Need to fill your CareFirst Blue Cross prescription? Good luck.

You may recall my ongoing health care nightmare. In a nutshell, I have the best self-employed health insurance that Blue Cross Blue Shield offers in DC, and the prescription coverage is pretty mulch zilch. Oh, they’ll tell you it covers $1500 a year in prescription drugs, but try to pick up an asthma drug, at $350 a month, and see how many months of breathing you get under the plan (that would be 4). And if you have something really bad, like MS or HIV (I don’t, but know people who do), your monthly drug costs are easily in the range of $2000/month. And, as I’ve noted before, CareFirst doesn’t increase your annual limit – so I was permitted $1500 in prescriptions in 1997 when I got the plan, and I’m still stuck at $1500 a year, which buys a lot less today than it did in 1997 (even though my premium has tripled). So, if I ever come down with anything chronic, or catastrophic, I basically have no prescription drug coverage. And it’s the best plan I can get with Blue Cross as a self-employed person. What a country.

Anyway…. our latest saga is something I think a lot of you will find illustrative, and helpful. Being a good citizen, I’m trying to lower my prescription drug costs, since CareFirst basically offers me next to nothing in coverage, and that coverage is dwindling, so I’m shopping around. Specifically, I need a drug to help with some allergy-induced breathing problems. The brand name drug, Advair, is absurdly expensive for a one-month supply (on the order of $270 to $320 per month). So, my doctor came up with a solution – just buy the component parts, the two drugs that make up Advair. Surely that’s cheaper. Well, kind of. The one drug, my doctor has lots of free samples of, so that we have covered for free, for now. The second drug, salmeterol, is still kind of pricey. And there’s another catch – sometimes it kills people.

You see, if you take salmeterol by itself, without the other drug they mix with it, people seem to have a habit of dropping dead occasionally from breathing problems, the same problem the drug is supposed to fix. But when you combine the drug with another drug, which is what Advair does, it actually works very well and everyone at the FDA gave it a thumbs up.

So, the solution I’m having to follow is this. I am having to take the two different drugs separately, and hopefully I’m not dumb enough to miss a dosage of the one drug and risk killing myself. Now, I’m a smart guy, but even I know that it’s kind of easy to forget what drug you’ve taken when, when you’re doing a lot of prescriptions. And I’d have to imagine that some people out there are even flightier than me – so they might even run a great risk of missing a dose of the companion drug, and thereby putting their lives at risk. This is the solution to our high drug costs in this country, have patients put their lives at risk and hope they’re smart enough not to screw things up.

Oh, but it gets better.

Being the diligent guy I am, I called around to find a good deal on salmeterol, and some other prescription drugs, since I want to help my insurance company cut costs. Good luck with that. I called Costco (and you can check their prices online too) and was told that the salmeterol is $150 a month. I then called CareFirst/Walgreens (they have an exclusive deal for CareFirst partients to buy drugs online) and was quoted $199 a month. But the Walgreen’s lady told me something interesting. That might not be the “real” price. Huh, I said. Well, she explained, sometimes they negotiate better prices with the drug companies, so the price I actually pay might be lower. Great, I said, so how do I find out what the real price is? She couldn’t tell me.

So, I called BlueCross directly and was given the number for Argus, their prescription drug people. The nice man at Argus was a blithering idiot. First off, he couldn’t understand the concept of my asking “how much does the drug cost.” He kept going away for ten minutes and then returning with my co-pay. I kept telling him, I don’t want to know my co-pay, I want to know the overall price of the drug, and then, if you want, telling me my co-pay wouldn’t be a bad thing either. He’d go off again for five minutes, and return with another off-the-mark answer. The thing is, every time I’d hear him talking to someone behind him – why they couldn’t just put the other guy on the phone was beyond me. In any case, the guy finally gave me a quote for the salmeterol – $72 – which was almost a third of what CareFirst/Walgreen’s told me, even though they’re all quoting me the price I’d pay buying it online from them. And the guy kept coming up with different price quotes on various drugs (“oh, I’m sorry, I got that wrong, let’s try again”), so God only knows what the drug really costs.

So, if you want to buy your drugs directly from CareFirst, they won’t tell you how much they cost without pulling teeth. Way to comparison shop. But again, the story gets even better. Costco offers cheap drugs on a lot of things, but Costco, for some reason, doesn’t take CareFirst-DC insurance for their online pharmacy. Why is that, I asked? Because CareFirst-DC wants you to go to their own online pharmacy run by them and Walgreen’s, Costco told me. But I can’t find out how much CareFirst/Walgreen’s even charges for prescriptions, even when you call them by phone. So how am I to comparison shop, get the lowest price, and save CareFirst money, when the only online pharmacy I’m permitted to use under their plan is their own, and they won’t tell me how much the drug even costs?

Are you seeing a pattern here?

These guys are begging to be regulated by the federal government. They’re not interested in cutting drug costs. CareFirst couldn’t care less how much I spend on prescription drugs each year because they’re never upping my coverage limit beyond $1500 a year – that’s all they pay, period. What CareFirst is interested in is making sure that every dollar I spend on drugs goes through them, regardless of whether that option is more expensive than alternative pharmacies. The incentive structure is totally wrong.

I did finally get one woman on the phone at CareFirst/Walgreen’s today, and asked her if we can submit the order, not give them my credit card yet, and then when they try to charge me, ask them how much they’re charging me for. She said that would work, but I’d first need to get my doctor to fax them the prescription. So that’s what I’m doing. And if CareFirst/Walgreen’s charges more than Costco, I’m going to have to get a handwritten prescription from my doctor, or have them fax Costco the same prescription, and trudge out to Costco in the suburbs since there they probably will take my CareFirst insurance (apparently, the walk-in service doesn’t compete with Walgreen’s monopoly – then again, it clearly does, and I don’t yet have confirmation that Coscto’s walk-in service can take my insurance).

Folks, this is a deplorable state of affairs. I needed a law degree to try to figure this out. We need a health care system that doesn’t limit your annual amount of prescriptions in a way that basically makes your prescription plan meaningless if you have a chronic, or catastrophic illness. We need a system that forces ever pharmacy to accept whatever insurance policy you have, so long as it’s a reputable policy from a reputable company. We can’t go on living with firms like BlueCross and CareFirst and Walgreen’s who seem more interested in making money than cutting costs, or helping people stay alive.

UPDATE: I just read my policy, and get this. My copay is twice as high if I use a mail-order pharmacy – i.e., if I buy less expensive drugs – than if I go to a retail pharmacy. Another provision to help Walgreen’s and screw the customer? Yeah, CareFirst Blue Cross is very very concerned about those soaring drug costs. So concerned that they provide disincentiv
es to anyone trying to buy their drugs cheaper. It’s time for Obama to clean this industry up, and out.


Follow me on Twitter: @aravosis | @americablog | @americabloggay | Facebook | Instagram | Google+ | LinkedIn. John Aravosis is the Executive Editor of AMERICAblog, which he founded in 2004. He has a joint law degree (JD) and masters in Foreign Service from Georgetown; and has worked in the US Senate, World Bank, Children's Defense Fund, the United Nations Development Programme, and as a stringer for the Economist. He is a frequent TV pundit, having appeared on the O'Reilly Factor, Hardball, World News Tonight, Nightline, AM Joy & Reliable Sources, among others. John lives in New York City, and is the cofounder of TimeToResign.com. Bio, .

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