To Our Clients and Friends:
For a variety of reasons both personal, financial and political, medical insurance companies and Big Pharm are not on my happy list. On a good day, I find them annoying. On a bad day, I find them … very annoying!
In this short article, I am going to deal with managing the financial costs of medical insurance and Big Pharm as it relates to prescriptions.
Most of you will not care about my political views on the topics of medical insurance and Big Pharm so I will leave that discussion at the end of this article. It will be easy for you to skip over.
The problem
Last week I discovered that my Medicare Supplemental Drug Policy will not cover a medication that I need. The medication is expensive, without insurance, it is $300 a month; with a 20% co-pay under my old policy it would have been $60. Remember that number: $60; it will become important a bit later on.
A bit of related personal information and background
The advantages of having a long-term relationship with an outstanding primary care physician cannot be overstated. For the past three or four years I have been developing a collection of minor symptoms that are collectively getting a bit more pronounced. My doctor said, ‘I think you are suffering from this medical condition and I am going to prescribe this medication to see if it is effective.’
Two things about this meeting surprised me:
- The doctor’s diagnosis was 100% understandable; I had heard of the condition among my peers and it is not unusual in my age group. I understand my condition; I can even pronounce its name!
- The medication was immediately and remarkably effective!
So yea! Good diagnosis and good medication.
The problem
The problem, as I said, my supplemental drug policy will not pay for the drug. A $300 a month payment for a necessary medication is more money than many of my peers can comfortably afford. This is a problem!
My physician’s nurse, who called to give me the bad news, was as frustrated as I was.
The propaganda and the exclusion
I mentioned to the nurse the possibility of having a local pharmacist compound the medication. The nurse said,
“O-no; that’s not a good option. Compounding medication will be twice as expensive as the drug companies. It will cost $600 or more to get this medication compounded and the insurance companies never pay for compounded medication.”
It is a fact that medical insurance companies only pay for manufactured medications, i.e., Big Pharm! They systematically exclude compounding pharmacies from any reimbursement whatsoever.
The propaganda (or marketing if you will) that is pervasive is that compounded medication is more expensive than Big Pharm manufactured medication. This is 100% untrue.
My Compounding Pharmacist
CPAs are trained to be skeptical. When someone presents me with an unsupported fact such as, “compounded medications are twice as expensive as manufactured drugs”, I want to verify the accuracy of that statement. So; I called a compounding pharmacist and did a bit of price shopping.
My new pharmacist said this,
“Sure, I compound that medication every day. A monthly supply will be about $50, but, I have to tell you, your insurance company will not reimburse a compounded medication so you will have to pay full price.”
The exact same medication for $50 instead of $300! The compounded medication will cost me $50; with full insurance coverage, the co-pay alone would cost me $60. This is a serious pricing mismatch!
How to fight back against Medical Insurance and Big Pharm!
I asked my new pharmacist to call my primary care physician and discuss my case; the result is that prescription has now been transferred to my new pharmacist.
Is this a massive blow against the machinations and machinery of the medical insurance industry and Big Pharm? No; it doesn’t even qualify as a little bitty blow.
But –
I accomplished two things:
- I took care of my family’s finances
- I sent my business to a compounding pharmacist.
It’s those professionals, the compounding pharmacist, who can strike a significant blow against Big Pharm.
My recommendation is this: if the medical insurance industry and Big Pharm give you problems concerning your medication, investigate your local compounding pharmacist.
Skip the politics
Two things have influenced my politics on the topic of medical insurance and Big Pharm; one is an event that occurred 30-years ago, the other is a recent article written by an esteemed physician, Adam S. Richardson, Dermatology. Esteemed in my eyes anyway, he is my son!
Thirty-years ago I was out of the country when I discovered that I left home without my high blood pressure medication. Even with my insurance coverage, this medication was $160 a month. I called back to my primary care physician (the same physician I still use) and ask him to call a local pharmacist in Jamaica. A 30-day supply of my prescription was delivered to my guest house with a $7 bill (which included delivery). Wow! Same drug; same packaging, same inserts, exactly the same. $7 (not insured) verses $160 (with full insurance coverage). I am delighted and also annoyed!
The policy of Big Pharm to overcharge US customers and undercharge non-US customers is a political issue for me.
Dr. Adam Richardson wrote an article for a respected dermatology journal one of the conclusions was that dermatology patients could be better served by more judicious use of local compounded medications because of the significant cost savings.
One reason that I have a high level of respect for the medical profession is their commitment to a central unwavering concept; in the final analysis, it is the “Quality of Patient Care” that matters!
Adam’s article points out an important issue: the cost of medication can compromise the quality of patient care. To any physician, that is an unacceptable outcome.