Beating Aetna at its own game

By John Olesky (BJ 1969-96)

Last year I hit the donut hole for prescriptions in May.

This year it's nearly November and I'm still $654.96 short of hitting the donut hole, which kicks in this year at $2,840.

How did I do it with the same prescriptions in both years?

I switched from getting my prescriptions through Aetna to getting them at a local pharmacy -- in my case, Walgreen's. And, when I hit the donut hole last year, I switched my brand name prescriptions to Canada.

How did this save me so much money?

Well, the brand name prescriptions through Canada were one-third to half the cost of getting them through Aetna. I also made sure that I stocked up on prescriptions by getting all my brand name refills in December 2010. I saved nearly $2,000 last year by going to Canada once I hit the donut hole.

So how did switching to a local pharmacy save money?

Aetna's charges for prescriptions are higher than what local pharmacies charge. In effect, Aetna is charging itself the higher price if you use Aetna mailed prescriptions. Although Aetna has a lower per-pill rate for 90-day prescriptions, the savings is more than offset by Aetna over-charging itself. That puts you in the donut hole sooner, and then Aetna collects 100% (in 2010, 50% in 2011) of the value it put on the prescriptions.