Last January, I was diagnosed with diabetes. When I recently went to pick up a diabetic medication at the pharmacy, the bill shocked me.
I have a theory about drug prices. The price tag for a monthly dose of a new diabetic medication my doctor wanted to try me on prompted the theory.
My diabetes, which my doctor officially diagnosed in January 2020, is well under control. I manage to keep my A1C, a measure of your average 3-month blood sugar level, under 7.0.
Since my last visit to the doctor, I also lost 10 pounds, which certainly helps.
But my doctor suggested I try a relatively new medication that helps some people lose weight and might even help my A1C level more. You’ve surely heard of this stuff. The commercials feature a jingle sung to the tune of Pilot’s 1975 hit “Magic.”
The drug involves the use of a pen similar to an epi-pen. My doctor warned me they might charge me $25 for the pen and another $25 for the monthly dose. But with insurance covering it, that should be the most I’d have to pay. If the bill ran much over that, he told me to let him know and they’d look for coupons.
Some drugmakers offer further assistance, clearly realizing the prices they’re asking are far too high to begin with.
When I went to pick up the prescription, the pharmacist asked me if I’d ever been on this stuff before. That struck me as an odd question. I told her I’d been on it for about a month because my doctor started me on a sample kit. But this, I said, would be my first actual prescription.
She said, “Well, the bill for it comes to $828.”
That’s for a one-month supply.
I asked if my insurance company didn’t cover this diabetic medication.
Oh, they did cover it. They paid enough of the roughly $1,000 price tag to drop the price all the way down to $828.
Who can afford that for one month of medication?
That’s a mortgage payment for a lot of people I know. It’s almost a full mortgage payment for me.
Maybe I hang around with the wrong crowd, but I don’t know many people who have an extra mortgage payment each month burning a hole in their pocket to spend. If I had that much extra money that didn’t need to go to anything else, I’d pay off my mortgage faster.
I called the drugmaker and asked about their “discount card.” They claim it can drop the bill down to as little as $25.
But I actually read the fine print. The discount card offers a maximum of $150 in discounts. That would drop that $828 bill — for a month’s supply — down to $678.
They may well think that’s a huge bargain.
Every insurance plan is different.
Some of us are fortunate enough to have insurance that includes prescription plans.
But some of you are lucky enough to have insurance with prescription plans that actually make prescriptions affordable. Clearly, I’m not one of those people.
My doctor’s office suggested that the deductible for my prescription plan might be to blame. I have no idea what the deductible is. When I signed up for insurance, I didn’t have a choice in deductibles.
So I’m at their mercy.
I suspect that’s exactly where they want all of us.
That way, they can decide what they get to pay and we have no voice. They can be as generous or as stingy as they want.
But I have a theory on prescription prices.
Yes, I realize we live in a capitalist system and manufacturers and retailers get to set prices they think are reasonable.
But I think many have completely lost sight of what reasonable means. So I’d propose this little test.
It would involve every executive at every drugmaker and insurance company. The plan would affect the prices of every prescription either they or any member of their family needed.
With their higher levels of income, since they’re executives, they’d face a sliding scale for their own prescriptions. If they had to pay a similar percentage of their own mortgage for every prescription, I suspect we’d quickly see prices coming down.
I don’t fault any company for trying to make a profit.
I do fault makers of medication and businesses who step into the delivery process who make needed medication unaffordable.
But I have friends who faced cancer diagnoses in the past few years. Some of them face far more expensive prescription bills. Fortunately, most that I know have insurance plans that did make their medication affordable.
But what about those who don’t? What do you do when you have to decide between a mortgage payment and a one-month supply of medicine?
I can get by without this medicine. Needless to say, I left without that subscription.
Whether it’s a diabetic medication, a cancer drug or something else that you need, none of us should ever reach that point.
If drugmakers and insurance executives faced that question, I doubt any of us ever would.