I was reminded of the recent news about the price for an Epi-pen today when I tried to straighten out a particular prescription that I need. I am going to have a medical test in a few weeks and the doctor prescribed a particular type of prep to take in advance of the test. He sent the prescription to my usual pharmacy. So far, so good, but then the fun began.
First, I went the next day to pick up the prescription. The clerk checked my records and told me that the prescription had not yet come in, but it would be in one Monday. That was fine; after all, I don't need it for ten days.
I went home and a few hours later found that I had a phone message from the pharmacy telling me that my insurance would not cover the prescription. They asked me to call a special number so that I could get right through and let them know what I wanted to do. I called and got a fax line. I also rechecked the message and found that it had been left about four hours prior to my first visit to the pharmacy.
Today, I went into the pharmacy to discuss the matter in person. I spoke to a clerk who told me that there was no problem with my insurance but that the prescription had not come in yet. Since I know how these things worked, I asked her to please double check the insurance. When she did that she told me that she needed to get the pharmacist. I knew that was a bad sign.
After waiting a few minutes, I was joined by the pharmacist. She told me that my insurance would not cover the prescription for the test prep. I said that this seemed odd since the insurance covered the test, but she said that it is not uncommon. I asked what the prep would cost if I bought it without insurance. She replied that she could not tell me exactly but that it would be roughly $500.00. She said, however, that there was another alternative item that is basically the same as the prescribed "prep". It was covered by my plan and would cost $40. Then she added that were also over-the-counter items that worked just as well. They would cost around $10.
Think about that for a moment. My doctor prescribed a $500 item when there are $10 over the counter items that work essentially the same. Think what this tells you about our system. I wonder how many people have used the $500 item without having any idea that there was such a less expensive alternative available.
Tomorrow, I plan to call my doctor's office and inquire about changing the prep. Most likely, the pharmacist is correct. I will save $490, but I wonder how many people don't know that they can look for alternatives. How many people are prisoners of the ridiculously complicated and expensive system?
First, I went the next day to pick up the prescription. The clerk checked my records and told me that the prescription had not yet come in, but it would be in one Monday. That was fine; after all, I don't need it for ten days.
I went home and a few hours later found that I had a phone message from the pharmacy telling me that my insurance would not cover the prescription. They asked me to call a special number so that I could get right through and let them know what I wanted to do. I called and got a fax line. I also rechecked the message and found that it had been left about four hours prior to my first visit to the pharmacy.
Today, I went into the pharmacy to discuss the matter in person. I spoke to a clerk who told me that there was no problem with my insurance but that the prescription had not come in yet. Since I know how these things worked, I asked her to please double check the insurance. When she did that she told me that she needed to get the pharmacist. I knew that was a bad sign.
After waiting a few minutes, I was joined by the pharmacist. She told me that my insurance would not cover the prescription for the test prep. I said that this seemed odd since the insurance covered the test, but she said that it is not uncommon. I asked what the prep would cost if I bought it without insurance. She replied that she could not tell me exactly but that it would be roughly $500.00. She said, however, that there was another alternative item that is basically the same as the prescribed "prep". It was covered by my plan and would cost $40. Then she added that were also over-the-counter items that worked just as well. They would cost around $10.
Think about that for a moment. My doctor prescribed a $500 item when there are $10 over the counter items that work essentially the same. Think what this tells you about our system. I wonder how many people have used the $500 item without having any idea that there was such a less expensive alternative available.
Tomorrow, I plan to call my doctor's office and inquire about changing the prep. Most likely, the pharmacist is correct. I will save $490, but I wonder how many people don't know that they can look for alternatives. How many people are prisoners of the ridiculously complicated and expensive system?
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