Thursday, April 02, 2009

Medication and Insurance Companies

Okay, I just posted a nice fun post, but now I'm irritated. As you all know, my daughter got married a couple of weeks ago and you also know that she has been diagnosed with a seizure disorder (epilepsy, is what they are calling it but they don't really know). Anyways, when she was on my insurance her medication was a $50 co-pay. On her husbands insurance, they are telling her it's going to be $86.44. When she told me that it made no sense at all because, I had contacted the pharmacy before she got married to find out the cost of the medicine without insurance and was told $150 something dollars. Her new insurance card states that prescriptions are as follows: Tier 1 - $10, Tier 2 - $20, Tier 3 - $30, all other 20% copay. Okay $86.44 is more than 1/2 the cash price. So I called the pharmacy, I know, she's married now and an adult with a child of her own, but I'm still her momma. Anyways, I called the pharmacy and they are now telling me the cash price is $331.72 for a 1 month prescription. What the hell happened in the last 3 weeks???? Okay, so if her medicine is that much and she has to pay 20% that's only $66.34, where is the other $20.10 coming from. The pharmacist technician, Mandi, told me that I would have to contact the insurance company because everything is done online and that was the price she was given. Chelsea called the insurance company and found out that her medication is actually a Tier 3 drug and should be a $30 co-pay. Wait, Chelsea just called me back and was told that because she has to take 100mg per day and the pills are 25mg each it is basically a double prescription each month and the price will be $86.44. I don't understand that at all, if it's a Tier 3 and should be a $30 co-pay, even doubled would only be $60. What a rip off.

Now my question, what if she didn't have insurance? How in the world is someone supposed to live with a siezure disorder and carry on a 1/2 way normal life if they can't afford $331.72 a month for medication. I guarantee you that the insurance company isn't paying near that for the prescription. They are probably only paying 1/4 if that. It's so sad, but shouldn't it be the other way around. I know Wal-Mart has the new $4 prescriptions, unfortunatly her medication isn't on that list.

Okay, my rant is over.


lunaticraft said...

It's a terrible thing to think about... Health Insurance in this country really is run like a business, and as someone who has been on the crap end of the stick (although, luckily, not for anything as crucial as seziure medication), and also as someone who personally and closely knows people who work at the Insurance companies themselves, I can confidently say that the patients are far worse off for it. Some of the horror stories that have been shared with me about claim denials are heart-breaking. And I don't even want to think about those who can't afford it.

Lupie said...

I have no idea what I would do if I didn't have the insurance I do. My meds for Lupus are over $1,000 a month. The drug companies have to make money and I understand that buut why so much I don't get. I think it comes down to the CEOs. I am sure they don't live in houses like yours or mine!