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.