Medical Costs-Part II

A family member, who lives near me, is currently visiting in another upstate New York city.  She has encountered a medical problem, called the doctor, and was prescribed a needed medication.  She is low income and her health coverage has lapsed.  She has been trying for over a month to straighten out the problem and get it reinstated.  The bureaucracy can’t get out of its own way and accomplish anything in a reasonable time period.  So, she does not have coverage for the medication and does not have money to pay for it.  She called me.  I agreed to call the pharmacy and use my credit card, so she could get the medication started as soon as possible.

Oh, boy….

The drug store where she is currently visiting does not have the medication.

The drug store here in town does not have the medication, so she does not have the option of getting it here when she returns tomorrow.

She is passing through another small city on the way home, and it has a drug store that is part of the same upstate New York chain as the other stores.  She can stop there on her way back home tomorrow.  They have the medication and when she talked with me, they had told her they would fill the prescription generically as it is quite expensive.

Even the generic sounded ridiculously expensive to me.  This is an old medication.  I remember giving it over 50 years ago when I was in nursing school.  I got online and looked up the cost.  I discovered I could sign her up for a discount card at drugs.com.  I called her and told her what I was doing.  She said the doctor had only prescribed 4 pills.  I determined that with the discount card the cost should be $38.

I called the pharmacy and was about to cheerfully give my credit card number when I was told the 4 pills would cost $260.  What?????

It turns out she had not been quoted the correct price.  They have only the name brand medication ….there is no generic available.

The brand name costs $260.

The generic with no discount card is $106.

The generic with discount is $38.

But since there is no generic available in any of the three cities that are possible places to obtain the drug, we are stuck with paying the $260.  She NEEDS the medication.  I am concerned that she can’t obtain it until tomorrow.  I talked to her about the issue and tried to impress that if the problem becomes severe, she should go to an ER.  I’m thinking a hospital might actually have the medication.

In regard to the unavailability of the generic, the pharmacist explained to me that many generic drugs are actually manufactured in Puerto Rico.  Since the hurricane devastation, these facilities are out of business.  I’m sure it isn’t possible to produce medications reliably with no power and no clean water.

If she keeps the receipt, she should be able to submit the cost once her insurance is reinstated, but I will have already paid the brand name price, not the agreed upon insurance price.

The pharmacy claims they only make about $4 on this prescription.  How can this be?  I understand when NEW medications cost a lot, because you are helping pay for the research and development, but this medication was not new when I was giving it to patients over 50 years ago.

What do people do who can’t call Grandma Ruthie?