Losing Big Time With Your Private Insurance Drug Plan

The following is based on a quick twitter chat with someone who needed to obtain 2 Valium for a Lasik eye procedure.

How could you go wrong? You have a fine insurance plan. You can obtain any prescription you like for only meeting a $30 deductible. That goes for the $80 athlete’s foot prescription to the $180 antibiotic/steroid combo ear drops. You are set. No government big brother socialist between you and your money, your doctor or your pharmacist. Only you and that plastic card separate you from the medicine you need. The marketplace is a wonderful thing. And of course there is no such thing as an aberrant market. All markets are perfect or they wouldn’t be markets, they’d be cooperatives or something we don’t understand at all.

Here you are pharmacy assistant. My super duper pharm discount card is yours for the asking.

2 10mg Valium…. How much is that and yes, generic is fine.

$30?? …. (expletive deleted)!!!

Well, where did things go wrong? It seems that Valium according to the Epocrates Database should cost about $4 per tablet for the brand name and 40 cents for generic. Something seems to be wrong with this picture. The charge was $30. The way the pharmacy views this and the way it is likely defined is that the $30 is a co-payment or processing fee for submitting the prescription to your private insurance health plan (which you never want to leave home without or trade in for something unknown that might even have death squads waiting for you).

Many prescriptions cost more than $30 so a $30 co-payment is not awful. But it is awful if your big chain pharmacy is charging you $30 for an 80 cent prescription. They should have informed you that it would be much cheaper to purchase the medicine without submitting it to your insurance carrier. I recommend going back to the pharmacy and complaining to them of this unethical behavior. You should also ask them where they are sending the data with your name, social security number, address and dosage of the medication without ever asking your permission.  Apparently this seems to happen often. I had heard that the drug information was separated from name but read just this week, that apparently it is not.

The take away lesson is to first ask how much the medicine costs without a prescription card, and how much it is with the prescription card. Then you’ll know if you are saving or losing money by using the prescription card. This will be the same, most likely whether you are in a government operated program such as medicare, or a “you pay your way and premium” public option plan.  There should be a safeguard to prevent you from being charged more on a “co-pay” then the cost of the prescription, but it isn’t there yet. Of course that could ruin the perfect market place we are said to have.