Having problems getting insurance companies to cover enough doses of triptans for migraine has been an ongoing issue for many years now. Many of us thought that triptan prices and insurance limitations would fall as more of the triptans were available in generic form. That hasn't happened.
Today, I saw a piece on the Huffington Post that made me say, "What on earth?" Here are the basics of what happened:
- Patricia Bernstein has had migraines since the age of four, and now has several debilitating migraines each month.
- Fortunately, Maxalt has been able to abort her migraine within minutes.
- In September, her doctor, David Belk, prescribed 40 generic rizatriptan tablets for her. He got a phone call from Walgreens, telling him that Patricia's Blue Cross plan didn't cover it. His receptionist called Blue Cross and got the generic rizatriptan authorized.
- When Patricia went to Walgreens, sure enough, Blue Cross was only allowing 10 tablets, and her copay would be $167.94.
- Patricia was suspicious, so she took her prescription to Costco. There, she could get all 40 rizatriptan tablets for the CASH PRICE of just $41.21 - WITHOUT her insurance.
So, let's do some math here. Patricia's choice was 10 tablets for a copay of $16.79 each, plus whatever her insurance company paid, OR 40 tablets for $1.03 each without using her insurance at all. So, two issues here. Which would we prefer - $16.79 out-of pocked per tablet or $1.03? Second, would we prefer to get just 10 tablets or the 40 as prescribed by the doctor. The answer on both counts is, "Duh!"
Now, let's get to the issue here. The Centers for Medicare and Medicaid Services (CMS) tracks an average of what all retail American pharmacies pay for medications. Their records show that the average price pharmacies paid for generic rizatriptan in September was approximately $1.20 per tablet. Let's not forget that the $16.79 per tablet at Walgreens was ONLY Patricia's copay. We don't know how much Blue Cross was going to pay. So, in simple terms, Walgreen's was pulling a gigantic rip-off. What they tried to do (and are probably doing to other migraine patients daily) may not be illegal, but it should be, and it's certainly immoral and unethical.
Who wants to guess the moral of this story? Patricia's story shows us that it absolutely pays to price our prescriptions at multiple pharmacies. I can tell you right now that before I refill my Axert prescription through my insurance mail-order pharmacy, I'm going to call some local pharmacies and price it. We don't have a Costco here, but we do have Sam's Club.
Oh, and on the off chance that someone from Walgreens should come across this post, SHAME ON YOU. I make you a promise - I will never set foot inside one of your stores again.
Belk, David. "It's Not Just Hedge Fund Managers: Pharmacy Hikes the Price of Generic Drug 3000%." The Huffington Post. October 13, 2015.