My Insurance Drove Up an RX Price by 100%

So, late last week I got my bivalent Covid boost (just in time for new variants to dodge it, of course), and flu shot on the same day. And, as I expected, I felt crappy. I expected that to last a day, and had the liquids and OTC I needed to cope. And when it lasted longer than expected and got worse, I just assumed the double-dose was kicking my ass.

Saturday I crashed into bed in the middle of a game session. Sunday I was only alert for short bursts. Monday morning, I realized both my ears hurt the way they do when I have an ear infection. And since I had self-misdiagnosed for the whole weekend, it was suddenly at the constant-pain-and-occasional-icepick-in-the-ear-level-agony stage of ear infection.

No bueno.

So, off to my local favorite urgent care, who have always taken great care of me when I can’t wait a few days to see my Primary Care Provider, but don’t need the E.R. It was one degree above freezing, awful slush was falling from the sky, and my wife had to drive me. The Urgent Care was nonstop back-to-back with children with respiratory infections, but got me safely in a waiting area by myself, took my vitals when a medical assistant had a spare moment, and eventually a nurse practitioner managed to see me. She checked, confirmed I had ear infections in both ears (and quipped “How do you DO that?” as they have seen me for this more than once), and that it needed immediate antibiotics, and sent me to pick up a prescription they called into my pharmacy. Eardrops, because they’d be gentler on my system than an oral. But, the nurse practitioner assured me, if I didn’t feel better in day I should let her know, and she’d write a new script.

This had taken a few hours, much of it in the feeing dark, but normally this is the point when we can pick up the RX at a drive thru pharmacy, go home, and begin to recover. But if that had been how it shook out, I wouldn’t be making a bog post out of this.

So we went to the pharmacy, and waiting for the prescription to be ready. And when it was, the pharmacy tech asked if we knew how much it would cost, and we noted we did not.

“$180,” she said.

“What?! For eardrops?!”

“Yeah.”

“Did you run our insurance?”

“Yeah. Let me double check for you.” [Click, click click.] “Yes, I double checked your insurance is current, and ran it. It’s $180. Do you want me to fill this, or put it on hold so you can call the doctor or your insurance?”

We put it on hold, and called the clinic. We explained, and the assistant said she’d go talk to the nurse practitioner, and could we hold.

We held. Sitting in a packing lot, in now sub-freezing temperatures, ice slowly forming on the car, we held. Thank goodness I *could* afford $180 for eardrops if I had to… but I couldn’t afford to do so unless I really did have to. And I love my wife, and love spending time with her. But this was eating my entire day.

The assistant came back on the line, and explained that the eardrops were only $90 without insurance… but yes, she had checked, and they cost $180 with our insurance.

Wha… what? We could get it at half the cost if we DIDN’T use the insurance I had spent hours selecting, and paid for out of pocket every month as a freelancer? It was MORE EXPENSIVE with my insurance?!

Yes.

But, she was sure that was still more than we wanted to pay, so they had called in a new prescription. Let them know if there was any problem with it.

So we waited a bit, drove through the pharmacy window to see if the new RX was ready. It wasn’t. So we waited a bit more, hoping roads weren’t getting slick. (They weren’t, thankfully.) We drove through again, and this time they had it.

“How much?”

“$25.”

“How much without insurance?”

“$40.”

“Great, just checking.”

And, apparently, while the double-cost/$90 upcharge is rare… prescriptions in the US costing more when you use your insurance is NOT rare. “Clawbacks” may affect close to 25% of US prescriptions, often running $5-$10 higher than the uninsured cost. That doesn’t explain the huge difference for me, which may be a result of a pharmaceutical manufacturer offering a huge discount to uninsured customers, and my insurance not covering the drug at all, so I both have the higher price and no help covering the cost.

So, yeah. The system is broken. And, when getting a new RX, check both the insured and uninsured price.

Speaking Of Money
If you are in a position to, please consider supporting the work required to create this blog by joining my Patreon for as little as the cost of a cup of coffee each month, or dropping a coffee-cup worth of one-time support at my ko-fi.

Advertisement

About okcstephens

Owen K.C. Stephens Owen Kirker Clifford Stephens is the Starfinder Design Lead for Paizo Publishing, the Freeport and Pathfinder RPG developer for Green Ronin, a developer for Rite Publishing, and the publisher and lead genius of Rogue Genius Games. Owen has written game material for numerous other companies, including Wizards of the Coast, Kobold Press, White Wolf, Steve Jackson Games and Upper Deck. He also consults, freelances, and in the off season, sleeps.

Posted on November 15, 2022, in Musings and tagged , , . Bookmark the permalink. Leave a comment.

Leave a Reply

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

WordPress.com Logo

You are commenting using your WordPress.com 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

%d bloggers like this: