In a post-Martin Skreli and post-EpiPen debacle world, you’d be forgiven for fatalistically thinking that price gouging is a way of life in the pharmaceutical field and that you have no means to fight back as a consumer.
But fortunately, you’d be wrong!
A tale of two prescriptions
David Lazarus of the Los Angeles Times writes in his latest column about an elderly husband and wife with the same insurance who both required the same prescription.
The scrip was for generic fluorourcil, a topical cream for pre-cancerous skin growths containing 5% of the drug.
But while the wife had a co-pay of $20, the husband faced a co-insurance cost of $300. (With co-insurance, you pay a percent of a drug’s cost, rather than a fixed co-payment. Co-insurance typically is set around 25%.)
Why the huge spread for the same drug for a husband and wife on the same insurance plan?
Turns out the wife got the last tube of the generic 5% fluorourcil that their pharmacist had. When the husband filled his scrip a few weeks after her, their pharmacist only had a brand name version of fluorourcil (Carac) at .5% strength — not 5% strength.
But because their insurer put the brand name in a higher pricing tier, the husband had to pay $300.
Imagine that — One-tenth the strength of the original prescription for more than 10 times the price! It’s enough to make a consumer go crazy. Fortunately, you have some savings strategies…
Go north for cheaper prices
For years, people who lived along the Canadian border have looked to our neighbor to the north for prescription savings. Canada has been a viable alternative for residents from Washington State to Maine. They simply go across the border and fill their scrips for a fraction of the cost for an identical medication.
If you don’t live in a border state, there are legitimate Canadian pharmacies online where you can fill a scrip. From time to time, our federal government will seize a shipment as a show of force. But it is a rare thing and the pharmacy will usually replace it for you at their cost.
Ask for a ‘biosimilar’
The Wall Street Journal recently wrote about a move in the U.S. to lower drug prices through something called ‘biosimilars.’ Simply put, that’s a drug that’s more affordable than the dominant player in the market and it’s chemically exact in its structure as the industry leader. These things will be a very important part of the future of medicine, even though many traditionalists are nervous or opposed to biosimilars.
If you are a doctor, a lot of the meds you’re writing now are things that patients won’t be able to afford. And they may die for lack of medication. So why not write a scrip for a biosimilar that costs one-twentieth to develop and could be a completely life-saving event?
As a patient, the next time you’re with a doctor, if there is a medicine you are prescribed that you can not afford, ask for a biosimilar!