This is a personal tale that, I hope, will help you better navigate the drug prescription game: especially if your insurer is Medicare.
Medicare is my insurance provider. I also signed up for a Medicare Part D drug prescription Plan (Silver Script), but never had significant out-of-pocket costs. Recently, I also signed up for GOODRX, when I saw it advertised on television, because it is a free discount drug card anyone can use in conjunction with his or her Medicare Part D Plan or any private plan. With it, you can compare pharmacy prices and choose the least expensive purveyor of your medicine.
Last month, my doctor prescribed an antibiotic medication for my GI disorder. His office suggested that I use Capsule, an online pharmacy in NYC that offers the best price, free home delivery of medications and, best of all, wrangles with insurance providers. My physician knew that the antibiotic he prescribed would be pricey so I followed his suggestion, called Capsule and got the shock of my life when Capsule told me that ( a) a 2-week prescription of the antibiotic cost $3,000, and (b) my Medicare Plan refused to cover it.
“Do you have any discount coupons?” Capsule inquired.
I didn’t, but then I recalled GOODRX. I gave them all the information on my card and, within a few minutes Capsule called me back and said, “The cost is down to $1,000. Now we’ll go back to your drug insurer and see if they’ll contribute to the cost.”
Sure enough, Silver Script said they would now cover $500 of the $1,000.
All of this seemed insane. I didn’t have a mortal disease. Nevertheless, for a variety of reasons, I decided to pay the $500 for Xifaxan. Capsule delivered my medication within a few hours to my apartment house doorman.
When I went back to my doctor for a follow up, I told him how much the drug cost, how Capsule had wrangled the price down to $500 and how crazy all of this seemed. He looked at me, sadly, and then dropped another bombshell, “And if you were on a private prescription drug plan, the cost would be $20.”
“Medicare, by law, cannot get volume discounts or in any way negotiate drug prices, and therefore wants to discourage its members from taking expensive medicines. On the other hand, private insurers, like Aetna or Blue Cross, etc., can and do negotiate drug prices, and therefore can deliver lower prices to their customers. It’s a horrible situation and we can only hope that this Congress will rectify the situation.”
Were you aware of this? I was not. I thought it was only people with rare diseases or chronic illnesses that found themselves mortgaging their homes and losing all their savings to pay for drugs to keep them alive. How wrong I was.
As it happens, this week House Speaker Nancy Pelosi unveiled her plan to lower prescription drug costs. It empowers the HHS secretary to negotiate drug prices and also includes a $2,000 out-of-pocket cap on prescription drugs for Medicare beneficiaries and the disabled.
Now that I understand the situation I will communicate with my representatives in Congress to support Pelosi’s plan, and so should you. In the meantime, I will always ask my doctor how much a drug costs, continue to use GOODRX – and/or any other discount coupon available — and as a New York resident, will use Capsule (capsulecares.com, 212.675.3900), to fill my drug prescriptions.