insurance insanity, primary care

You Better Shop Around

Everybody knows that some medications can cost a lot of money.  I always try to take the cost to my patients into account when prescribing a medication- after all, if someone can’t afford it, they are not going to take it.  When it’s appropriate (and 9 times out of 10 it is), I try to prescribe a generic medication.  They are much cheaper and work just as well as the brand name (almost always).
Imagine my surprise when a patient recently presented me with this receipt, along with a request to change medication because the one I gave her was too expensive.
The medication was diltiazem ER, the generic form of Cardizem CD.  The patient pay portion was $0.  However, this patient is on Medicare, and the cost of every drug inches her closer to the “donut hole.”  Basically, when the cost of drugs gets up to a certain amount (around $2700), the patient enters a coverage gap and must pay 100% of medication costs.  If you look in the upper right hand corner of the receipt, you will see that the cost of this drug was $536.84.
To say I was stunned is putting it mildly.  So much so that I was convinced it was a mistake.  After, the cost of brand name Cardizem CD is $288.99.  How could a generic be more expensive?  Cardizem went generic in 2010- that’s plenty of time for the price to come down.
I called Walmart to see what the story was.  I spoke to the pharmacy tech and asked her how much diltizem ER costs.  Her answer was that there was one that was $54 and another that was $84.   I then gave her my patient’s information and asked her why she was charged $536.84.  After a lot of hemming and hawing, she said that that was the cost for one particular pill made by one particular manufacturer.  I then asked her why my patient was given this one, instead of the one that was 10x cheaper.  She couldn’t answer the question, so I got the pharmacist on the phone.  
I wish I could say I got a good, reasonable explanation.  I did not.  She told me that there are several versions of generic diltiazem ER.  They are all basically the same, but range in price from $53 to $536, depending on the manufacturer.  She had no idea why my patient was given the most expensive one.  I have some ideas, but I’m not going to speculate here, since I was always taught that if you can’t say anything nice, then don’t say anything at all.   I clarified to her that my patient was to only get the cheap one.  However, the damage is already done and she has edged an extra $500 closer to the donut hole.
So, what’s the moral of the story?  Don’t just accept that the price of a drug is what it is.  If something seems much more expensive than it should be, talk to the pharmacist or your doctor.  Shop around and bring your business elsewhere if a pharmacy is not willing to assist you.  

6 thoughts on “You Better Shop Around”

  1. While that's great in theory what happens if three meds are cheaper at WAG, two at Walmart, and six @ Target? Then your encouraging patients and readers to fill their scripts @ multiple pharmacies? Just saying?


  2. There's nothing wrong with using multiple pharmacies, if you're organized. There's no law against that! However, you can probably just shop around within the pharmacy itself. If a medication price seems very high, ask if there's a cheaper version.


  3. When a prescription is billed to medicare, contract pricing is applied, medicare did not pay $500 for that rx. They paid the contract pricing for generic rx regardless of the brand used. Walmart should have checked the reimbursement screen. That price is the imaginary “cash ” price…that nobody pays.


  4. AND when a claim is billed to medicare while the patient is in the donut hole, medicare assigns the price…and it will be the contract price regardless of the manufacturer used.


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