notify me as soon as it was back in stock, but they gave no indication when that would be.

For a couple of weeks, I waited, keeping a wary eye on my supply, to see if the medicine became available. I considered calling the doctor again to ask to have yet another prescription sent to a different pharmacy (since you can't transfer prescriptions away from Cost Plus either), but the high cost deterred me. Finally, I tried getting in touch with Cost Plus customer service to ask if they had any idea when the meds would be back in stock, and here I ran into the fifth problem: You can't. There's a FAQ on the website and a chatbot who doesn't know anything that isn't in the FAQ, and there's a feedback form on the site you can use to email them a question and hope someone answers. (I tried it over the weekend and got a response on Monday, but all it said was, "We don't have an ETA at this time. You will get an email when it's back in stock," which is exactly what they'd told me already.)

I finally settled on a solution I'd used once before when I ran out of this medicine while on vacation: I bought an over-the-counter preparation of azelaic acid instead. It's only 10 percent azelaic acid instead of 15 percent, but it should be good enough to get me through to my appointment next week. If Cost Plus doesn't have the prescription strength back in stock by then, I can ask the dermatologist to send a new prescription to another pharmacy (ideally one where I can use my GoodRx coupon). But the whole situation made me kind of nervous. If they could simply run out of this medication, could it happen with others as well? Could I log on one day to refill my prescription for, say, my thyroid medication, only to see that it's out of stock and there's no indication when it will be available again? 

I went searching online to see if anyone else had experienced this problem, and I found not one but two Reddit threads where people complained that their medications—much more essential ones than mine—had been out of stock for weeks or even months, with no indication when they'd be back. I also found a bunch of negative reviews on both Reddit and Trustpilot accusing Cost Plus of still graver errors. Some people said their doctors had sent their prescriptions to Cost Plus multiple times and they still weren't showing up on the site. Others said they'd been charged for medications they never received or had orders canceled with no notification. Worst of all, some said they'd ordered medications that were supposed to be temperature-controlled, and Cost Plus had shipped them in a regular envelope in the blazing summer heat, making them unusable. And all of these people said that they were unable to get a satisfactory response from customer service, if they got any response at all.

All this makes me feel torn about relying on Cost Plus in future. On one hand, it's much, much cheaper than the alternatives for some of our meds. But that's assuming we can actually get them there, and that seems far from guaranteed. Right now, my inclination is to keep using Cost Plus when possible, but make sure to have a backup available. I plan to refill all my meds as early as possible, and if they aren't available within two weeks of the time I need them, call the doctor and ask to have the prescription sent somewhere else. I'm not worried about the cold-chain problems, since Brian and I don't take any medications that require temperature control, but if we ever do, I'll make sure to get those somewhere else.

In the course of writing this post, I also learned about a couple of other alternatives. There are two other online pharmacies operating on a cost-plus model that can ship to my area: Blueberry Pharmacy and Midtown Express Pharmacy. (Reddit mentioned the first one, and I found the other through a search on CostPlusPharmacies.com.) Unforunately, Blueberry doesn't offer most of the medications we use in the appropriate dosages, and Midtown Express doesn't let you check prices online. So for now, it looks like my Cost-Plus-plus plan is the soundest one.