Prescription Drug Insurance Pitfalls

Prescription Drug Insurance Pitfalls

Do you have health insurance that covers prescription drug costs? Do you pay a “copay” on each prescription?

A word of caution. Utilizing this benefit may not always be the right thing to do.

My dermatologist recently prescribed a topical (cream). As I needed to apply it over a moderately large area for several weeks, she told me she was going to write the prescription for a large size tube. She transmitted the prescription directly to my neighborhood pharmacy.

I picked it up on my way home. The “copay” was $22.03. When I got home, and started the first application, I was surprised to see that they had given me a 15 gram tube of cream. That’s only ½ ounce–not enough to last more than a few days. Something was not right.

I looked at the package insert, and saw that it was available in an 85 gram size. I thought the doctor was going to request the large size? So I called the pharmacy, and asked what size the doctor ordered. They told me she ordered the 85 gram size! “Well, why did you give me a 15 gram size?” “Because the insurance company will not authorize anything larger than the small size,” they replied. “You can get it refilled every few days.”

My first reaction was irritation at the inconvenience this would entail. But then, another thought occurred to me. “So, will I have to pay a $22.03 copay every time I get another little 15 gram tube?” I asked. “Yes, you will.”

So for me to get the equivalent of one 85 gram tube, utilizing my health insurance coverage, I will have to get six individual 15 gram prescriptions, paying a $22.03 copay each time. That works out to a total of $132.18 (6 x 22.03).

“So wait a minute,” I said. “What would it cost me if we forget about the health insurance, and I just have you fill the prescription for one 85 gram tube? I’ll pay for it directly.” “It would cost $49.95,” they answered.

My first reaction, of course, was to ask why they didn’t tell me this initially. But the answer is obvious–both they and the insurance company make a lot more money having me purchase 6 individual prescriptions at $22.03 copay than they do if I just bought one large tube at $49.95.

Now, it doesn’t always work out this way. The copay may be so low (i.e. $5 to $10) or the cost of the drug may be so high, that it pays to use the insurance even if you have to get no more than a 30 day supply at a time. But, as you can see from my example, that is not always the case. It pays to ask your pharmacist first.

In this instance, I had the prescription transferred to another pharmacy, I purchased a large tube, without using insurance, for less than fifty dollars.

Don Goldberg

About Don Goldberg

Hello. I am what you might call a Nutritional Pharmacist. After college, I worked in the Pharmaceutical and Nutritional Industry, first in Quality Control, and then in Manufacturing and Product Development. Increasingly, as the years passed, I became more involved with nutritional supplements. I spent many years detailing physicians, herbalists, and homeopaths about nutritional and herbal therapies and products. In 1992, along with my friend Arnie Gitomer, I bought Willner Chemists, a well-established nutritionally oriented pharmacy. For the first time, I had an opportunity to communicate directly with the consumer, the patient, and the customer. I love it. This blog is an additional way for me to extend my personal views and opinions directly to you. I also used to be on the radio, every Sunday, from 2 to 4 pm on WOR radio in NY (710 AM). You can listen to, or read excerpts from those shows on the website,
This entry was posted in General, Nutrition & Health. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s