Trick Question

(Every so often at Pond Parleys, we’ll vary the format just to keep it interesting. This week Toni addresses one specific point and invites comment.)

TRICK QUESTION:

Q. When is an anti-biotic tablet not an anti-biotic?
A. When it’s masquerading as gold bullion.

Recently I had occasion to take one of the kids to a dermatologist (typical teenage skin problems). We were prescribed two creams and a wash, which cost me a total of $140 and that was after the discount they give through my health insurance company. The fourth prescription was for a thirty-day course of anti-biotics. The doctor gave me a “coupon” which assured me that I would only have to pay $25. Anyone in the States should set their “scam” alarm to go off when coupons offer seemingly big deals. Live by the motto “If it sounds/looks too good to be true, it probably is”.

My regular pharmacist referred the prescription on to a big chain pharmacy saying that he never managed to “get these things to go through”, and didn’t want to land me with the full bill.

“Oh, how much would it be normally?” I asked, innocently.

“Seven hundred dollars” he said. Yes, you read that correctly. Not quite sure what the conversion rate is today, but that would be upwards of three hundred and fifty quid on any day.

Now I have heard of some expensive medications before, but give me a break. I asked the pharmacist why it was so different from any other anti-biotic on the market and he said it wasn’t, it was just new and therefore the manufacturers “incent” doctors to prescribe it. (Not naming any names for fear of lawsuits.)

When I presented the prescription and coupon to the big chain pharmacy, no one batted an eyelid. I expressed concern about the coupon actually working and was told that they take this sort of rebate coupon all the time.

“So who picks up the other $675” I enquired, not quite so innocently this time.

“Don’t worry about that, your insurance company will be billed”, was the breezy response.

Now, without rehashing the intricacies of the US Health Insurance system, this was not the answer I was looking for. First, it’s not a “rebate” or any other kind of bargain if the cost is just being passed along to the health insurers. Everyone knows that the health insurers don’t absorb this cost; they pass it straight back to us, the people needing coverage, in the form of extortionate monthly premiums and “out of pocket” expenses. It’s no wonder the cost of health insurance is sky-rocketing and out of reach for over 47 million people in this country.

Second, and more important to me, we have a high deductible (excess) which we haven’t yet reached, so anything that is submitted to my health insurance company comes straight back to me in the form of a bill. I am NOT paying $700 for acne treatment no matter how much I love my kids. I called my insurance company, and I was correct, they wouldn’t be covering the cost. I then called the anti-biotic manufacturer to ask about the whole thing (more from a “discovery” angle than actually finding a way to get the tablets, at this point). Lo, and behold, on hearing that I would be picking up the $700 bill, they told me to get the pharmacist to re-enter me into their system as a “cash-paying patient” and the manufacturer would pick up the balance. So I did, and I think I only had to pay the $25, but can you imagine if I hadn’t started asking questions? I’d be interested to know how many people have been caught this way, and also if indeed, $25 is all I end up paying. Once that cost is processed, it’s very difficult to straighten it out because you can’t exactly take medications back and the system isn't particularly customer friendly.

This is not a call to debate the merits of one health care system against the other. I don’t care whose health care system you think is the best – a $700 30-day course of anti-biotics is a sign of an industry that’s completely out of control and out of reach for too many people.

Don’t you think?