Yet another article about U.S. healthcare and pharmaceuticals

I changed my insurance recently. After I retired from my job in tech, I was on COBRA. After 18 months I had to change to one of the insurance policies on my state’s exchange. There were a lot of policies to choose from, but the website made some plan recommendations and I picked one of those. It was cheap, and I knew it wasn’t going to cover some of my prescription costs as well as my old policy, but I also knew that with drug company coupons I could reduce the cost of the most expensive ones.

Oh, Canada!

It’s turned out pretty well: my generics are cheaper and the non-generics more expensive (I take a lot of meds, true, but I’m in pretty good health; in other words: I get by with a little help from my friends). However one of my brand meds was going to cost me nearly $600/mo (with coupon). I couldn’t pay that without feeling a twinge of pain every month, but what really motivated me to find an alternative was when I found out how much this drug cost through Canadian mail-order: $176 for a 90-day supply. That’s a tenth of the cost!

So I called my doctor and asked if there were alternatives. There are several, fortunately, but none were generic. Still, the one she suggested I try was a bit less than $400/month. Better, but still made me wince, but there was a discount coupon I got online.

No reply

I went to my local pharmacy. They didn’t have the drug in stock, but they took my printed coupon to enter into the system. I went home I waited a few days. When the prescription arrived, they still were going to charge me almost $400 for a 30-day supply. “That’s with my coupon?” I asked. Oh, well, maybe not it turned out. They did have it in their system. I then waited over 20 minutes as they tried to apply the coupon to the prescription cost, without success. I left without the med.

My new insurance company will do mail-order prescriptions, 90-day supply. I had looked over their prices for this drug and remembered them to be cheaper, but didn’t recall how much exactly. I talked to the service rep at the mail-order pharmacy and they said they would call my local pharmacy and get the prescription. I gave them my coupon information so it would be applied when the prescription was filled.

A few days later, still no word, so I called again. Turns out they never got a response from the local pharmacy. The service rep offered to contact my doctor to get a prescription from them directly, so I gave him the info. A couple days later, still no word. Contacted them again, and they said the doctor’s office never responded. So I got hold of the doctor’s office. The next day their pharmacist said he will shoot over a prescription. Great, progress.

A few days later, still no word from the mail-order pharmacy, who assured me they would give me a price quote before they sent me my meds. Went online to their site and my order is there, but still in a pending status. Another phone call reveals that this time the blockage is that my insurance denied the claim because it was filled (but not picked up) at the local pharmacy, so they wouldn’t approve it until April (it was mid-February, and the prescription at the local pharmacy was for 30 days, not 90 as my insurance company assumed).

Okay, back to the local pharmacy. They remembered me! They tried one more time to get the coupon to word, but no go; so they cancelled the old prescription and sent the drug back. I called the insurance company the next day, and sure enough they got the message. Good, but what of the price? About $550 for a 90-day supply. Well, that was a third of the cost of what the original drug at the local pharmacy was going to cost me, so better…but did they apply the coupon? The insurance rep didn’t know, he’d have to call the pharmacy. So I waited on hold.

This is success?

He transfers me to the pharmacy, I talk to their rep, and finally I get the correct quote (with coupon): about $230, which works out to about around $80/mo. I am okay with that; though not as cheap as in Canada, it was in the ballpark.

— —

I should receive my new med in a day or two, and with luck it will work as well as the former more expensive med. If not, it’s only slightly more expensive to get the stronger dose, and there are the other alternatives.

And now you have finished reading yet another article on how the U.S. health establishment is a total mess.



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