New Subtle Ways Insurance Companies, Pharmacies and Drug Companies Continue to Screw Consumers. What Can We Do?
Where should I start? I am writing today because I am so disgusted with the blockades thrown up as I try to help my patients save some money, while providing good quality care.
The reality of OB/GYN is there have been no major prescription medication breakthroughs in the realm of birth control, menstrual bleeding, menopause, menstrual cramps or anything related to having a baby in the 17 years I have been in private practice. That being said, almost everything in our office can be treated with a generic medication. Most branded medications we offer are strictly for patient convenience and optional.
Good example, the annoying yeast infection. Most often, a seven day over the counter medication will eliminate all internal symptoms but it is common to need a generic combination anti-fungal and corticosteroid. My go to medication has been Mycolog (Nystatin/Triamcinolone) cream it has cost $10 or less as a Tier 1 medication on every insurance plan since FOREVER. I never had an issue, it always worked, patients could afford it, everyone was happy.
In the last 2 months, three patients contacted us stating, ‘the medication Dr. Weinstein said was cheap is now $120!’ All I can think is WTF. Of course I call the pharmacy, you the know the huge super friendly, helpful, customer service oriented CVS and Walgreens, your insurance company is now forcing you to go to in order save ‘you’ money. The pharmacist says “that’s how much are system says it costs.” I inquire, “Are there any other cheaper options?” Response, “I do not know, you would have to write another prescription and see what the system says.” So a giant pharmacy chain and the super profitable insurance company with a direct connection to pricing and formulary, something that doctors and patients do not have, cannot take the time to create a simple computer algorithm that tells the patient and the doctor what is the most cost effective treatment. Does it sound like your insurance company (Aetna, United Health Care, Blue Cross or Cigna to name a few) is there ‘for you’? I love those awesome commercials they put on TV for millions of dollars that say they want what’s ‘best for you.’
I read an article explaining the generic pricing increase recently and it made me sick to my stomach. Generic medication still costs pennies to make but because the profit margin on these drugs are so low for pharmaceutical companies most companies just stopped making them. There are no branded versions of most of these medications because no insurance would cover them so they also stopped making them. Then the CEO of the one remaining generic pharmaceutical company that stuck it out thought of a w a brilliant very profitable idea, ‘Hey, you know we can charge whatever we want for these previous reasonable priced medication because the doctors and consumers have no other choice’. Hence $10 medication now $120, well come to America, capitalism at its finest.
I have one more example that really made me just want to go home and find anything else to do but practice medicine. An unfortunate patient of mine had a miscarriage and need a D&C as she was getting an infection. Speaking from personal family experience this is incredibly stressful and depressing, additional stressors are the last thing you need. Again, I write for the same generic medication I have written for the last 17 years. Anaprox DS, 60 pills (prescription strength Aleve) and Methergine, 6 pills (a medication that is vital in preventing bleeding after the procedure). I get several messages from the patient stating ‘do I really need to take these medications, the first is $100 the second is $120 for 6 pills’. These are 20 plus year old generic medications, not life-saving cancer drugs.
What Can We Do, short of marching on Washington, picketing in front of your pharmacy and the beautiful corporate headquarters (i.e. Cigna building on the Tollway or the United Health Care on the George Bush Turnpike) of your insurance company?
Go to the pharmacy prepared to do battle. Find every coupon for your medication on the internet and get the lowest price. Always ask the cash price. Unbelievably, the pharmacist will give you the price your insurance wants to charge which maybe $28, while the cash price for an uninsured patient maybe $6. From personal experience, the pharmacist has no incentive to share this cost savings information to you. Lastly, www.goodrx.com, they have an app for most phones and it shows you the price at every pharmacy in your area and has coupons you can show the pharmacist at the drive thru. Remember the $120 Methergine I tried to get for my patient, we checked the app, found the drug for $11.26 with a coupon and the patient was set. Small victory!
Long Acting Reversible Contraception (Mirena/Skyla IUD’s and Nexplanon)
Here is another example of Americans being fleeced by the same culprits. Bayer Healthcare manufactures Mirena IUD in one plant in the entire world, located in Finland. Mirena purchased for cash in Canada cost $200 or less, until a few years ago Americans could buy them on the Internet have them shipped to your house and inserted in my office. There was even a time when a physician could order them in bulk. Then the FDA along with Bayer started claiming this this practice was dangerous and patients could be getting counterfeit IUD’s. So they made it a federal offense to obtain them, same thing applies to getting them in Mexico. So what is the big deal? A Mirena IUD purchased in the United States cost $759 or more. A $560 mark up because we are Americans. The box for the Mirena, the labeling and package inserts and the serial numbers are identical. You could not tell an IUD from Canada from one in Mexico.