A simple experiment amongst the health care debate

I recently had a prescription that could not be refilled on-line or over the telephone.  I decided to conduct a simple experiment on the cost paid  by my insurance carrier to three different pharmacies located within a 1.2 mile radius of my home for the exact prescription.  My co-payment of $5.00 remained the same.  The prescription: exactly the same.  Pharmacy #1: Walgreens.  Walgreens “charged” me $8.99 for the medication.  Of which, I paid $5.00.  Pharmacy #2:  CVS  $7.99.  Again, I paid $5.00.  Pharmacy #3 Hannaford Pharmacy (a regional grocery store): $6.25.  I paid $5.00.  As all of these are located in the same zip code, *and* the regional business has the lower charge back to the insurance company, I am perplexed. 

Health care reform has been one of, if not, the single most divisive issues of domestic policy that I can remember.  Amongst the back and forth on both sides of the aisle (and both sides are to blame), I went back to my experiment.  When I go to purchase a Diet Coke, I *know* how much it will cost.  There is not a hidden charge back to my ATM card or the bottom of my purse.  Yet, for many people who have insurance, the insurance companies to do not post how *much* the original charge, “waived off charged”, insurance covered charges and out-of-pocket charge incurred were to the consumer. 

How can an average consumer, concerned about the rising costs of medical care, hope to help to contain costs if we cannot find out how much a pharmacy will charge our insurance company?  I am pointing to pharmaceuticals and pharmacies (please note not pharmacists because they are employees!) specifically because they provide a fixed cost of goods.  A 5/500 Vicodin pill costs x to produce.  The fact that the lowest charge back to my insurance company was the regional chain demonstrates several pressing issues that can easily aid in health care reform.

1) Start with a full audit of prescription medication reform including the cost of goods.  Unlike food items, they are not dependent on crop issues.  A pill should have the exact same cost cross-country.  While pharmaceutical companies deserve to make a fair profit as that funds research and development, insurance companies do not deserve to profit off of prescription medication to off set other costs.

2) Grocery stores, drug stores need to end promotions such as “free antibiotics”, gift cards for transferring prescriptions.  This only encourages pharmacy hopping and increases paperwork for the pharmacists and doctors offices.  Both of these practices are then passed along to the medical consumer through increased health care cost.  Hannaford’s? They do not participate in such schemes.

Is health care reform necessary? Yes. Do individuals have a responsiblity use health care wisely? Completely. *And* It is up to the consumers to demand from our insurance companies, our legislatures at both the state and federal level an accountability system which demonstrates just exactly how much our medication is really costing us.  We are paying far more than the copays: and we have the right to know which companies are abusing the system that is in place.  And if you can get a free chicken with your new prescription for antibiotics? Chances are your insurance company is being over-billed.


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2 Responses to “A simple experiment amongst the health care debate”

  1. Amanda Says:

    Some good points on reform here, but what you were experiencing in those price differences between pharmacies were the different drug stores “dispensing fees” on a medication which has a cash price that is that low, there is a base price that all pharmacy will charge for it. Say you get 2 pills of of a medication that cost 10 cents, for the pharmacy to purchase, obviously they can’t sell it to you for 10 cents or they would not have any cash to run their businesses or pay their employees, because the time it took to process, fill, and the bottle, bag, label etc, and salaries of those involved have been taken into consideration in the price of the prescription. These prices vary by chain and if a medication cost under a certain price there is a lowest price that any prescription that is not billed to an insurance will leave the pharmacy for and 6.99 or 7.99 are the typical price ranges for that. On the other hand our receipts show the amount that was billed as cash to the insurance and the amount that the copay ended up to be on them, which is important information especially for those with medicare part D where they fall into the infamous donut hole and on prescriptions which are expensive.

    While there defiantly needs to be an end to coupon shopping at pharmacies because it is compromising the health care of all, there has to be legislation backing new laws to put things like this into place and most politicians see this as career suicide as I’ve discussed this issue with the state board of pharmacy here and they have a difficult time finding anyone to back the bills until someone gets hurt and grabs media attention it’s going to sadly continue.

    Another area that needs reform are medicaid programs. I am not against medicaid for those that need it, but I don’t see why brand name omnicef or celexa or any other drug is covered on medicaid when generic is required by most any private insurance. These aren’t prescriptions that the doctor is stating the patient needs brand name on, these are prescriptions the patient says they need brand name on because they don’t like generics and the government lets it go through and instead of free, it’s okay to get brand because they make their copay $3 dollars, the biggest catch… the patient can then state they can’t pay and I still legally have to give them their medication. Why is the brand name approved? I think some formulary changes need to be made. If there is not a medical need for brand name specified by the doctor, I’m sorry then generic medicine is good enough, as it is for the rest of the world and that would free up a great deal of money to put to good use elsewhere! End ramble.

    • zebrastravels Says:

      right. i couldn’t think of how to put it – what i noticed was that the fees were higher where the rebates/coupons were in place. i don’t mind a fair profit: you have a PhD level education and I rely on my pharm(s) (there are 2 where I go!) and don’t hop for free antibiotics, etc. They are an UNDERvalued resource in the health care industry. What surprised me was 2 things (1) the local place had the lowest charges and (2) the different charges and my insurance company agreed to pay! :) but you know i celebrate your profession.

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