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Comment by mattlondon | Hacker News Reader

Whenever I visit the states and pop into CVS I am frequently amazed at the sticker prices on some of the dugs there. Things that literally cost pennies per tablet in the UK (generic hayfever tablets, pain killers etc) were absurd prices. 20USD for 7 hayfever tablets? 15 USD for 12 ibuprofen tablets? WTF?! Do not forget to get 12 hayfever tablets for £1.80 (~2USD) from a supermarket before your flight otherwise you'll need to spend 45USD (+tax) at the CVS a block from your hotel.

Do you guys actually pay these prices for this stuff, or is it only forgetful travellers who fall for it and end up paying through the nose because they have no other choice?

Surely you won't be claiming for pain killers for a headache etc on your health insurance? (...although at those prices maybe you should??!)

It feels to me that is pretty criminal to charge those prices at retail - to inflate even more to insurers just seems pretty outrageous.

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> Do you guys actually pay these prices for this stuff, or is it only forgetful travellers who fall for it and end up paying through the nose because they have no other choice?

Usually you can get those cheaper in bulk, like at Costco, or at a pharmacy that your doctor works with, or you can get a discount by showing your insurance card.

But yes, sometimes when desperate, we pay that much too.

We also have these health savings plans where we get a debit card and can buy that stuff with pre-tax money, which is sort of like saving 10-40% depending on your tax bracket.

But yes, it sucks. When I go to other countries I try to stock up. You have better prices and stuff that we can't get here.

> health savings plans where we get a debit card and can buy that stuff with pre-tax money,

These are stupid, and I wish they'd die, for multiple reasons.

First, the list of things that are allowed and not allowed is completely arbitrary and random. Feminine hygiene products are allowed, but baby formula isn't. Wtf why? And now someone's gotta maintain this list of items and enforce it (Wageworks et al), and process claims made manually. So now we've just added another actor in the whole system that can add their own profit margin on top. All so we can save a few bucks in paying taxes.

Second, these aren't available to everyone (just like 401k plans, the other symbol of taxation inequality). It's a benefit that has to be offered by your employer, and there are plenty of shitty employers out there. The people who could most use a tax break on a $10 bottle of aspirin are the least likely to get it.

Third, the use-it-or-lose-it nature of FSA money. And if you lose it, the money goes back to the employer. Again, wtf why? You're basically placing a wager against your expected healthcare expenses every year at open enrollment time. For really no clear benefit. Why can't the "debit card" work like a "credit card" instead, with payments made directly from your paycheck? There's no guessing involved, and no one ever over- or under-contributes.

I agree 100% with everything you've said.

They're dumb and just another band-aid for the fact that our insurance is tied to our jobs.

> feminine hygiene products are allowed, but baby formula isn't

One is a healthcare product, the other is a food (nutritional supplement at best).

It's baby formula not protein powder. It's literally life-sustaining. Calling it merely "a food" misses the point because, other than breast milk, it's the only food very young infants can consume.

I'm not arguing that tampons and sanitary napkins shouldn't be FSA-eligible; I think it's 100% correct that they are. I'm just pointing out the randomness of what is considered eligible.

Food and water is necessary to sustain human life. Why isn't food and water covered?

Whether something is necessary to sustain life is not the criteria used to decide if an HSA covers it or not.

I was talking about FSAs, not HSAs.

> Whether something is necessary to sustain life is not the criteria used to decide if an HSA covers it or not.

And I'm arguing that the criteria, whatever they are, are arbitrary and stupid and need to die in a fire. Along with the the whole concept of FSAs. Yeah food and water are essential, but baby formula isn't ham sandwiches or avocado toast. It's the only food that a baby can have - it's an essential health item. That an account meant to pay for health expenses doesn't allow it is downright dumb.

Calling it a "flexible" spending account is downright Orwellian language. It's the opposite of flexible.

To a baby, baby formula is a life saving drug. Many women can't produce enough breast milk for their child, or have to work, or can't breast feed at all, or myriad other reasons that they need to supplement or completely replace their supply with formula.

There is a reason formula is sold at pharmacies.

Formula is literally the only thing some babies can eat particularly less than 6 months old. You cant just give them cow milk, or chocolate or bread or whatever. Has to be formula if it cant be breast milk.

Not all parents breast feed their babies for myriad reasons - some by choice, some not by choice.

Formula is quite expensive in the UK - no idea how expensive it is in the states, but a 800g tin of powder might cost about £12/15USD. That makes about 4 litres of milk which might last a 100% formula-fed baby 2-7 days depending on how old/hungry they are. By comparison 4.54L (i.e. 8 imperial pints ... we still seem to sell milk in imperial sized bottles for unknown reasons) of cow milk is £2.18, so formula is roughly 5x or 6x as expensive.

Is £12 for 2-7 days worth of food for your kid expensive? For people on HN probably not, but I do know that the formula in the supermarkets often have security tags on them (along with razors etc) so I am guessing a lot of people cannot easily afford the formula/can't afford to feed their kid literally the only thing they can eat. Sad stuff really - this is why I would expect it to be on these sort of discount schemes.

This Costco brand formula is about the cheapest you'll find in the US [0]. It's 5kg for $82 (or about $13 for 800g).

So basically the cheapest we have is a little less than your average.

Our cow milk is sold by the gallon (3.72L) and is about $4, so about the same ratio.

[0] https://www.costco.com/kirkland-signature-procare-non-gmo-in...

> Formula is literally the only thing some babies can eat particularly less than 6 months old. You cant just give them cow milk, or chocolate or bread or whatever. Has to be formula if it cant be breast milk.

I think the ideal compromise for this situation is that if this describes your situation you get a doc to sign off on it and then your FSA/Insurance should cover it as medical expense. Like it wont and it makes little sense for it to be excluded in the first place but I think we could find a compromise that satisfies everyone.

I think the point was more that whomever makes the list of acceptable items for the HSA is clearly out of touch and missing important things, and there shouldn't be a person in that role anyway.

> if this describes your situation you get a doc to sign off on it

That's how it works for a lot of items. But still...why? Now you definitely need an FSA administrator to examine the letter of necessity - all this to save again, a measly few hundred bucks in taxes.

> if this describes your situation you get a doc to sign off on it

For those with feeding tubes, this is possible - insurance will often cover the special enteral formulas. But it seems (based on various Facebook group discussions) that the individual must be 100% tube fed to qualify.

> It's a benefit that has to be offered by your employer, and there are plenty of shitty employers out there.

This seems like a weird indictment of health savings accounts, because it has nothing to do with the type of benefit, and has everything to do with the coupling of healthcare to employment. If that's your issue, solve that — don't drag down everything else. Decoupling it from employment has the added benefit of essentially killing the FSA because, you're right, it's dumb that it belongs to the employer.

Health savings accounts are exactly how most people pay for their healthcare in Singapore, and it enjoys some of the best health outcomes with some of the lowest costs. I think that there's a lot of room to improve the experience in the US, but you don't have to throw the baby out with the bathwater.

I was talking about FSAs, not HSAs.

But HSAs are kind of weird too. Why pre-allocate money specifically for healthcare expenses to a separate account? Instead, why not bump up IRA contribution limits and allow penalty-free distributions for qualified medical expenses?

Why restrict HSAs to high-deductible health plans?

Why are we asking people to deal with investment stuff in order to pay for their healthcare? Isn't that the point of an insurance company? You pay them premiums, they invest the money and pay for all your healthcare needs - none of that co-pay, coinsurance, deductible shit.

The whole thing is a hack on top of a hack on top of a hack. One kludge after another.

> Instead, why not bump up IRA contribution limits and allow penalty-free distributions for qualified medical expenses?

Seems indistinguishable from a higher limit HSA, but I'm on board with that.

> Why restrict HSAs to high-deductible health plans?

Removing this restriction is a great idea! I agree.

> Why are we asking people to deal with investment stuff in order to pay for their healthcare?

Most HSA providers use robo-investment. Where active investment is an option, it's usually only used by the most savvy users. Half the value add of most off your HSA providers is this investment management, which 100% beats having it sit around in cash.

> Isn't that the point of an insurance company? You pay them premiums, they invest the money and pay for all your healthcare needs - none of that co-pay, coinsurance, deductible shit.

This is really debatable, because the concept of "insurance", traditionally, is tail risk mitigation. Having insurance pay for everything from flu shots to regular check-ups makes it something else entirely, that's no longer insurance, it's a glorified health payment plan with all of the price information removed.

Indiana has a very interesting program for their government employees, where they offer "deductible security", in which the state provides a health savings account into which it deposits an amount equal to the annual deductible every year. Another potential policy avenue to incorporate with HSA's.

> Having insurance pay for everything from flu shots to regular check-ups makes it something else entirely, that's no longer insurance,

I don't disagree with that sentiment. However, it's my understanding that traditional health insurance in the US pays for those things (often without co-pay) because preventative treatments are cheaper. If you add a co-pay for getting a flu shot, or even worse don't cover it, many more people might skip it and some of them will inevitably develop the flu. Treating those cases will likely end up costing way more than paying for flu shots for all the insureds.

I get that HSAs are an attempt to give patients more pricing information and agency, and encourage them to shop around for their healthcare. But (to me) it comes off as a self-managed insurance plan that you use to pay for your actual health insurance. It's insurance for insurance. Which is slightly bananas.

> However, it's my understanding that traditional health insurance in the US pays for those things (often without co-pay) because preventative treatments are cheaper. If you add a co-pay for getting a flu shot, or even worse don't cover it, many more people might skip it and some of them will inevitably develop the flu. Treating those cases will likely end up costing way more than paying for flu shots for all the insureds.

So full disclosure: I work in insurance and adjust claims myself.

This is certainly a reasonable cost-reduction strategy, but it isn't necessarily the most cost effective strategy, nor is it the only strategy. Indeed, Singapore has shown us that you can achieve more efficient per capita health spending WITHOUT covering flu shot co-pays, etc for everyone.

> But (to me) it comes off as a self-managed insurance plan that you use to pay for your actual health insurance. It's insurance for insurance. Which is slightly bananas.

I recommend listening to 3 or so minutes of this Reuters podcast (starting at 12:30)[1] that talks about Singapore's healthcare system, its journey trying different systems out, and some of its learnings. One key insight that they picked up on was that for the vast majority of people, the bulk of one's healthcare expenditure in life occurs at older ages once health starts to deteriorate. In that regard, it's almost like social security, where you save up over the course of your lifetime and build up this trust fund that you would eventually expect to use once you're older...which is largely what HSA's are: a savings account in a wealth fund that grows over time.

[1] https://soundcloud.com/reuters/the-exchange-too-small-to-fai...

Gotcha. Thanks for the thoughtful responses and the pointer to that podcast.

There are also HSA plans, which are not "use it or lose it", but require high deductible insurance plans. I consider the two options targeting two entirely different audiences. If you have high or very predictable medical costs, you only contribute to an FSA what you will use in a year. If you are young, with no pre existing conditions, and generally take care of your own health, you can save some money on premiums with the high deductible plan and HSA, you are unlikely to need to make any claims so the high deductible never comes into play, and you get to keep the HSA through retirement when you are sure to have more medical costs and you get to benefit from the triple tax advantage.

This is side stepping the issue. The solution is very simple and straight forward: you simply buy whatever is "FSA approved", and submit a claim. Can't be any more straight forward. Or as OP presented, you use the same card, but then it gets deducted from your paycheck minus tax.

We have to see who's benefitting from this elaborate gambling scam that steals money from people.

> Third, the use-it-or-lose-it nature of FSA money.

This has always surprised me, as it is nothing but literal gambling. Very strange how this is a "government approved" program.

You can get a discount on allergy medicine by showing your insurance card?

Is that true, that's a really good tip. How does that work I feel like they would just tell me this is an OTC drug and politely decline

Depends on the pharmacy. Some have negotiated prices for OTC. If you already use that pharmacy for your prescriptions they can give you the discount, and sometimes by contract they have to give you the discount.

Like all things insurance, it's very specific to you and takes more work to find the discount than it's worth. Usually it's just something that is surprising when it happens.

I've never gotten a discount on OTC with any of my insurance cards. However, my OTC allergy meds are available as a prescription, which the insurance happily covers. Thank goodness because I otherwise couldn't afford the $400/yr.

Generic OTC allergy meds are cheap when you don't buy boutique retail. I pay less than $11/year for daily generic Claritin (365 doses) at Costco. Allegra is a touch more.

CVS and corner stores generally inflate prices outrageously. For example, for 24 pills of Aceteminophen (Paracetamol), you'll pay $4.59 at CVS [1] vs $1.19 for 50 pills at Target [2]. It's even cheaper if you buy in bulk. CVS is just a ripoff and primarily caters to people who need something right now or at some odd hour.

Generally, generic drugs aren't too expensive in the US. But we pay more for many brand drugs.

[1] https://www.cvs.com/shop/cvs-health-extra-strength-pain-reli...

[2] https://www.target.com/p/acetaminophen-extra-strength-pain-r...

It could be argued CSV and the like are taking advantage of uninformed people or charging more for people who need medicine now, perhaps because they didn't build a good medicine cabinet. The same medicines can be bought on Amazon or at CostCo for 10x cheaper than the generics at CSV or Walgreen, but you need to know about that option and plan for it.

Some price comparison:

- 30 400mg guaifenesin tablets cost $10.50 ($0.35 each) at a Walgreens in San Francisco

- 200 400mg guaifenesin tablets cost $8.50 ($0.04 each) on Amazon (CostCo Kirkland brand)

Where were you seeing those prices?

I can walk into any drugstore here (US East Coast) and get a bottle of 500 ibuprofen for $20.

https://www.cvs.com/shop/cvs-health-ibuprofen-tablets-value-...

all of my local cvs drugs store mark that as "out of stock" according to the link you posted.

the closest that Walgreens offers, according to their website, actually in store (97201 if you want to look) appears too be around $50 for 500 200mg ibuprofen.

As a point of comparison, an equivalent product is available from Walmart for less than $8.

https://www.walmart.com/ip/Equate-Ibuprofen-Tablets-200-mg-P...

when I first lost insurance, I asked my local (rite aid) pharmacy about the generic price of what I was taking hoping to buy 90 days worth - they quoted me ~$10/pill (one per day).

I can order it from aliexpress for ~$0.24/pill, and from alibaba for ~0.002/pill (in powdered form). since it's a fairly common chemical that was patented in 1957, and is listed by wikipedia as costing between $0.01/pill and 0.04/pill wholesale, I really started to question the prices.

of course, now my insurance pays for it, and marks it at ~$1/pill in their "invoice".

still, somehow the math doesn't add up. no cvs near me to compare to, but Walgreens was similar prices. it really feels like a scam, but who can you really complain to? I'm in no way sympathetic of for-profit health insurance companies, but I have to hope that someone can push legislation to help curtail this.

of course, this is just one point of anecdata, but looking at similar costs of things like omeprazole over time seem to corroborate these findings.

You can usually get a discount using something like https://www.goodrx.com/

Pharmacies have certain "list prices" that they don't actually want to charge.

In my experience when I was uninsured, Costco's uninsured rates for prescription drugs beat everybody.

Compare prices between Boots in the UK and Walgreens in the US. They're the same company, Walgreens Boots Alliance. Many items come from the same sources. But the price difference is huge.

Personally I find boots in the UK to be an absolute scam anyway. Their prices on everything are almost always more expensive than supermarkets - not just by a few pennies but often in the 25+% range.

I think they survive solely on makeup sales, and small stores in airports and stations where there is a captive audience? No one can seriously shop there for everyday stuff.

In the UK (and most other countries), a 25% markup is outrageous. In the US, a 500% markup is pretty common. I don’t understand how this is not competed away. Yes, CVS offers convenience, but not more convenience than offered by a corner Tesco in the UK, which has very competitive prices.

CVS is probably one of the most expensive stores to buy OTC drugs in.

You can go to Costco and get it way cheaper. I think acetaminophen is less than $0.01 per tablet.

Where were you shopping, and were you looking at "Generics" or fancy name brands? You also pay a premium if you don't buy in bulk. Getting 10x more drugs sometimes only costs 50% more.

The prices you listed are definitely not normal— last time I bought Ibuprofen I think it was 2¢ per pill, although that was on sale. According to their website, the CVS by me is charging 5¢ per pill right now.

If it's prescribed, you can try to get insurance to pay for OTC meds. You can also pay for them with pre-tax dollars. Sometimes there's also prescription versions of OTC meds. I've been offered a prescription for 800mg ibuprofen but didn't bother.

Pricing is per-location, so the hotel thing could be part of it. Downtown locations will also be more expensive than suburbs etc.

Typically, at all locations, you'll pay a much higher per-unit price for smaller containers.

(I only know about non-prescription stuff.)

The US health system is geared towards ripping off patients as much as possible. The treatment is fine but the billing side is basically criminal.

Yes. Purportedly, prices are so high in the United States in order to compensate for the hybridization of the rest of the world.

My eyebrow is still stuck to the ceiling from the first time someone pitched that excuse to me with a straight face.

I’ve heard the argument that it’s because we’re subsidizing the costs for third world countries. Somehow.

Gah! s/hybridization/subsidization

Damn you autocorrect, I know what I want to say!

A lot of stuff in CVS are overpriced. I guess they are charging for "convenience". You are better off going to Walmart, Costco, Target to name a few. Even my local hospital pharmacy has OTC medicines at lower prices.

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