A bitter pill indeed
A seemingly innocuous request recently led me to a bout of righteous indignation and a passionate battle.
At the end of an appointment with my orthopedist, I asked him to refill my prescription for an NSAID pain reliever. Though it happens to be available over-the-counter at a reasonable price, the prescription is a 12-hour version, and its cost (to me and to my insurance company) is even less than OTC retail.
The physician assistant asked if I wouldn’t prefer a different pill that’s coated to avoid stomach upset. I said no thanks. That’s one problem I don’t have (yet).
But he pushed a bit, saying the new pill is supposed to be helpful, and wouldn’t I like to try it? Again, I said no, adding that I once was prescribed something like that in error, and it had a horrendous co-pay.
He said, “Oh, there’s no co-pay at all for this drug! And I have some samples. Why don’t you take some home and try it?”
He gave me the samples and a piece of paper with the name and phone number of a particular “family pharmacy” I hadn’t heard of. He said they discount the drug and absorb the co-pay, and he would call the prescription in to them. If I decided I wanted it, they would mail the pills to me free of charge.
I left feeling somewhat uncomfortable about the whole exchange, but took the samples with me.
Back home, I read the fine print on the packaging. It explained that the new drug, called Vimovo, was basically a high-dosage NSAID coated with a common proton-pump inhibitor (to reduce stomach acid).
I realized this was another of those increasingly common situations where a drug company combines two older drugs available in generic form into one branded pill. That allows them to patent the combination and to charge a significantly higher price for the convenience.
I tried the new pill and didn’t find it any better than my trusty generic. So I decided to forget the whole thing.
Over the weekend, I found a voicemail on my cell phone from the family pharmacy, seeking to confirm my address so they could mail me the prescription. Since I didn’t plan to order it, I ignored the call.
Two days later, a small package arrived in the mail. Inside was a bottle of Vimovo, plus a return mail envelope and a receipt with instructions to “sign and return this form in acknowledgement of receipt of correct prescription.”
OK, now my suspicions had grown. Combining the PA’s eagerness to push me to try it, and the pharmacy’s presumptuousness in sending me the pills without my asking, I felt there was something fishy going on.
So I scrutinized the mailing. The receipt included my name, the Rx#, the name and quantity of the drug, and “co-pay: $0.00.” But what did they charge my insurance company, I wondered?
So I looked closely at the label of the pill bottle packaging. It showed something shocking: “co-pay: $0.00. Ins. paid $2,236.76.”
Whoa! I expected to see a brand-name kind of price there, but more than $2,000? I was spitting nails. By what right are they charging hundreds of times the real cost of the ingredients?
And why did my insurance company pay such an outrageous price without complaint? I had no illusions: insurance rates for the Beacon, like for the rest of the country, have been going up much faster than inflation. Costs like this ultimately get passed on to us, the customers.
I was on the phone within seconds to the pharmacy, giving them a piece of my mind. They kept trying to calm me down by reminding me, “but there’s no co-pay! You don’t have to pay a cent!”
That just made me angrier. In the end, I’m paying; we’re all paying! I insisted they take the pills back and credit my insurance company for the full charge.
To their credit, they sent me a postage-paid return slip so I wouldn’t incur mailing fees, and once they got the bottle back, they called me to confirm they had refunded my insurance company.
In the meantime, I called my orthopedist’s office to find out if they were part of this scheme, or maybe just the victim of a drug company marketing rep.
When I reached the head of the practice, I told him what happened, and he was as flabbergasted as I had been. He asked me to repeat myself, then he slowly repeated the same thing back to me, clearly growing more and more incredulous at the outrage.
He called over the PA and asked him if he had any idea what those pills cost. The PA said no, he didn’t.
The doctor repeatedly thanked me for bringing this to his attention, and said he would immediately warn his staff about the situation and the pharmacy.
After that conversation, I went online to see what Vimovo’s standard retail price was, and I was floored yet again: $2,650 is the average retail cost. To my amazement, the family pharmacy was indeed “discounting” the drug!
But that didn’t change the fact that the price sought by the drug company is, to my mind, unconscionable and exploitative.
I was relieved that my doctors were as shocked as I, and that they were determined to take the price into account before ever prescribing the drug again. But this lack of knowledge about the cost of drugs on the part of doctors is as appalling as it is common.
I didn’t think it was the responsibility of patients to inform our doctors about the costs of drugs. But apparently there’s no one else with the incentive to do so. Not even our insurance companies or Medicare Part D plans. (However, just recently, CVS Health announced it will start informing doctors about drug costs in an effort to avoid patient sticker shock at the pharmacy, and to reduce the number of patients who don’t fill their prescriptions.)
So I urge you: take a look at your prescription receipts and note what your insurance pays. If it seems out of whack, or if there are cheaper alternatives you are willing to try, let your doctor know.
And those with Medicare Part D are not off the hook. While such plans can negotiate drug prices, if you are taking a more expensive version of a drug than you need, it’s contributing to the overall problem.
There are many reasons healthcare costs in America are rising much faster than inflation. One might point to surgeries (such as the nearly 500,000 knee and hip replacements done each year), and the extraordinary costs for the latest treatments for cancer and genetic diseases.
But the price we all pay for our prescriptions drives at least part of the rising cost. Be vigilant and speak up. It might be a small thing in itself, but I can tell you from experience: It can make your day!