January 20, 2014

"Crabby Old Lady" vs. Big Pharma

Ronni Bennett's Time Goes By is my favorite senior blog. Last week, Ronni -- aka Crabby Old Lady -- was battling both the flu and Big Pharma. I'm sure she'll beat the flu but, like the rest of us, she was no match for Big Pharma. Her tale is a fun read. But it also illustrates why we desperately need a single-payer healthcare system and government regulation of drug prices.

Here's the Crabby Old Lady, in her own words:

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In a couple of weeks, Crabby Old Lady will undergo her first cataract surgery so on Tuesday she delivered herself to the physician's office for measurement of her eye and to go over admitting procedures.

Among those were an explanation of how to use the prescription eye drops she is required to begin three days before the surgery and continue for several weeks following.


Before continuing, some background is necessary.

Because Crabby does not use any prescription drugs and because there is no way on earth anyone can predict what drugs might become necessary in the future, each year when the enrollment period for Medicare Part D (prescription drug coverage) rolls around, Crabby buys the least expensive plan.

There is no other sane way to approach the dilemma.

So, in the surgeon's office on Tuesday, the technician asked Crabby what pharmacy she uses so the prescription could be phoned in.

For lack of using drugs, Crabby doesn't have a pharmacy and she told the technician that she wasn't certain but suspected that if she uses a non-network pharmacy, the drops will cost a fortune.

The technician related the horror story of a recent patient who was charged nearly $500 for what others pay less than $100 and she suggested that Crabby check prices at the network pharmacy and elsewhere, then phone her with a selected pharmacy.

Crabby, who wanted nothing more than to go home to bed and continue nursing her flu, drove four or five miles out of her way to the network pharmacy.

The technician had given Crabby a printout of the drugs' names – generic and brand - so Crabby offered this piece of paper to the network pharmacist along with her Part D membership card and asked the price.

“This is not a prescription,” said the pharmacist.

“Yes, I know,” said Crabby. “It is just a listing of the drugs so I can check your price. The physician's office will telephone you with the prescription when I have chosen a pharmacy.”

“I can't tell you the price,” said the pharmacist, “without entering a valid prescription into the system.”

“Why?”

“I can only tell you the price when I get the prescription order for the drugs,” said the pharmacist.

Crabby, who had risen from her sick bed to see the doctor, was tired and very cranky. “You want me to buy something before I know the price?”

She told Crabby to phone the big pharma Part D company for the price but she, the pharmacist, could not tell Crabby the price.

It's like living in Wonderland where everything is upside down. As usual, Crabby had left home without her cell phone so 30 or 40 minutes later back at her desk Crabby worked her way through the big pharma insurance company's menu of choices and finally spoke to a customer service representative.

You already know, of course, this did not end well.

After handing over her membership number and spelling the names of the drugs, Crabby asked, “What is the price of these drugs, the brand name and the generic, in a network pharmacy?”

The woman gave Crabby the two prices – about $144 and $65 - and then said, “But those are only estimates.”

“Huh?”

“They are estimates. The prices could be higher or lower.”

“What?” said Crabby. “This is a drug, not a car repair.”

Silence.

“How much higher or lower?”

“I don't know,” said the woman.

“A lot either way?”

“I don't know,” she said.

“Who would know?”

“I don't know.”

“Are you telling me that I can know only an estimated price before committing to a purchase?”

“Yes.”

Crabby was already weary, and now livid as well which was certainly evident in her tone of voice. “Would you buy a gallon of milk if the tag in the grocery refrigerator gave you only an estimated price?”

Long silence.

“Well, would you?” asked Crabby again.

Click. Disconnect.

Crabby checked with the nearby, non-network pharmacy where she purchases her (apparently useless) flu shot each year. She got a slightly more sophisticated runaround than at the big insurance phone service and the network pharmacy.

The pharmacist said he couldn't give her a price without a valid prescription and he would need to know if she had fulfilled her deductible.

Crabby explained that the deductible wasn't an issue, that she is capable of adding and subtracting. She just wants the price of the two versions of the drug.

The pharmacist refused.

A friend with whom Crabby later spoke believes that the big insurance companies, in collusion with big pharma, do this now to prevent comparison shopping.

By refusing to name a price, he continued, it makes it easy for them to increase the price of the drug when – oh, you know, the CEO wants a million-dollar salary rise or a new corporate jet.

Let Crabby put it this way: she does not disbelieve that explanation.

Here is how it ought to work. Pharmacies provide prescriptions to all comers with any kind of health coverage. They are plugged into all the insurance companies' networks for their individual formularies, dosages and prices. So:

Plug in the name of the drug
Plug in the dosage
Plug in the membership number
Voila! See the price

But our corporate masters now have complete control of us and we have no recourse. Crabby thinks this used to be called slavery.

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