With regards to Costco…what was said upstream…check the out of pocket cost at Costco. For SOME medications…it’s cheaper to pay out of pocket at Costco than to submit to insurance at all…
Specialty drugs can be a nightmare. D was on human growth hormone for 13 years and at different times we had all the major players–Caremark, Express Scripts, etc. Every time H’s employer switched insurance carriers (most years), the fight, pre-auths started again. UG. Was always sort of amazed they’d leave $9000 of meds without a delivery signature.
Caremark mail order (as well as Express Scripts) either worked very well on 90 day mail-order, or horrendously–no in between. Either it filled cheap and arrived on time, or they held the script and sent you a form letter a month later with blah-blah excuses and did not return the physical script.
We have had to use 90 day fills for maintenance meds for at least the last 5 years. There are 5 pharmacies in my town and the CVS would be my 5th choice. Hopefully we are never limited to them.
You will see cash price less than insurance most often with the cheap drugs. For expensive drugs, you won’t see the gap from the fixed co-pay and the cash price. Most insurances will drop your payment to the cash price if it is cheaper but some will not.