The Price You Pay At The Pharmacy Is Not An April Fool’s Joke

                                                                                  Adam King, CPhT, PRS
Pharmacy Savings Program Manager


You walk into the pharmacy, plunk down your insurance card thinking you just got the best possible price for you and your insurance on your generic medications, right?  Well not so fast!  If you want to really save money on your prescription, where you fill your prescription is just as important as which medication you take.

Let’s consider the cholesterol drug atorvastatin which is better known as Lipitor®.  These prices were actually paid by members of the same prescription drug plan for a 90-day supply.

If the first thing that strikes you is that the chain retail stores charged the highest price, then you are very observant.  When it comes to negotiating with insurance companies chain pharmacies with thousands of stores have the highest negotiating power with insurance companies.  They can often dictate what the insurance company reimburses them which explains the higher cost.

The second thing you will notice is that member 1 got the best deal which is free.  The advantage here is that the member did receive the medication at no cost to themselves and the employer.  The store in this case is using this medication as a “loss leader”, or a method to get you to the store hoping you will purchase other items.  While free is a great price, just remember the retailer is hoping you’ll reward their “generosity” by spending money with them elsewhere.  These pharmacies will also often have higher charges for other medications you might fill.

If you want to save money without strings attached independent pharmacies, regional grocery chains, and hospital outpatient clinics do not share the same negotiating power of the large chains.  Instead the insurance company can often dictate the maximum allowed price the pharmacy can charge the patient.  This is how they claim to save health plans money, and in truth they are half right.  If you use one of these pharmacies, ask them if it might be possible to get a lower cost on your medication by paying out of pocket rather than billing insurance for some of your medications.  You’d be surprised how many insurance companies charge abnormally high rates for low cost generics.  While most people think HIPAA is a privacy law, its regulations are also put in place that give you the right not to bill your insurance.

Member 6 got upset by the higher cost he was paying at a larger chain pharmacy and decided to do some price shopping and discovered that one of the big box warehouse club pharmacies had a discounted “cash” price of $20 for his medication.  Cash pricing refers to prices charged by providers without billing the prescription or service to the insurance company.  So rather than bill their insurance, member 6 paid out of pocket to save money.  While member 6 got a good deal on that medication, member 6 did not get the best deal.

There is one cautionary warning on member 6’s tactic.  Member 6 should now get all their medications at that pharmacy to avoid a potentially dangerous drug interaction as there is no central database that tracks every medication that is filled unless those medications are filled by a pharmacy and billed to an insurance plan.

Member 7 used a discount mail order pharmacy to fill their prescription again by doing some price shopping.  Online mail order pharmacies are convenient and often inexpensive just make sure you order your medication early to allow for the delivery time.  Be aware that if the pharmacy advertises drugs from Canada, that they may be sourcing those medications from third world countries that have very lax pharmaceutical regulations.  What you think may be your cholesterol medication may very well just be a sugar pill.

If you choose to have an online discount pharmacy fill your medication, make sure that you get a good deal on all your medications.  Also verify that the pharmacy is registered with your state board of pharmacy which oversees that the pharmacy is following state and federal regulations related to pharmacy practice and drug sourcing.  The website should also be registered with the Verified Pharmacy Program offered by the National Association of Boards of Pharmacy.  Again, this pharmacy will not bill your insurance, so you should make sure that the pharmacy is aware of all the medications you take and that there is a pharmacist available to answer questions about your medication.

Last, it pays to have a patient advocate that is aware of all the tactics companies use to maximize their profits at your expense.  Health Plan Advocate offers a certified and licensed pharmacy technician that will help you, your company, and your colleagues save money.  If your employer does not offer this benefit, ask your human resource department to contact us about this valuable service.

Well Leaders: Involving the Right People

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 Toni Sperlbaum, CWWPM, CHWC, Vice President of Sales & Marketing

When a company implements a wellness program, many program administrators are very used to hearing that the promotion and support for this program needs to come from the top down in order for it to be successful.  While this is true, it’s not the entire story.  Each culture and logistics of the company has a role in how this plays out, but who could be more important than your CEO, CFO, HR team, and other key executives?  Middle Management.

If your CEO sends a letter home to employees encouraging their participation, their message is in your newsletter and on a flyer in the break room, that’s great.  But how much time do your employees actually spend with the CEO?  What is their level of trust of your CEO (another topic out of my expertise!)?  While in a perfect corporate world, the answers here would be “a lot of time!” and “a lot of trust!”, it’s just not reality.  Employees are spending a majority of their time in their own departments with their direct supervisors.  If those middle managers are not buying in to the program, neither will their employees!

We encourage you to host separate meetings with your management team, even one-on-one perhaps, to get their buy in and almost most importantly, their commitment to participating themselves.  Setting the example is half of the message!  Consider running special challenges or programs just for them.  Highlighting in a newsletter “Healthy Leaders” and showing what they have accomplished, or the results of your WellLeader Challenge.  Communication is also huge.  In many companies, the main route of communicating all of the fantastic programs you have going simply aren’t reaching all employees.  Your middle managers are the key.

Monday Mourning

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Nahshon Cook-Nelson, PR & Marketing Intern
GUEST BLOG

My first job was working at a fresh food market in the 11th grade
Finally it was my chance to get my own wage

Even more than getting paid
I was thrilled for the friends and new relationships to be made

And on that first day I…

Found out it was a masquerade
Most weren’t filled with praise but self-pity

Constantly complaining
Dramatically draining

Persistently persuading themselves and each other
That their place of work was an utter, sentence to chains

Specifically on that first day of the week
There was a sense of mourning
More people grew meek
Seeking to pull themselves from the present

As I look around today
Lots of things seem the same way

Now this may sound dumb
But I think most have grown numb
To the feeling they first had walking in the door
The urge to try new things and explore

Whether it was 9 to 5 or 8 to 4
We were passionate about the struggle and the growth
But now, we’ve grown sore

We are not required to live this way any. more.

If our work has truly brought us to the stage of worry then let it be discontinued
And our refugee begin

Otherwise, the only reason we complain is if we know of something better within
Where every Monday we can pull in to work with a grin

We may approach those whose internal lights have grown dim
But we will spread the notion of TGIM

Where many have felt the need to plead until their last working minute has struck
We will feed the seeds to give our best until our time is up

We can defeat this feeling that is so alluring
Give gratitude instead of complaints. So our joy is ever enduring

When agony rises and moments seem boring
Let us fight back so it is NEVER “just another Monday Mourning”

Find Your “Why”

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Jess Welch, Wellness Coordinator

Lose 10 pounds in 10 days! Twelve workouts to a flat stomach! Lose unwanted cellulite in just 30 minutes!

Tag lines like these pollute our media and are riddled throughout our everyday lives. Misinformation and misleading titles lead individuals to think sustainable weight loss is as easy as a snap of a finger. This leaves people feeling disheartened and unmotivated with continually fluctuating weights.  Not to mention, we live in a society which thrives on instant gratification; thus making the humbling reality of weight loss a tough pill to swallow.

One thing I have continuously learned is this: weight loss is hard. We wouldn’t have an obesity epidemic on our hands if it was easy as pie to avoid… well… pie! Oh, and bacon, ice cream, cheeseburgers, chips, and other sinful tantalizing treats. The old adage of “consistency is key” couldn’t be truer. But those three words are far easier said than done. Too often, I talk to people who have lost a whopping 55lbs in 4 months sometime in their past, gained it all back, lost 20lbs then gained that back too, plus some. The list of weight-loss attempts is never short and too often, I hear defeated voices whisper “I should do better, be better, and have better self-control.” Too many of my clients are consistently reliving their weight loss failures.

The other thing I know about weight loss is this: sustainable weight loss is slow. It is healthiest to lose 1-2 pounds per week. Like I said, sloooow. And when you’re staring at a scale that has a decline as slow as molasses in January, you lose hope.

So why try? Weight loss is difficult and time consuming. Why care? That’s an important question to answer and its one I cannot answer for you. For some people it’s as simple as wanting a pair of jeans to fit or to go to the doctor and finally not receive the advice of “you should really lose weight”. Maybe it’s more clinical, like getting off medications for high blood pressure or getting out of the pre-diabetic range. It could be psychologically deeper, like having a past of bullying or a severe deprivation in self-confidence. Your perception is your reality and once you find a reason captivating enough to make the hard work and patience worth it, weight loss will come easier, I promise!

If you can’t think of your “why”, answer this: What do you gain with weight loss? It could be that size of jeans you always wanted to be in or that number on the scale. You could gain the confidence you never had to rock that bikini you never thought you could. Maybe it’s just the accomplishment itself, the follow through to actually accomplish a goal once thought of as unattainable. Whatever it may be, I urge you to find your “why”. My message is to utilize this as step one in your final weight loss journey to a happier, healthier, you!

Superman, The Hulk, The Flash, Mr. Fantastic & He-Man walk into a Gym……

   Ryan Hall  MS, CSCS, Wellness Coordinator

Superman, The Hulk, The Flash, Mr. Fantastic & He-Man walk into a gym…stop me if you have heard this one!  You’re probably wondering where I’m going with this.  Sit tight as I drop a little superhero analogy on you.  First off, a little comic book background on our subjects:

Superman (Muscular Endurance):  As the saying goes – “Faster than a speeding bullet. More powerful than a locomotive. Able to leap tall buildings in a single bound…nanana…it’s Superman!” With this intro behind us, Superman represents all that is seen as muscular endurance; speed, strength and power.

Hulk (Muscular Strength): The green giant with the strength to destroy buildings, throw a tank and pretty much put any power lifter to shame. I don’t know of a better epitome of muscular strength in the comic world.

Flash (Cardiovascular Endurance): Does this one really need any explanation? With the ability to move, think and react at light speeds as well as having superhuman endurance that allows him the ability to run incredible distances, there is no one better to represent cardiovascular endurance.

Mr. Fantastic (Flexibility): Some of you may be wondering who this one is, think Fantastic 4. Mr. Fantastic has the ability to stretch his body like a giant rubber band, i.e. he’s very flexible.

He-man (Body Composition):  Think Arnold Schwarzenegger in a loin cloth at his peak.  Yeah, that’s He-Man.  Not to mention the superhuman strength and speed.

Okay, introductions out of the way I’ll get to the point. My question to you is: who do you want to be? In other words, what is your goal? Too many people start off an exercise routine not knowing what they really want. They want to lose weight, get stronger, bulk up their muscle mass and be able to run a half marathon.  That all sounds fine and dandy, but you have too many contradicting factors.  You can’t bulk up and lean out at the same time.  It’s incredibly hard to build serious muscle mass and train for cardiovascular endurance.  And not to mention become a yoga master and dead lift 600 pounds.  The way you train needs to match what your goals are.

If you are looking to gain muscle mass and you are starting off as a scrawny 6 ft – 175 lbs, you will probably need to go through a bulking process where you are consuming extremely high amounts of calories and limiting your cardiovascular exercise in order to gain not only muscle, but some excess fat in order to push heavy enough weight to make the muscles grow.  You say you want to get faster and run a marathon?  You should probably skip max dead lift day.  Training the muscles to be able to work hard for long periods of time is your strategy.  Think lots and lots of lunges and core work.  You want that rock hard six-pack?  Nutrition should be your first thought, but moderately heavy weight coupled with moderate intensity cardiovascular exercise is your route.  And it is really hard to pull off a Handstand Scorpion Pose (yoga – look it up) if your traps, shoulders and biceps are so large that you can’t scratch the back of your own neck.

My advice here is to have a goal in mind before you step foot in the gym. Think long and hard, do you want to lose that spare tire?  Look good in a bikini?  Sculpt that chest and back?  Bench press 450 & Squat 600?  Are you thinking you’d like to try your hand at a marathon or triathlon?  Or do you just want to be Batman?  That’s my goal, just be Batman!

Batman (All Around Bad***): But wait, wouldn’t Superman embody this description? The answer is yes, except for the fact that he is not human and Batman is just like the rest of us. No special powers, no magical abilities, just grit, determination and looks good in a spandex suit.

The Definition of Healthy

Nicole Griswold, CHWC, Wellness Coordinator

What is your definition of ‘healthy?’ Give someone a topic that is considered healthy and I guarantee they will come up with a statement (even if it’s factual or not!) as to why it isn’t good for you.  Over the weekend, I had an epiphany; as a society, we will do whatever it takes to come up with a reason why something is unhealthy. Anything! With so many studies, opinions, and fads out there these days, we are able to find someone or something that will give a reason as to why something is unhealthy.

I’ll give a few examples. These are actual examples that I have heard through health coaching in corporate wellness, personal conversations, and social media.

  1. Avid runners have such horrible knee and joint issues. It just wrecks their body!
  2. Apples are bad for you because they contain sugar.
  3. Vitamins are a waste. They’re not as natural and effective as food sources.
  4. The fresh produce at the grocery store was picked past it’s prime ripeness, so it’s really lacking nutrients.
  5. That chicken isn’t good for you because it’s been processed.
  6. Going for a walk doesn’t burn that many calories, so it’ just a waste of time.
  7.  I had to take some broccoli off my plate so I wouldn’t go over my carb count.

What do you think? Do you agree with the above statements? I believe this trend has a lot to do with our underlying psychological instinct to achieve perfect health on top of our constant ability to produce excuses and reasoning as to why most of us are not healthy. Kind of like a “I do these healthy things but they don’t work because of *excuse* so you can’t blame me” type statement.

My two cents – Don’t overthink what you know is good for you. Don’t believe everything you hear. Educate yourself. Focus on the positives. Don’t compare your state of health to others. Create your own definition of healthy!

Top 5 List: Community Service and Wellness


Toni Sperlbaum, CWWPM, CHWC, Wellness Account Manager

January 18th was “King Day of Service”.  This got me thinking about the great opportunities organizations have to incorporate service into their wellness programs.  I believe there really is something to volunteering and the benefits that directly correlate to an employee and a health plan.

You’ll see a variety of programs that are considered “wellness”.  Flu shots, biggest loser challenges, biometric screenings, yoga classes, and countless additional programs can fall under this umbrella.  At HPA, we believe that a good program incorporates 3 major prongs; Nutrition, Exercise, and Mental Health.

According to Harvard Medical School, studies have shown that volunteering not only wards off feelings of loneliness and depression, but can also reach beyond mental health, affecting physical health as well.  This includes lowering blood pressure and having a longer life span.

The benefits are there, but how can companies be using community service as a tentacle of their wellness efforts?  Here are our top 5 options we have put together based on what we are seeing in the industry:

  1. Designate 2 non-profits or movements a year to focus on.  Focus less on making 1 huge donation as a company and focus more on how you can involve your employees to either fundraise or be directly involved with the mission in a hands-on manor.  Allowing paid time offsite or department trips to volunteer is an important piece to show your buy in to your efforts.  Visiting your local soup kitchen or children’s museum are great options and make great team building activities.
  2. Have a points program?  Make community service hours a part of it!
  3. Join a local effort such as Relay for Life or the American Heart Walk.  Employees can fundraise AND be physically active.  Events like this also help build a culture of giving-back and wellness.
  4. Partner with some local charities to allow your employees a mentorship opportunity, or host a kickball game or something similar with underprivileged kids in the community. One example: Big Brothers, Big Sisters has a corporate mentorship program.
  5. On a much lesser scale, some organizations will incorporate a donation method into their challenges.  For example, within a Hold it for the Holidays weight maintenance challenge, the winning employees will earn money for themselves and a company match of the winnings to the employee’s charity of choice.

Community service not only provides the aforementioned benefits to mental and physical health of your employees, it molds the culture of your workplace and improves the image of your company’s presence in its community.

Be well and VOLUNTEER!