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- Written by Arthur Vidro Arthur Vidro
There is one question every consumer should ask the pharmacy when making the initial purchase of a new prescription. But we tend not to ask questions. We just slap down our cards and wait for a computer to tell the pharmacy how much money to collect from us.
Earlier this month, I was given a new prescription by my doctor. If it proves helpful, it’s something I might take perennially.
Unfortunately, until you get to the pharmacy, you probably won’t be told how much the drug will cost, how much your health insurer will chip in for it, or how much you’ll be expected to pay out of your pocket.
The prescription might even go directly from doctor to pharmacist, electronically, never being placed in your hands. Which means you won’t even know how to spell the darned drug.
I don’t like surprises at cash registers. I prefer to know my costs long before I reach the checkout. But with the pharmaceuticals industry, there’s no way around it.
And I don’t blame the pharmacies — they’re as hamstrung by the rules as are we consumers. The cost they tell you comes from the insurance company, and it varies greatly from one insurer to another.
So I went to the local mom-and-pop pharmacy to get my first month’s dosage of this drug. (If it improves my health, then I’ll label it a medicine.)
Though I didn’t know it when I entered the shop (doctors don’t automatically mention these things), there is a generic version available. Therefore, the purchase would cost me much less than I had feared — about $22 and change out of my pocket for a month’s supply, said Carl the pharmacist.
But before paying, I asked Carl the one question all consumers should ask when starting a new prescription: “How much would it be without the insurance?”
Normally you can expect a great difference in drug costs between a person with health insurance and a person without. That difference could get magnified manyfold if there is no generic version of the drug available.
As a rule, the cost via insurance is lower, sometimes considerably lower, or there is no difference at all.
Ah, but every once in a while, the consumer with no insurance at all — or the consumer with just a freely dispensed drug-saving card from the manufacturer that some pharmacies honor and other pharmacies don’t — pays less than a consumer using expensive insurance.
Carl happily obliged my request by researching the answer. Without insurance, the cost would be $13.50 — which, you’ll note, is about $9 less than the rate for purchasing the very same drug, in the very same dosage, in the very same quantity, and at the very same pharmacy, than if I were to have the purchase processed through my health insurance.
“Oh, dear,” I replied. “I seem to have left my health-insurance card at home. Would you mind ringing this up without applying my insurance?”
Carl obliged me again.
I’ve asked around. Seems that until just a few years ago, pharmacies were not permitted to alert you up front on those occasions when it would cost you less if you circumvented the insurance. They were under a type of “gag order” implemented by some of the pharmacy-benefit managers, who act as a sort of subcontractor for the health insurance providers.
However, if you broach the subject, the pharmacy is required to answer your question.
So when you initiate a new prescription at the pharmacy, ask the question: “How much would it be without insurance?”
If you don’t ask, you might never know.
Arthur Vidro worked for a decade in the stock industry. Before and after, he wrote newspaper articles and edited a few books. He has served as treasurer of theater and library organizations. He’s been cautious with money ever since a dollar was worth a dollar.