Tuesday, December 31, 2013

Price-Gouging Pharmacies, Inflexible Insurance, and Healthcare 2014

Normally at this time of the year, people write their end of the year reviews or predictions for the year ahead.  I find most of those features slightly more entertaining than guessing how many times Ryan Seacrest has his makeup touched up during his Times Square broadcast on New Year's Eve.  So rather than write about what I saw in the last year or what I see ahead, I want to share a true story about healthcare, especially with the Affordable Care Act affecting so many people.  There is a lesson here, or at least I hope there is.

Metformin, prescribed 48 million
times a year
I'm a fat guy, and fat guys sometimes get high blood sugar or diabetes.  My doctor recently put me on a medication to try and keep my sugar down, along with diet and exercise.  I don't mind telling you what the stuff is, it's called Metformin and it's been around forever as a first step in treating cases like mine.  No big deal, let's try this stuff for a few months and see if it helps.

I took the prescription to my neighborhood Walgreen's store, got it filled and paid $8.01 for a month's supply using my health insurance. When I tried to get it filled for the third month of the experiment, my insurance company, Express Scripts, refused to pay for the medicine, saying after two fills I HAD to get the drug filled in a 90 day supply via mail order through them.  No exceptions, even though you only need 30 days to see if the stuff works, you need to get a 90 day supply and wait for us to mail it to you.

Full disclosure: I've had so many problems with Express Scripts "customer care", website, and mobile app that I've offered to come to work for them or consult to help them improve what is arguably some of the worst "customer care" other than major airlines. Funny, I've never heard back from them.

Walgreen's already had the refill being processed, so I checked with them to see how much it would cost without insurance paying part of the freight. After all, the insurance price for the generic was just over eight bucks,, the pill has been around forever, and it's a generic.  How much worse could it be?  How about $24.99? You're seeing it right, no insurance and I have to pay more than THREE TIMES the cost of the drug, which I guessing wholesales for about $3.50.  Now I know every pharmacy makes most of their money at the "back of the store" on prescriptions, but $25 for something that cost $8 with insurance?  I might have to call that price gouging. Wait, I already called it that.

So I took to the interwebz and did some comparison shopping.  Turns out
Metformin is an inexpensive drug, so inexpensive that big box stores and other places that offer $4.00 30 day prescriptions have it on their list.  So do many grocery stores with pharmacies, and I like to give my business to local companies
when I can, so I had the prescription transferred to Dierbergs, a family-owned St. Louis grocery chain. They're just a few blocks away from Walgreen's, even have a drive though pharmacy, and sell the same exact pill, right down to the manufacturer, for HALF of what I was paying for it using my health insurance and less than ONE SIXTH of what I would have to pay at retail.

Here's the lesson, one that will get more and more important as Big Pharma, doctors, pharmacies, and other healthcare providers try to figure our how to make more money in the new world of Obamacare.  These people are not your friends.  They don't stay up nights figuring out ways to save you money on the services and medicines you need.  They have no guilt about charging you $25 for a drug you can get down the street for $4.  Forget the commercials with the caring, fatherly doctor or pharmacist making people happy. Those people are actors, and they're doing a mighty fine job of playing the part of someone who gives a damn about you.

Healthcare, and especially the pharmaceutical industry is BIG business. Don't just take what your insurance company or pharmacy says as gospel. Take a little time to make sure you're not being taken advantage of and overpaying for the things you need, whether it's Metformin or (G-d forbid) a mastectomy.  Get a second opinion, check to see if you can get the same medicine or service for less, and sometimes that means not using your insurance at all and taking advantage of a better deal. You'll be healthier, happier, and have more money in your pocket.
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