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Understanding the Cost of Prescription Medications


            Every trip I make to the pharmacy for new prescriptions or monthly refills is always faced with dread because I never know what it is going to cost. While I have prescription drug coverage included with my health insurance coverage, I also use a pharmacy plan at my local drug store to lower my monthly costs.             

            I use prescription eye drops to control glaucoma. Six months ago I paid $10 for my prescription, two months later the same drug cost $20 and my most recent prescription of the same drug cost $30.57. When I have called in the past to protest the rising costs their response was always “if you used our mail order system the prices would be cheaper”.

            According to our benefits plan, prescription drugs are broken down into two major categories: 30 day supplies from a retail drug store and mail order 90 day supplies.  The full breakdown of our plan is (1) Generic medications are supposed to be $10 from a retail pharmacy for a 30 day supply while the cost of a mail order 90 day supply is $20; (2) Preferred brand name drugs range from $25 to $65 for a retail pharmacy 30 day supply while the same preferred brand drugs are $70 for a mail order 90 day supply; (3) Non-preferred brand name drugs range from $40 to $120 from a retail pharmacy for a 30 day supply while the same non-preferred drugs cost $120 for a mail order 90 day supply.

            While there are many things that I find objectionable about this plan it is the one that I am stuck with since that is the coverage that is provided.  However, the one thing that I can object to is that our provider does not even follow the basic rules of their own plan.

            I choose to have my prescriptions filled at my local pharmacy where the pharmacist not only knows me by name when I walk in but they know my prescription history which is important when you have multiple doctors or have switched doctors a few times. So, needless to say that I am using the 30 day retail prescription portion of my plan.

            At another recent trip to the pharmacy I brought in four new prescriptions to be filled. These prescriptions are for medications that I have been on for some time but it was the beginning of the year and our provider requires new prescriptions to start the new  year and will not honor any refills left over from the year before. Three were generic and one brand name drug that has no generic equivalent.  When the pharmacy cashier rung up all of my prescriptions I was floored at the total which was $148.

            Questioning the total price the cashier went through each item with me and what our provider charged. The brand name prescription was $83; one generic prescription, which cannot be filled through mail order, was actually $10; one prescription, a high dose weekly vitamin was $7; and the last generic prescription for a 90 day supply was $48.  Voiding the original transaction I had the pharmacy run each one through their pharmacy plan to see if I would save a bit of money. While they could not do any better on the price for the brand name prescription and the $10 generic prescription, they were able to save me $36 on the three month generic prescription and $4 on the high dose vitamin bringing my total down to $108.

            When I came home I reviewed my prescription coverage again only to find that our provider again overcharged me for the brand name prescription.  Finding the list of drugs which were in the preferred and non-preferred categories, the drug I had purchased was in the preferred category which means they should not have charged me more than $65 for the 30 day retail pharmacy purchase.

            Perhaps our provider should have put the following disclaimer in our benefits package: These prices are subject to change at any time on the whim of the provider’s discretion.