Effective March 1st, our medical insurance was changed by my husband's employer to a new company, a cheaper version of insurance coverage and one which will require us to fill our prescriptions only by Target, Walmart or Costco. Otherwise, this new company will not honor or cover our needed RX's. It is still not certain they will cover or partially cover some of them at all. That is yet to be determined.
We are effectively covered but do not have our insurance cards, I.D.'s or group numbers, etc., that are necessary for us to be seen by our physicians or to have on-going prescriptions filled, under the coverage of our "new" insurance company. This is a new reality for us and certainly not the end of the world. Sooner than later, we will have our necessary documents to continue seeing our doctors, filling our long time addicting drugs under the new coverage, once approved, without which we could not exist! This, according to the hundreds of daily television ads for life saving drugs is for everything that ails us, from head to toe. "There is a drug for that."
Ours, is hardly a big dilema, when so many households and individuals have absolutely no medical coverage at all! We are grateful, those of us who do have employer paid medical benefits, for sure. A mere inconvenience is all. One does wonder what would happen in the interim, however, if there was an accident or medical emergency with the ensuing stall for the paperwork, red tape and sign-in protocol at the emergency room. Could be a veritable nightmare. Perish the thought!
My husband, the insured, asked this question of the insurance rep for his company, who is handling this "transition." The answer was quite simple. "You pay out of pocket and then fill out a claim to be reimbursed, which may or may not be covered" by the "new" insurance until investigated. Well, then, we'd sure better be careful not to get hurt or sick, have a car accident or go into cardiac arrest until the "new" cards arrive. Check. Got it. We'll be very careful.
Having used a nationally recognized mega drug store chain for our prescriptions for nearly two decades, we were informed we can no longer use them for our refills. OK. No more convenience of the corner drug store near our home. Will now need to drive over half an hour away to the nearest approved drug counter. Or, go on line to have the scripts filled. Will look into that as well.

First phone call was to Costco to confirm they carry all the RX medications we require, including my NBHRT, natural bio-identical hormone replacement therapy meds. Don't question my use of these. You don't want to see a raving sleep deprived, sweaty, emotionally strung out woman without them. Trust me on this. They make me feel really good. Leave it at that.
First question to the Costco pharmacist was to request their costs for said drugs, particularly, the hormone replacement which is soon to run out. She told me it will cost $120 for 30 pills, less the Costco discount, once I come in and sign a form and provide my Costco membership number. Easy enough. She provided some other costs relative to our medications, which I noted and hung up.
Second phone call was to our current drug store pharmacist for the same information for comparative purposes. I'm thinking they will undoubtedly be higher but wasn't prepared for the disparity in costs. This one particular RX would be...and the pharmacist prefaced his response with, "You are not going to believe this when I tell you, but it will cost you $800 and change a month for just this one." In utter disbelief and shock, I dared to ask, "Are you serious? Are you sure!?" He confirmed it was the correct cost, so I told him what Costco quoted me. He very apologetically explained to me that the enormous cost difference was due to the fact that major drug chains are "profit centers," whereas, Costco is not. So, I did a little quick math and realized with an even bigger lump in my gut, that the pharma companies and the retail outlets where their RX's are sold, are both obscene profit centers!
I realized first hand and for the first time in my medically covered life, just how much excess profit there is in prescription drugs and was struck by the horrifying truth. Pure and simple, this is just so wrong. I felt instantly guilty for not knowing this, yet how could I have? It was always just billed to our insurance company, less the co-pays, which I will never, ever complain about again in my lifetime.
Goodness, gracious, did I ever get a wake up call and major reality check! Never again, will I fill a prescription anywhere else other than a non-profit pharmacy. I had no idea there was such a thing. Apparently, the big box warehouse clubs, the one's with pharmacy centers, are non-profit and provide a tremendous service and savings, both to the insurance companies and to it's members.
So, before I go through a nasty withdrawal from my daily meds, I am headed up the road a piece, to sign a form and retrieve my life saving RX, to ensure another restful night's sleep without suffering the ravages of menopause.
So I ask you: What did we ever do...back in the "olden days," before prescription drugs?
(Those Cherokee women must have been wound tighter than a tee pee)!
Do you know where all the profits in drugs are going and all in the name of "wellness?"


Salon.com
Comments
With a deductible of $2,500, even with insurance, I just try to stay out of health care.
Indeed Cathy. I can't say enough things about Costco as a company. They are based out of Washington and the CEO is excellent. His base salary is in the 250K range, well below his contemporaries. He believes he should actually 'earn' his income by how his company performs and share with his employees. They provide a great service. They treat their employees well and provide growth opportunities.
One bit piece I want to do is on the ratio indicator, which is listed on every publicly traded company (I forget what its called), of CEO's salary to the average employee. I did an analysis of this in the late 90s, and during the early 90s, the average income was approximately 220x the average worker. By the late 90s, it was over 400x - with Walmart's CEO being the highest paid. That means he is paid 400x more than the average worker. That type of greed is what goes unnoticed by the average American and it could be changed by how we use our dollars.
Anyway, my little rant. Sorry to take up space here. I just pay an inordinate amount of attention to business ethics - having lived in that world for awhile.
Thanks, all, for your valuable input on this concerning subject.
Beyond that I can say I did not know this info at all.
I just question why we all did not know already here. I TY for letting us know.
Wise as ever, Cathy, well said. Rated.
Yeah. That's a good reason for a nearly 600% markup over what the NP pharmacies charge. I mean, how much "profit" is really needed here? Big oil used the same excuse when they had a $10 billion profit posted while crying that supply and demand required a $4/gallon price for gasoline.
Rated.
Rated.
If there is one kind of service employee I DO NOT want pissed off, it's a pharmacist.
Here in OZ we have no such problem. It's simple. No insurance coverage, no prescription coverage, no drugs... 'xcepting those we pick up here and there.
Dr. Evan S. Levine
Ugh.
R
I had that wake-up call you just had when I took the youngest to an urgent care for a flu/fever. It was a Friday night. Then went to fill the amoxicillin scrip. It was over $100.
I. Could. Not. Believe. This.
They said if her "treating physician" prescribed it, it'd be the normal whatever, eight bucks, I think. But this is what it is with an out of network provider, etc.
Buncha bullshit.
So how is the million dollars spent? About 30% goes to the health insurance policy and TPA administration fees the rest is used to pay claims for doctors, hospitals, and drugs. Most TPA's have preferred providers network list. These doctors, hospitals, and agree to a set fee or discounted fee to be part of the network. The more the company reduces actual claims and drug cost the more it saves on employee healthcare cost. The good ones use their healthcare dollars to promote greater wellness and reduce the cost of illness. The bad ones find ways not to cover claims or procedures. The really bad ones find a way to get rid of high risk employees before they get sick.
Note from husband: As he travels extensively out of the US for business, he recently discovered that he can get a well known sleeping aid designed for trans-Atlantic/Pacific travelers, which helps one adjust to an upside down time zone. We know these as Lunestra and Ambien. When asked for the cost here in the US through a regular, for profit pharmacy, he was told it would be $440 (without insurance). Overseas, the exact same drug was OTC and $30 bucks out the door! No scrip necessary with the usual doctor visit first and no questions asked. And to sweeten the deal, the dosage was more than double what it would be here, so he splits them in two for double the value!
So I have to ask another question: WHY OH WHY are American Pharmaceutical companies "sticking it" to Americans?!?
Though we all have multiple choice answers to that question, it remains quite startling to me that we are in this predicament today. I am in awe of this discovery and not in a good way.
More disbelief, disenchantment and disharmony among the masses?
Heck, yeah!
Monte
if we were a society without insurance and someone came to you and described what their 'service' would be, i think we'd laugh at them or turn them over to police.
everytime i take my husband to the dr's the lobby is filled with pharma representatives. there will be at least 3 and the last time i counted 7 waiting to see the various drs. if they are paid on commission (i don't know if they are or not) the pressure to push their products on the doctors who are then pressured to push them onto the patients must be horrendous.
i am not against anyone making a fair profit. but profiteering is another thing entirely.
now i gotta go take a pill to calm my stomach down... :-)
Boy do we talk, and talk. We learned something new about Walgreens, they charge her the scrip copay no matter what. In trying to find one generic drug that worked she moved her scrips to Rite Aid and the cost of the same brand generic was half her copay. They even got us and we are well guarded against the medical Industry.
As far as big pharma goes, the only drug I'm willing to try that hasn't been pumped into humans regularly for at least five years is if they come up with a anti jerk pill (instead of jerk I used a word that starts with A) that will keep me protected from that bacteria. I told that to my GP who I adore the last time she wanted me to try something new and better.
There is good news in the Boise area, all the provider groups and hospitals have lots of openings in account collections. If you're looking for a job, give it a shot, they're all hiring for that job.
I think I see a bump in the road ahead... rated out of shared desperation.
I love Costco. They treat their employees well. They offer fair products for a fair price. There's no Muzak, no baggers, no frills, no extras, and competent, well-paid, well-insured, happy employees.
Great post.
And, yes, for those who gave a shout out to Costco for their superior eye care services, this I knew some time ago. Absolutely right and we sent our daughter there for her eye when she was in high school. Both the filling of her RX and the frames, were a fraction of going to a private Optometrist. Should be no surprise by now.
When all else fails, a really authentic Mexican dinner, complete with Cadillac Margarita's (extra Grand Marnier) please, just fits the scrip perfectly. I'm there.
Thanks for all the great discussion, feedback, wisdom and perspective on this subject.
As always...
Cheers,
Cathy
that is unreal. i had no idea there was THAT MUCH difference ...
it's probably bad that this all made me feel a little sick, huh?
I did a post of health insurance. The average American switches health insurance every 3-5 years. As a rough estimate, the average insurance company client will be with them for another 2 years.
This means that there is little incentive for insurance companies to invest in your wellness. Most programs to help with chronic disease, overweight, high blood pressure, etc, take time and money.
Resolving many health problems take a long time to pay off, when you will probably be some other company's (or Medicare's) customer.
This is why health insurance tied to jobs is a really stupid way to fund health care.
I laugh bitterly and sardonically when pundits and politicians pronounce people "satisfied" with our current system. As you have pointed out here so dramatically, people are satisfied only so long as they remain ignorant about the actual costs.
In fact, most people who have had to use the system in the last ten years are NOT satisfied with the system. And every objection people raise about a single-payer system is already a reality with the insurance that denies coverage and rations care.
You also wrote: "You pay out of pocket and then fill out a claim to be reimbursed, which may or may not be covered" by the "new" insurance until investigated."
Good luck with that!! Remind me again, what are you paying for with those outrageous premiums?
Well, suppose we did the unthinkable and cut spending on prescription drugs by NINETY-FIVE PERCENT. Would that take us back to the Dark Ages? Nah, it would take us back to... 1980. And if memory serves, the streets weren't littered with dead bodies back then.
It says in the book of Genesis "Our days on earth are threescore and ten, or fourscore if we are strong." In other words, we can infer that at the time thise words were written, if you didn't die of accidents or violence or infectious diseae, you could expect to live to be about eighty. Today, if you don't die of accidents or violence or infectious disease, you can expect to live to be, uh, about eighty.
We still grow old and die. That hasn't changed.
Most people are born with everything they need to have a powerful and healthy body into their seventies, with minimal help from the medical profession, if they exercise, eat sensibly, and refrain from smoking and excessive drinking (and most people can't be bothered to do those four simple things). And after eighty or so, you won't be able to expect much from the medical profession except to keep you as comfortable as possible during your final days.
This is why health care reform is necessary.
Yesterday I spoke to my Dr about a possible hysterectomy which is scary enough but not knowing my out of pocket expenses is just as scary!
Maybe I will have a Top Shelf margarita and think about it a while : )
When you pay for your own health care, you learn to shop around, just as for any other expense.
However, it should be noted that this is the price that is being paid as the result of a" Lack of Wellness" versus"The cost of wellness".
The single biggest contributor to U.S. health care cost is our ever increasing epidemic of excess weight gain/obesity. The exploding incidence of obesity with the younger generation is bound to deal a crippling blow to our Nation's future security.
In fact, 75% of the 17-24 year olds that apply for military service no longer qualify according to the latest reports by the Generals. Some of this is due to a lack of education and or criminal records but the overwhelming majority is excess weight.
Although Big Pharma would have you believe R&D is responsible for the high costs of their wares, it should come as no surprise that their massive advertising budgets contribute significantly to the prices you pay at the pump.
As a measure of the growth curve, in 1952, Merck & CO total annual sales were 1.5 million dollars....today @ 24 billion per/yr!
As an aside, over the last 50 years, nearly half of the prescription drugs approved by the FDA have been removed from the marketplace as the result of their dangerous and potentially deadly side effects on human health! 120,000 people die each year(U.S.) from prescription drug use/abuse....fewer than 15,000 die from all the illegal drugs combined in any given year.
Silkstone, Kristina, Gary and Angela - All such excellent points to this discussion and valuable information for all of us to know and understand.
Sorry that I didn't address all the individual comments to this post. I am very grateful for them all as they each express such important individual incites and experiences with our insurance dilema.
Check your mutual funds and be sure you don't have stock in Big Pharma. Most doctors do, I'll bet. You can't argue with their profitability, but it would sicken me to make a buck off it.
By the way, that's the same society where people who love each other, but just happen to be the same sex, can only get married in certain states of this "union."
Just Cathy: Thanks for the Costco tip; I'll try it as soon as I figure out where one is.
Thanks Cathy! And good luck BTW
With the wellness crisis we’re in now, you’d think some actions would take place, but of course, that gouging doesn’t apply to big pharma and, surely that has nothing to do with campaign contributions and lobbies.
BTW – you getting pounded by snow this year?