Published October 22, 2019
THE VIEW FROM MY SEAT
I want to take you higher...
By Ernie Williamson / The Bulletin
It’s amazing how often, when I am wracking my brain for a column idea, something just pops up.
I was waiting for a prescription in the drive-thru lane at the pharmacy.
“That will be $273,” said the woman at the window.
“What? That can’t be right! How much with insurance?” I asked.
“That is with insurance,” she replied.
After getting over the shock, I looked at the bright side: I had a column.
Until now I have been fortunate to have insurance that does a good job covering my medicines despite the fact I need several because of spinal cord damage. Drug pricing, however, seems to be a national problem that every political candidate talks about, but nothing gets done.
The National Center for Health Statistics reports that 8 percent of American adults don’t take their medicines as prescribed because they can’t afford them. Among the poorest adults, nearly 14 percent don’t take their medications as prescribed to save money.
Please understand that the $273 was not for a life-saving medicine to fight cancer, ward off an infection or battle any of the new diseases that appear on television commercials. This was for Carafate, a medicine that helps battle gastritis and acid reflux.
I don’t remember paying that much the only other time I had purchased Carafate. Because I had some of that Carafate left and was sure that the $273 was a mistake, I thanked the woman and drove off without my Carafate.
I am fortunate. I can afford my medicines. I thought, however, it would be worth a column to check into Carafate’s cost.
A couple of days later I went back to the pharmacy on other business. It was a Sunday, and there was no line at the pharmacy counter so I asked the pharmacist to double-check the price of Carafate. She did. It was still $273.
But, she explained, that $273 was for Carafate in liquid form. There is, she informed me, a generic version of Carafate in pill form. That was news to me. That price was $29, but, of course, I needed a new prescription.
I went home and researched Carafate in pill form. It seems doctors think the Carafate liquid is more effective than the pill, but many patients simply drop the pill in water or juice and drink it. I wondered if the liquid form, at almost 10 times the cost, was 10 times more effective than the pill.
Next, I checked my insurance company’s formulary, or the list of drugs covered by the plan. The formulary showed that Carafate liquid was in the second most expensive category of drugs. The pill wasn’t covered at all.
The next day I called the insurance company. Before I could even get my questions out, I was informed that it was my lucky day. I was such a good customer the company was going to send me a certificate worth $100 in 3-5 days.
I was then transferred to another department. After hearing my questions about the Carafate, the company representative said he would arrange it so that I would not only get the $100 certificate but, if I gave him my credit card number, I could get the liquid Carafate for $2.91.
I am cautious, perhaps overly so, when an offer appears too good to be true and somebody asks for my credit card number. No thanks, I said.
So I haven’t yet filled my Carafate prescription. But I am filled with questions. Why wasn’t I told earlier about the cheaper pill form of Carafate? Why wouldn’t my insurance company cover the cheaper form? Why, when the pharmacy price was $273, would one call to the insurance company get me Carafate for $2.91?
Drug pricing is a mystery, and I didn’t get answers to all my questions, but I did get a column.
(Ernie Williamson welcomes reader input. Please contact Ernie at firstname.lastname@example.org)