I was so inspired by Charles Ornstein’s ProPublica piece this morning "One Drug Two Prices" about how he tried to navigate the insurance industry,that I did some digging too.
Ornstein wanted to know why his 9-month-old son’s asthma medication that used to cost him 15 dollars, now cost 30 dollars. I wanted to know why my 20-year-old son’s eye drops for hay fever went from 45 dollars one year, to 30 dollars the next and then a whopping 123 dollars this year.
Ornstein made some calls and was given a bunch of different reasons (including the more expensive price was wrong, then he was told the cheaper price was wrong) until a manager said him the medication was switched from Tier 1 (lowest cost to consumer) to Tier 2 (higher cost).
As he writes: “Consumers are navigating a health care system in which they pay an increasing share of the cost but often have insufficient information to make the right decisions. They assume that pharmacies are charging them the right co-payments, that insurance companies are paying the correct share. But as health plans' rules for prescription drugs become more complicated, it's harder to tell."
He also suggests that we all start asking questions. So I did. I found out that my son’s eye drops climbed Tiers too, moving also from Tier 1 to Tier 2. But nobody told me.
When I called customer service at the insurance company, they informed me of the switch and said I may want to try an over-the-counter eye drop for 15 dollars, or a generic brand—on their preferred list—for 10 dollars.
My pharmacist told me that the generic doesn't work as well. She also added that pharmacists and doctorscan’t possibly keep up with each patient's specific plan. Prices vary not just within the insurance company but it has to do with the arrangement your company has with the insurance company. What I pay for my eye drops may not be the same as what you pay for the very same stuff. I can’t expect my doctor to keep up with the changing Tiers or the pharmacist, but I do think we deserve to get a notification by the insurance company to let us know ahead of time when our share of the pay for our drugs switches. And I expect to know ahead of time rather than getting a shocking bill at the drug store.