Recently, both my daughter and my spouse needed to purchase medications that their doctors recommended for them.
Our high deductible HSA plan includes drugs, but we need to reach the deductible first before the plan pays anything.
One drug was an antibiotic and was quoted in generic form at over 200 dollars for the dose. When I asked about the price, I was told that the brand name drug was even more expensive. The other medication was more expensive for the generic than it was for the name brand when a coupon was given to the pharmacy.
If this sounds unreasonable and confusing, it is. Welcome to America’s healthcare system.
According to big pharma, middlemen drive the costs of drugs up and they push them down with coupons and offers either to the general public or to insurance carriers.
If you have a low copayment for medication, it may cost you little or nothing out of pocket if you have a coupon. If you have a high deductible plan like mine, you begin to ask questions and you may decide to skip the prescription altogether. You may even call around to get pricing elsewhere and sometimes, a generic can cost much less elsewhere.
The Trump administration is now taking aim at the middlemen who raise the price of medications. True, middlemen for years have existed to distribute drugs and medical devices, making a nice profit while doing so but to be fair, we as consumers are paying much more than other countries do for the same medications.
A simpler system for how we purchase prescription drugs may be just what the doctor ordered. Perhaps, pharmacies should post their prices.
Check out this recent NPR story on how the Trump administration intends on attacking the middleman problem.
Trump Administration Wants To Cut Drug Prices By Eliminating Middlemen’s Rebates
February 1, 2019
The Trump administration is proposing major changes in how prescription drugs are priced and paid for by Medicare.
The effort is designed to cut costs for senior citizens at the pharmacy counter and by its example could spur changes in the broader market for prescription drugs.
The draft rule from the Department of Health and Human Services would encourage drug companies to offer discounts directly to consumers and would reduce the role of middlemen that many policymakers say drive up list prices for medicines and increase consumers’ costs.
“We’re going to fundamentally rewire how we pay for drugs in this system,” HHS Secretary Alex Azar said in a briefing with reporters on Friday.
The key change would be the phaseout of rebates negotiated secretly between drugmakers and pharmacy benefit managers such as Express Scripts and CVS Caremark. These PBMs administer prescription drug plans for insurers and employers.