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Thursday, 16 January 2014

Crabby Old Lady Versus Big Pharma

In a couple of weeks, Crabby Old Lady will undergo her first cataract surgery so on Tuesday she delivered herself to the physician's office for measurement of her eye and to go over admitting procedures.

Among those were an explanation of how to use the prescription eye drops she is required to begin three days before the surgery and continue for several weeks following.

Before continuing, some background is necessary.

Because Crabby does not use any prescription drugs and because there is no way on earth anyone can predict what drugs might become necessary in the future, each year when the enrollment period for Medicare Part D (prescription drug coverage) rolls around, Crabby buys the least expensive plan.

There is no other sane way to approach the dilemma.

So, in the surgeon's office on Tuesday, the technician asked Crabby what pharmacy she uses so the prescription could be phoned in.

For lack of using drugs, Crabby doesn't have a pharmacy and she told the technician that she wasn't certain but suspected that if she uses a non-network pharmacy, the drops will cost a fortune.

The technician related the horror story of a recent patient who was charged nearly $500 for what others pay less than $100 and she suggested that Crabby check prices at the network pharmacy and elsewhere, then phone her with a selected pharmacy.

Crabby, who wanted nothing more than to go home to bed and continue nursing her flu, drove four or five miles out of her way to the network pharmacy.

The technician had given Crabby a printout of the drugs' names – generic and brand - so Crabby offered this piece of paper to the network pharmacist along with her Part D membership card and asked the price.

“This is not a prescription,” said the pharmacist.

“Yes, I know,” said Crabby. “It is just a listing of the drugs so I can check your price. The physician's office will telephone you with the prescription when I have chosen a pharmacy.”

“I can't tell you the price,” said the pharmacist, “without entering a valid prescription into the system.”

“Why?”

“I can only tell you the price when I get the prescription order for the drugs,” said the pharmacist.

Crabby, who had risen from her sick bed to see the doctor, was tired and very cranky. “You want me to buy something before I know the price?”

She told Crabby to phone the big pharma Part D company for the price but she, the pharmacist, could not tell Crabby the price.

It's like living in Wonderland where everything is upside down. As usual, Crabby had left home without her cell phone so 30 or 40 minutes later back at her desk Crabby worked her way through the big pharma insurance company's menu of choices and finally spoke to a customer service representative.

You already know, of course, this did not end well.

After handing over her membership number and spelling the names of the drugs, Crabby asked, “What is the price of these drugs, the brand name and the generic, in a network pharmacy?”

The woman gave Crabby the two prices – about $144 and $65 - and then said, “But those are only estimates.”

“Huh?”

“They are estimates. The prices could be higher or lower.”

“What?” said Crabby. “This is a drug, not a car repair.”

Silence.

“How much higher or lower?”

“I don't know,” said the woman.

“A lot either way?”

“I don't know,” she said.

“Who would know?”

“I don't know.”

“Are you telling me that I can know only an estimated price before committing to a purchase?”

“Yes.”

Crabby was already weary, and now livid as well which was certainly evident in her tone of voice. “Would you buy a gallon of milk if the tag in the grocery refrigerator gave you only an estimated price?”

Long silence.

“Well, would you?” asked Crabby again.

Click. Disconnect.

Crabby checked with the nearby, non-network pharmacy where she purchases her (apparently useless) flu shot each year. She got a slightly more sophisticated runaround than at the big insurance phone service and the network pharmacy.

The pharmacist said he couldn't give her a price without a valid prescription and he would need to know if she had fulfilled her deductible.

Crabby explained that the deductible wasn't an issue, that she is capable of adding and subtracting. She just wants the price of the two versions of the drug.

The pharmacist refused.

A friend with whom Crabby later spoke believes that the big insurance companies, in collusion with big pharma, do this now to prevent comparison shopping.

By refusing to name a price, he continued, it makes it easy for them to increase the price of the drug when – oh, you know, the CEO wants a million-dollar salary rise or a new corporate jet.

Let Crabby put it this way: she does not disbelieve that explanation.

Here is how it ought to work. Pharmacies provide prescriptions to all comers with any kind of health coverage. They are plugged into all the insurance companies' networks for their individual formularies, dosages and prices. So:

Plug in the name of the drug
Plug in the dosage
Plug in the membership number
Voila! See the price

But our corporate masters now have complete control of us and we have no recourse. Crabby thinks this used to be called slavery.


At The Elder Storytelling Place today, Joyce Benedict: Life Without TV: Overcoming an Addiction to Mediocrity


Posted by Ronni Bennett at 05:30 AM | Permalink | Email this post

Comments

there are a couple of web pages online that offer comps for drugs citing the different drugstore/supermarket pharmacies.

I had the exact same experience a few months ago when I was trying to figure out whether it it would be cheaper to utilize my insurance's mail-order plan, or just keep buying my prescriptions at Wal-mart. I literally could not get an answer.

It blew my mind.

Yes, it is hideous traveling through the prescription drug maze. I hate Big Pharma. That is a huge range of pricing!

The best advice I received came from my endocrinologist. Go to Costco online and lookup drug prices. They are often cheapest. And you may not have to buy there. I have used Kroger grocery store pharmacies in two states and they have matched Costco's prices. You can print it out and take it with you.

Second, my insurer's formulary is available online and will tell me what tier the drug is in so I know my copay.

The last piece of advice was to ask the cash price. It often is cheaper!

I take a couple of maintenance prescriptions, and one is not generic. By the insurance tables, my copay would be $135 for a three month supply. By paying cash, I pay $26 a month or $78 for three months. They will even fill a 90 day script in one-third increments or a month's worth at a time.

My pharmacists have been pretty helpful, and it's so convenient to use the pharmacy where I also buy some groceries.

I never ever use the mail order option. It is more expensive at the higher tiers.

I'll be interested in hearing how it turns out for you!

This is really too sad--- How can we as older people cope with the confusion out there?

A lot of times one does not know one has chosen wrong until later -- and it usually costs money to get you out of the choice you made --if you can even remedy it --

I fear for our future--

Amen to your final paragraph. My blood pressure is rising at this--it's like a maze with no end and so very frustrating just to try and get an answer.

All I can say is that I have had the same "beyond frustrating" experience and have no idea how to remedy it. Maybe some online exploration could help as one of your readers suggests. It's the best idea I have heard. These kinds of things serve to take our independence away because they are unnecessarily complicated to the point where we need more help than we should. Frustrating and frightening...

When I became diabetic and needed test strips (expensive) I thought I could select the glucose meter by choosing the one with the cheapest test strips. Ha! Found out by trial and error and asking others in a diabetic support group. Most had no idea the real cost.

Wow. I went to Walgreen to ask for a price and thought he was just going to run the prescription as a test but ended up buying it there. Until today I thought this was a miscommunication on my part. *insert lots of four letter words here*

I have found that COSTCO has the cheapest generic drug prices. They have an online price checker and accept most insurance plans. You do not have to be a member to use their pharmacy. If you do not have a Costco near you, Sams has reasonable prices also; same rule applies. Just go to costco.com and type in pharmacy in the search box.
This is all just a big game that Big Pharma likes to play with people's lives and our Congress just looks the other way while stuffing their coffers.

My recourse is no doctors, no
drugs....vegan diet...
Three years so far with no
illness...

One-a-day vitamin, Omega 3,
81mg aspirin daily...

So far all is well at 82+...
NEVER eat out... (do not know
what is in the food).

Comparison shopping for drug plans is a nightmare. There's the monthly price, the formulary, the copay, and the deductible. I have found it utterly impossible to come up with comparable figures. Plus the prices change willy nilly.

I'm vastly over medicated, and I buy my meds through the Medicare Advantage plan online pharmacy. Most are six bucks each for three months, and they arrive all at once. As I lose weight, the meds will fade away one hopes.

Please write your federal repressentatives. This is common and outrageous and they are the only ones that do something about it. In addition, have you noticed how drug prices have skyrocketed since the inception of Pt.D? No regulation means free reign for Big Pharma.

This drug pricing thing drives me crazy too. Recently I got a prescription for some ointment, that my drugstore tried to bill me $777.54. Later when my insurance was approved, it was $35. But because my doctor had given me a coupon, I got it this time $10. The stuff looked like Vaseline. Even with the coupon I doubt they were losing money. Does anyone pay $777.54 for a tube of ointment?

Correcting this kind of thing is exactly what Republicans want to do for health care reform --- bring more transparency as well as more competition into health care, including pharmaceutical pricing like this. The problem is that they've focused so much energy on overturning Obamacare (which will probably fall on its own anyway without their help) when they should be talking about the ideas they have for real reform. This situation is ridiculous as we can all agree. There are ideas out there to fix it.

Outrageous and totally unnecessary. I hate Big Pharma and Medical Insurance Companies with a passion. It's time to start fighting for Single Payer Medical Insurance again. Even though Medicare is supposed to be better than private insurance the insurance companies and big pharma still have a stranglehold on ripping off elders.

I am fighting to keep the profit out of medicine. I wish it would happen in our lifetimes, but it certainly won't happen in mine and probably not in most of yours. I am fighting for my children and grandchildren.

Well the reason for this complex, complicated mess -- including private insurance, big pharm, etc is to siphon off as much money as they can for whatever. Probably the CEO's raise.

And think of the elderly out there who have trouble with navigating this mess; it does seem ridiculous and almost criminal. Yet, it's the system here in the USA.

I've had similar problems, but the worst is always trying to get a "price" for any kind of medical treatment. My opinion is that ALL clinics, doctors, pharmacies should have a big bulletin board with prices for everything -- kinda like when you go to a fast food place. Never will happen, because then the people would have power to stop the siphoning by the suppliers.

Why do I feel like this is merely the tip of the iceberg? A couple of days ago I was picking up a walker with a prescription. Since my income is sol low, I also have the Oregon Health Plan as my Medicaid plan to pick up the balance left after Medicare. Not only must you buy from certain contracted stores but you are also limited to only the cheapest of walkers. However, the cheap walkers were too small for me and so I said I would buy a bit more expensive walker and pay the difference myself. Well, you are not allowed to do this under the ACA. I then asked how much a decent walker would cost if I did not use my Medicare. They said they were not allowed to sell me one for cash. Also a new ACA rule. The only way I could pay cash for a walker would be to go to a different store and not tell them I have Medicare because the Oregon Health Plan shows up whenever I use my Medicare. Of course I cannot afford to pay cash. It is the principle of the thing dictating where and what I must buy.

I take only two, very inexpensive RX drugs which my Medicaid pays for. Your story scares the hell out of me.
Can you imagine your local, independent pharmacy down the block not willing to tell you the price of a drug.

Yes, tip of the iceberg is right--and our democracy is slowly or not so slowly being eroded. There seems to be no end in sight.

I guess I should spend 75% of my time writing to Congress-
persons, but sadly, many of them take huge contributions from Big Pharma (among others.)

Q: What is to be done?

Made me so angry! Do we have to be revolutionaries to get equity from drug companies & their handmaidens in the marketplace? Think so, also that it will not happen unless younger people rise up
ThinkProgress.org today has on cost of giving birth varying by "tens of thousands" of dollars--and "comparison shopping is virtually impossible."

Because Medicare Part D pays nothing until you've met the deductible (unless you have an Advantage plan) which I believe is $325 this year, I too buy the cheapest plan. Fortunately the two drugs I need are generic and very inexpensive - at Costco. Fred Meyer/Kroger will quote you a price and they wanted $86.00 for the same generic drug I get at Costco for $14.00. Each part of Medicare -A, B, C, and D has its own set of rules depending on whether you have Part C (Advantage Plans) or a Supplemental/Medigap plan which supposedly picks up the remainder of a doctor's bill, so they don't have to accept the small payment Medicare alone will pay. I'm finding that isn't always true. It's very, very complicated and oftimes the only way you become educated is by experiencing what Ronni is putting up with right now. It's nuts.

Hospitals have the same problem getting prices for "parts" like replacement knees.

I have blogged (ranted) about Big Pharma until I'm blue in the face. Futile, of course. Washington has been bought off by Big Pharma and the health insurance companies. I doubt we'll ever see significant regulation of those industries.

As noted elsewhere, there are online websites where you can compare drug prices from various pharmacies in your area. Prices vary in different parts of the country, but the site I'm thinking of narrows your search by ZIP code.

Wishing you a quick recovery from the flu.

Big Brother is pimping drugs to control the masses of New Age Elders.

When I had my cataract surgery, I was able to get from the surgeon's office,
at least one sample of one of the more expensive drugs...you could at least ask.

Every time I post anything about health care here in the UK I get people from the US telling me I've got it wrong, I don't know what I'm talking about or even that I'm lying. Strangely they never mention horror stories like this...

There are many devious ways to make us pay more than we should for things. I am reminded of how banks are finding ways to charge for things they never have before, in order to get more revenue since so many of us are using debits, not checks. Bah humbug.

This kind of thing makes you want to do crazy things to the pharmaceutical companies I'll bet. It's ridiculous. Makes me glad of our health system in Australia. Good luck with it.

More data is available from Charles Ornstein at Propublica.org

I truly believe that big drug companies are in cahoots with pharmacies like CVS, Walgreens, RiteAid. I am sticking with my independent neighborhood drug store for as long as possible. The pharmacist is very independent and tells me like it really is.

I just had my second cataract surgery and both times paid $134.00 for both prescriptions of drops...one antibiotic and the other steroid drops. Sam's pharmacy has said the same in the past about pricing...they will put a prescription through and if it's too high, I can refuse it. My doctor had given me the prescription so that I could find out the cost. Yep, ridiculous. All of it.

First...Ronni, you will love your new eyes. Colors will be so much more brighter and pretty. Reading and computer will be much easier. Oh, don't be alarmed...you will be able to see the dirt around your house more clearily.

Second... I had my eyes done couple of years ago. So glad I did.

Third...really, really thankful I live in area with excellent health care.

This is exactly what we've been dealing with. I don't know if there's even a way to fight it. It's so incredibly frustrating!

OMG, the US health care system is sicker than I thought in my wildest dreams. Yes, I'm Canadian. I feel for you: how can anyone make a considered decision under such circumstances?

If you do a personal search on the Medicare website, it will bring up your drug plan and you can put in the drug you need and you should get a fairly accurate cost for that drug as well as what it would cost you if you've already reached your deductible. You can put in the pharmacies you are considering as well. The information on the website is not guaranteed, of course, but is usually reasonably correct, because the planfinder calculates how long a person would take to get through the deductible. That planfinder is up all year around, so you can check it out. If the information you get doesn't mesh with what the store tells you, that's a good reason to complain to the plan and to the store and even to Medicare.

For years, long before the ACA, so don't please blame everything you don't like on that law, pharmacists have refused to provide prices for insurance because it costs them. On the other hand, some pharmacies will charge the lowest price they can. And some drug plans will assess the copay or the actual price, whichever is lower. I think it's all some big game - but not a fair one to the consumer.

Tried to comment yesterday but it didn't work so will try again. Go to Goodrx.com to price prescriptions. Costco seems to have best prices but not always so it is worth it to check. Got the link off a PBS program on drug costs and comparisons, I believe.

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