Saturday, July 21, 2012

Health Insurance Woes

Insurance is an expensive benefit for employers and families, but the coverage is so variable it's difficult to navigate the whole healthcare thing. I am a pretty well informed consumer, given that I hear patient concerns often about how much things cost and if something will even be covered or not. I often change prescriptions due to insurance formularies or have a nurse call a script to change to a cheaper pharmacy. I know these things happen, but even informed consumers can get caught off guard.

My family's health insurance changed April 1st, and I dutifully put the new card in my wallet but didn't read anything about the new plan. The new plan was chosen by my husband's company as the best deal they could get. We both work for small companies, so insurance deals are not great. I didn't make the time to read about the formulary or what pharmacies are preferred. Or even if they offer or require mail order pharmacies. (Typical consumer mistake.)

I had dropped off 2 prescriptions that members of my family have been on for quite awhile on Saturday, March 31st, but didn't have time to pick them up that day. I returned Sunday to pick them up and realized that my new insurance had kicked in that day, so gave my new card. 

Drug A had been $4 previously and was now $10.
Drug B had been $10 previously and was now $75. 
Both are generic!

The next month I forgot to look into pharmacies. A little busy, you know.  So my old cost of $14 was now $85 monthly. A difference of $852/year. I made a mental note that I really had to make the time to look into things. 

Finally in June I looked up preferred pharmacies on the insurance plan's website.  The pharmacy I have used is not on the list, but another close to home is, so I changed our prescriptions to the "preferred" pharmacy.

Drug A is now $15.
Drug B is still $75.
The preferred pharmacy is actually MORE money!

How can consumers win?

My next step could be to look closely at the formulary to see if they have another medicine in the same category that is less expensive, but it is already a generic, so I am doubtful. And I know that this medicine has been working well for about a year. If we change to another medicine it might not work as well and there is a history of a bad reaction to another medicine in this category for my family member, so changes are concerning.

So I will probably suck it up and pay $75 for one generic medicine. And I will go to the non-preferred pharmacy so the other generic is less expensive. I am thankful I can afford these because I know many go without needed prescriptions. 

I might call around to other pharmacies to see how much they cost, but that can be time consuming and may or may not be fruitful.  I hate to waste precious time. But $75 a month for a generic is crazy to me. Does anyone agree that this should not be so difficult?

Thanks for letting me rant.