Who to blame?

Many of you know me as a normally docile guy who uses common sense knowledge and wisdom to live life. And of course, we all have in faith in Him leading the way. Recent circumstances give me a reason to rant and vent about something that just defies common sense logic.

The practice that Steph worked for merged with another practice. We had to switch insurance to the new practice’s plan. There was nothing out of the ordinary that would cause us to be alarmed or consider alternative options, if there were any.

Last month, I went to get one of my prescriptions refilled. This was something that cost $30 for a 30 day supply…a buck a day. When the clerk said “that will be $201.50”, I was like “HUH?” Despite my frantic protests (has anyone ever seen me frantic??) and after some researching, she came back and said “your plan only covers generic”.

I am like ok…I can understand that but the drug I am refilling (Plavix) does not have a generic form. Not much I can do as she was only doing her job. So I paid the $201.50 and suddenly realized, WAIT…Steph is paying $1,000 a month for insurance and here I am paying over $200 for a refill???? The plan she came off of, she was paying $300 a month and Plavix only cost $30! Something is wrong with this picture!

After a few phone calls with the doctors office and the insurance company, it seems the attitude is “too bad…that is what your plan covers”. At least the insurance company has a grievance process. If I showed you the canned responses I got, you’ll laugh. Let’s get to that first…

Despite our best attempts, we got nowhere. Every single person we spoke to at BlueCross BlueShield of WNY said the same thing…”your plan only covers generic drugs”. And when we asked to escalate, the next person repeated the same script. I truly believe that if I had succeeded in reaching the President, he would say the exact same thing.

My rational for requesting an exemption is I am on a drug that if I stop taking it, the consequences can be life-threatening. Not that I won’t buy it or I can’t afford it, but come on….over six bucks a pill????? How in the world did it go from a buck a day to six bucks a day. “I am sorry Mr. Spritzer but you’ll have to talk to Bristol Myers Squibb. By the way, they do have an assistance program so you might want to look into that. Have a nice day!”

Lets see what could be a plausible explanation. Did Bristol Myers Squibb lose a plant in the Japan earthquake? Did a tornado pick up the plant and dump it in Poopadoopa middle of nowhere???? Is the main ingredient oil related??? Did they lose their main office building in the sub-prime mortgage crisis??? Did the credit card companies raise their fees 600%? Nope…none of these.

Ok…I’ll stop taking it. I’ll drop dead. My heirs can sue Bristol Myers Squibb (and BlueCross BlueShield of WNY) for medicinal homicide. And then they will collect about $500 after the lawyers take their cut of $9,999,500. And, Bristol Myers Squibb will blame Sam Spritzer’s heirs for causing the price increase.

Meanwhile, I contact their “Cost Assistance Program”. Seems I have to be on welfare or homeless in order to qualify. And that isn’t a guarantee either.

Then my son remarked that the generic form should be available this fall when the patent expires (thankfully, the federal government DOES look out for the interests of the consumer). So, when drugs are coming towards the end of that “protection” period, the pharmaceutical companies find it justifiable to jack up the prices.

If this isn’t highway robbery, I don’t know what it is. And it surely isn’t free market forces at play but more like greedy jackbutts sitting in their ivory tower offices overlooking the masses they are laughing at while ripping them off. And in all likelihood, couldn’t give a poop about their own health issues since they get all the dope they need to keep alive.

So who do we blame? Insurance companies? Pharmaceutical companies? Ourselves? In the meanwhile, off to work I go. I work, I pay, I live….end of story.

Post mortem – I got a text from Steph yesterday. Our insurance company gleefully approved a 90 day supply so that we wouldn’t be inconvenienced having to walk down the block every 30 days for a refill. The cost…$685. I text her back…and you don’t want to know what I said.

2 comments for “Who to blame?

  1. June 2, 2011 at 8:52 am

    Unbelievable! Well actually I DO believe it unfortunately. We are still fighting BC/BS over charges last August when my daughter was in Florida and suffered from a life-threatening ruptured appendix. Their claim that the ER, hospital, and specialists (here appendix wasn’t in the normal place) were out of state practitioners. Duh. Ya think? We still have 2 bills we are waiting for them to cover… grrr.

  2. June 2, 2011 at 1:47 pm

    Ugh Sam, that sucks!! Prescription coverage was always the first thing I checked when I had to switch insurance companies. The price of the drugs doesn’t change…what changes is how the insurance companies cover those drugs, what “tier” they fall into, and if you have a separate prescription deductible. It is very, very confusing!

    The same brand name drug can be covered at $25 or $30 a month with one plan, and cost hundreds of dollars on another. The plan I switched from before I became covered on Medicare was one that had a $500 separate prescription deductible. So I paid nearly full price for my brand name cholesterol drugs (around $100-$120 a month) until I met the deductible. Then I was able to pay a $25 co-pay after that.

    Even Medicare is confusing because you still have to pick a prescription plan. The medicines I take are covered in a wide variety of ways; some are Tier 2, some are Tier 3…all depending on the plan you pick. Since medicine is the one thing I need to pay for each month, that’s actually the most important component of insurance for me right now (sadly).

    Maybe you could talk to your doctor about this — see if there is another drug that does the same thing Plavix does, but is covered better by your insurance? I would get a copy of the formulary — it will show you all the drugs that perform the function Plavix does, and show how they cover those drugs and what your cost will be. I switched to a generic cholesterol drug this way — I took the formulary list in and went over it with my doctor. Unfortunately, the insurance companies can (and do) dictate care by refusing to cover what our doctors prescribe…it makes me just as angry as it makes you!

    I hope it all works out in your favor, Sam!!

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