Wasteful pharmaceutical system needs to be fixed

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Wasteful pharmaceutical system needs to be fixed

Postby Agitator » 23 Apr 2014, 00:06

Here is my experience today with the health system. My wife's doctor, a cardiologist, had prescribed the drug Diltiazem for her. Initially she took 120 milligrams a day. After recent testing, her doctor increased the dosage to three pills taken at the same time once a day.

To avoid counting so many pills -- I count out a weeks worth at a time -- I told the doctor it would be more convenient for me to have one 360 mg pill instead of 3 X 120 mg, since the amount of medicine is the same. He did. I purchased the 360 mg pills at Cub Pharmacy and paid a reasonable copay consistent with the previous 120 mg pills.

My insurance, UCare for Seniors, sent me a summary of pharmacy costs, showing what I paid (as co-pays) and what they paid. I was astonished at what I saw.

The cost to use 3 X 120 mg pills a day for three months:
UCare pays $81, I pay $45. Total = 81+45 = $126 (reasonable)

The cost to use 1 X 360 pill a day for 3 months:
UCare pays $708, I pay $38. Total = 708+38 =$746 (not reasonable)

Result: The cost to prevent having to count to three was 746-126 = $620
OK, I made a bad decision. It's not worth $620 to avoid counting to three.
One could claim that it doesn't matter because insurance pays for the bad decision. But not true. I pay because the total cost, not my cost, determines when I reach the "doughnut hole", at which point the insurance covers only a small fraction of the cost and I pay the rest. By the end of the year it will be my loss.

I had no way of knowing. When I switched to the more convenient pill my copay did not go up so I had no clue that it would eventually cost me nearly $620. They don't tell you that number.

To understand how such a stupid thing could happen I asked questions:
UCare for Seniors says it is not surprising. They just pay what the pharmacy bills them.
Cub Pharmacist says that at the time of sale, the UCare data base gives them the amount of copay to charge the patient but not the total price. In my case the 360 mg pill was not made by the same manufacturer as the 120 mg pill.

I remember from Econ 101 that for an economic activity to be efficient those who make decisions should have information as to the economic effects. That is not the case here. I had no way of knowing the effect, nor did UCare nor Cub Pharmacy. If I had known I would have opted to count out triplets rather than to pay an extra $620.

This aspect of way our state's/country's pharmaceutical system is organized contributes unnecessarily to rising cost and inefficiency. I suspect this type of waste is occurring throughout the US wherever drugs are covered by insurance. It needs to be fixed.
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