Drug Pricing, Co-Pays, and Other Nonsense

Sometimes dealing with insurance and healthcare companies just feels ridiculous. Take the following example, a true story culled from my experience. Filling a new prescription for a steroid cream, I approached one of my favorite pharmacists. They are favorites because they are always looking out for me to make sure I do not overpay. Yesterday was no exception. The insurance co-pay for that tiny tube of cream was going to cost me $100.

For costs and profits?

Now, I get a lot of drugs to handle my side-effects. And because of the specialized nature of many of them, I am used to the occasionally high price tags. And sometimes the drugs simply are not covered by my insurance for any number of reasons, some far more random than others. If the coverage has been denied, we try to appeal it, and sometimes that works. Every year, the insurance companies create new lists of what drugs they cover and they may drop a few from the previous year's list and replace them with other drugs. I would like to think this is all about covering the best available drugs, but it also has a lot to do, I am convinced, with costs and profits.

Coupons to help cover co-pays

I do not mind the preference of generics over brand names -- I have had plenty of substitutions along those lines and never experienced any problems as a result. But I do mind when the drugs that are covered simply do not work for me and the one I want to try is not affordable. Although, as my story from yesterday was getting to, sometimes even the covered drugs are priced egregiously high. $100 for a small tube seemed like it had to be a mistake. My pharmacist asked me to wait a minute while he checked the computer.

That minute turned into three, then ten. He confirmed the co-pay amount, then began looking for coupons. In the past, I have saved hundreds of dollars by using coupons that my pharmacists have found from different drug manufacturers, offering lower prices than my co-pays. There are websites that help to search for some of these (often dependent upon which pharmacy chain you use), but there are also coupons directly available from many of the pharmaceutical companies themselves.

Thankful for my insurance company

If drugs were priced more affordably and consistently overall, this would not be an issue, of course. But it is not all the fault of the drug makers -- insurance companies have their own share of the blame. I love my insurance company for many reasons, in spite of our on and off conflicts. In the end, I am one of the lucky ones, not having yet become a daily statistic, because of my coverage. It has been my insurance, sometimes kicking and screaming, that has afforded me the opportunities for treatments that keep me alive. But that does not stop me from noting and calling out absurdities in the system.

Pulling some strings

When my pharmacist came back to the counter, it was a good news / bad news situation. The bad news first, that co-pay was going to be my only option. I was in for the Benjamin, no matter what because, frankly, I needed that cream and the magic it promised. But I had no idea how long that little tube would last me. I might eek out a month, maybe just a week, and I hesitated to think about how pricey it would get if I used a lot. But this is where the good -- and ridiculous -- news came in.

The insurance co-pay was not based on the amount of the drug. I had run into that issue before with some pills I needed, discovering that there was no cost difference between 30 and 60 count bottles, so I was not completely knocked off-guard when I was informed that I could get more tubes for the same co-pay. It was for a "monthly" supply, my pharmacist explained to me, while typing away at his keyboard. He then handed me four tubes.

It was, he said, the best he could do. Monthly coverage maxed out at four tubes, no change in the price. Effectively, he dropped my cost from $100 per tube to just $25 each, which was not that much more than I have paid for other similar medications in recent days. In fact, I've paid that much for over-the-counter treatments without anywhere near the promised level of effectiveness.

Before I sound ungrateful, I should note that the retail cost of a single tube is still far-higher than my co-pay. And with four tubes, I am getting quite a comparative deal. The tubes retail for about $200 each.

Find people who care

The moral to this story? Expect the ridiculous when it comes to dealing with all the ins and outs of getting the medications you need. But more than that, try to find pharmacists (and other healthcare workers) who care enough to go that extra mile for you. And it never hurts to let them know you appreciate what they have done.

Editor’s Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.