Pills and Health Insurance

Have you ever gone to the pharmacy to pick up a name brand prescription, and as you get your card out to pay, the cashier asks for your first born in order to pay for only one months worth of pills? I hate to say it, but most of us have been in this familiar story, especially the veterans of prescription medication. Health insurance companies love these veterans! In fact, it’s these people that keep both the health insurance and pharmaceutical companies in business. It’s what I call “an open door at the edge of the mountain.” They will come to your aid for a price, and usually a hefty one at that. I would like to think of each company as an important aid in human health, but unfortunately these companies are businesses that prey on the uneducated and senior persons of this world.

Help is definitely on the way, but what’s the price you’ll pay? I really wish that pharmacies were required by law to post the prices of all of their drugs. Normally when I go to the super market and buy food, I get to see the price of the item and know exactly what I am going to pay at the register. Shouldn’t this be the same with drugs? I believe that insurance companies should be required to do the same. All drugs, either generic or brand name, should have a price. We, as Buyers of the insurance, should be entitled to view this pricing sheet. Like at the market, the price of the cereal is right there for you to see before purchasing. Not all pharmacies charge the same price for drugs, so having an actual itemized spreadsheet is a completely rational solution.

The other day I was prescribed a new medication for anxiety. The prescription was a brand name drug and I had been forewarned by my doctor that I might be seeing some heavy dollar signs, as there was no generic form at the time. Not only was he completely correct, but it was worse that I could’ve imagined. My pharmacist told me that the medication would cost me over $400! I was flabbergasted. Who in their right mind would ever pay $400 for 30 pills. This wasn’t a wonder drug; it’s another dime a dozen — it’s an anti-depressant.

The pharmacist was just as shocked as I was and started to help me find ways to afford such a steep cost. First she went to the drug’s website. A manufacturer’s coupon was available and stated that under certain restrictions, up to $100 would be discounted. That was still too much. I’d decided that if I could get it for $50, which was very unlikely at this point, then I’d just eat it. As the pharmacist was researching, she stopped to look at me. “Your insurance doesn’t even cover the drug. You will have to pay out of pocket. Your doctor needs to see if he can get this approved.” Now let me tell you something; Nothing got my blood boiling more than this huge A-Bomb. My family pays over $1000 a month, so if I am hearing this right, I need to pay my premium plus a ridiculous cost just so I can be healthy? Something is very wrong here. This is where the door is open to help me, but if I go through, I will still end up falling. Sign me up, said no sane person ever!

I left the pharmacy crying because I was so frustrated. Here I am, anxious as can be, worried that I may get sick with withdrawal. I spoke to my doctor and he told me that he would do everything he could to get the approval. This medication was in no way my life’s savior. It just happened to be a great drug that worked much better than the previous ones I had tried. I didn’t want to start over again, weening off one drug, just to go on another — and not for any other reason than cost. It had nothing to do with my health, nothing to do with my tolerance of the drug, nothing to do with anything — but the cost.

Since this whole problem started on a Friday, I was unable to get anything resolved until the new week started. I drove to my doctors office to get samples and start the weening process. Low and behold, I got some good news. The insurance company had a approved the drug since I had gone through so many trials with unsuccessful drugs. Still, what was the new cost?

I sped over to the pharmacy and found that they had received the approval, so now for the price. What is the actual price for this drug? “Well, we got the price down to $80 now. Would you like to pay that?” Absolutely not! I remembered the coupon that she spoke about at my last visit and asked her if it could now applied, thinking that maybe, just maybe, I could get the cost down to something more affordable every month. To my surprise, when asked to pay for the medication, the pharmacist only asked me for $10. I was confused. How can a drug go from $400 down to $10?

Without even explaining, we can all see how messed up this is. As the consumer, we are placed in a situation, only the witty can escape. There is always a way to make things work. It might not be your ideal way, but there are outs in each situation. I believed that I could get a better price and I did.

So, here is my question? How the hell do they get away with this? It’s quite simple. We pay the money — over and over again. It’s not about health care and it’s definitely not about you — It’s about the money collected for health care. Insurance seems “great” when all is well, but when things take a turn, so does the “great” insurance. Don’t forget only you can save you. Speak up — it’s for your survival. If you feel that your only choice is to walk through the door to fall off the mountain, think again. That same $400 bottle is also worth a whopping $10. Go figure!?!?