Story Time - My Prescription Drug Prices

Let’s talk drugs. Maybe I should be a little more specific, lets talk medication based drugs. To be even more specific, lets talk medication costs that I incur for my main diagnosis of rheumatoid arthritis, chronic pain, and atrial fibrillation (afib). Since a major portion of being a patient advocate is sharing my own story, I’ll be using my 10 current prescriptions as a basis for this post. Unlike many of my other posts, the goal of this post is not to solve a problem. The goal of this post is to remind you of the absolute weirdness and ridiculousness of the world of prescription drugs that patients like me have to navigate often on a hour by hour basis.

Let’s begin with a 50,000 foot look at our country’s prescription drug “system”.

If you have been following me for awhile now you know that I lost my job earlier this year. This loss also included access to a good, employer based healthcare plan. Simply put, I was paying very little for very good benefits. Now, I’m paying large amounts of money out of my unemployed pocket…that is life. As a chronic patient, it is not wise (both financially and medically) for me to go a long time without healthcare insurance. So after much research and cost/benefit analysis, I purchased a silver based plan off of Blue Cross of Idaho’s website with an effective date of June 1st.

Shortly after June 1st I was standing in Fred Meyer’s pharmacy line contemplating my new insurance and how it plays with our “healthcare system”. To begin with, my new health insurance has a $1,000 pharmacy deductible. This is separate from my $2,500 medical deductible. In the past I’ve always considered pharmacy as kind of a step B in the healthcare process. Step A is going to a doctor or specialist, step B is the treatment which often is medication in the world of rheumatoid arthritis and afib. As my mind kept wondering, it dawned on me how wrong I was. Pharmacy (meaning the entire prescription drug process) is a system unto itself. It has its own deductible and it has its own copays for prescriptions which are a barrier to access just like a doctor’s office copay and medical deductible is (I’m working off the assumption that even a $1 copay or deductible can be a barrier to healthcare). Let’s not forget the fact that a year’s cost for a growing number of prescriptions can rival the cost of a major surgery or other medical procedure. Stay tuned, more on my individual costs for prescriptions is coming.

The world of pharmacy is complicated and can’t be reformed from a 50,000 foot level. To many think that “big pharma” run the world and therefore will always put profits over patients. Patients, especially chronic and rare patients, need pharma in order to live so we are dependent on their products but can easily become disenfranchised when the system works against us. Health insurance, in a perfect, idealistic world (and confirmed by marketing departments of health insurance companies the world over), should be one of the most patient centric organizations in our system. They negotiate better prices for us while protecting me from things like possible overdoses and unnecessary prescribing through the preauthorization process. However, as I’ve found, their business decisions are fundamentally different from my quality of life decisions but since they have the checkbook, my quality of life is to often determined by their business decisions rather than my wishes as the chronic patient. I’m paying the equivalent of my mortgage payment to an organization every month for them to act like my father in determining when I can and can’t have the car keys on a Friday night (check out this post which is the basis of my analogy https://www.alanbrewington.com/blog/2023/6/18/adventure-struggles-with-new-health-insurance)

Ok, lets take the plane down from 50,000 feet and look at actual prices of my prescriptions.

First, and probably most importantly, I am under contract with my pain management doctor regarding my prescriptions. This is due to the fact that I am being prescribed 2 narcotics by my provider (Nucynta and Oxycodone). One of the primary elements of the contract is that I’m only allowed to use the pharmacy listed in the contract, which I do have the right to choose. If I want to switch pharmacy’s, I’m supposed to let the doctor know as soon as possible or risk being blacklisted by my provider.

I have been with my current pain management clinic for over 10 years now so I’m a little fuzzy on my first visit. That said, I’m 90% sure that I had to sign the contract and take a drug test before I was allowed to schedule a follow up appointment. Why is this important you ask? Basically, I have to accept whatever price Fred Meyer tells me. I can’t comparison shop for the best price. This means I’m completely reliant on my health insurance for an affordable copay.

As I mentioned earlier, my prescriptions are mainly for rheumatoid arthritis, chronic pain, degenerative disk disease, severe post traumatic osteoarthritis, and afib. I say mainly because I have multiple lesser known arthritic conditions that also contribute to my chronic pain. In total, I have 10 prescriptions at the moment. One of those prescriptions, Enbrel, is by far the most expensive on my list. My cheapest medication is Metoprolol which is a beta blocker which I use to treat high blood pressure and chest pain (angina), and hopefully prevent my heart from failing.

Before we dive deep into the numbers, I want to let you know that I will be using 3 different definitions for cost. For this post, I will discuss my out of pocket cost, the pharmacy’s cost to obtain a medication, and the manufacturer’s cost to produce a tablet. Please feel free to contact me directly with any questions or comments if I do not do a good job articulating the differences in these definitions of cost.

Ok, lets take a dive into the pool of prescription prices. Since my pain management contract states I will use Fred Meyer as my primary pharmacy, I looked up the price for my 10 medications using the website https://www.goodrx.com. For my 10 prescriptions, my monthly cost would be $9,562.09. Enbrel does account for 75.26% of that. My insurance dictates I have to use their speciality pharmacy for the Enbrel so if you subtract that from m GoodRX cost, I would still pay $2,366.09 per month for my prescriptions. That’s $28,393.08 a year, not a realistic request for someone who is currently unemployed.

Just out of curiosity, I looked up the GoodRX prices if Albertsons was my primary pharmacy. In Boise, my hometown, there is only a 2 mile difference between the nearest Albertsons and Fred Meyer. In theory, the prices should be the same. Turns out, they are roughly 7% cheaper at Albertsons than Fred Meyer (once again I have not included Enbrel in the total since it is especially expensive). That translates to a savings of $1,814.28, or almost 3 months of mortgage payments. However, like Fred Meyer, their price is also not a realistic expectation for someone who is unemployed.

Hopefully, many if not most of you, have heard about Mark Cuban’s low cost pharmacy. If not, his adventure is based on a patient paying the cost of manufacturing a drug with a 15% markup for each drug his company dispenses, plus $3 for pharmacy labor, and of course the cost of shipping. As an chronic pain patient accountant, this is a cost formula that is music to my ears. Since I’m a nerd, I looked up what my out of pocket costs would be if I used Mr. Cuban’s pharmacy.

I have good and bad news regarding Mark Cuban’s CostPlus Drug Company. Which would you like first? The bad news, ok. CostPlus only carries 4 out of my 10 prescriptions. The 4 prescriptions I could find on their website are generally the cheapest out of all of my meds I found too. To give you a couple of examples, my Metoprolol prescription was roughly 52% cheaper at CostPlus than if I were to use a coupon through the GoodRx website. Leflunomide, one of my meds for my rheumatoid arthritis, was roughly 23% cheaper at CostPlus than if I used a coupon through GoodRx. If you have the time, regardless if you have insurance or not, I would recommend checking your prescriptions at https://costplusdrugs.com. Ready for the good news? The good news is there does seem to be some real cost savings potential for chronic patients like me through the CostPlus Drug Company.

It is time to take a look at my potential monthly prescription costs if I use my new Blue Cross of Idaho health insurance. Sounds easy and straightforward right, nope! To begin with, it is important to point out that pharmacies, including Blue Cross’s own speciality pharmacy, can charge whatever they want for a prescription. There is no set or universal prescription cost for all pharmacies. Second, the price info I found on Blue Cross’s website was based on prescription prices if I used their pharmacy and had my prescriptions delivered. From personal experience, I do know that pharmacies like Albertsons and Fred Meyer generally have similar prices as a health insurance online pharmacy. In order to keep this post to under 3 billion pages, I’m going to assume retail prices at Fred Meyer and the Blue Cross pharmacy are roughly equivalent.

Once again, I’m excluding my Enbrel from my monthly costs since its a unique med with a corresponding price. In addition, for some reason when I looked up my Oxycodone on Blue Cross’s website there was no price given even though I’ve been paying $20 a month for that prescription. Ok, here are the numbers.

After reaching my $1,000 deductible, I can expect to pay $143.50 a month according to the research is did on Blue Cross of Idaho’s website. This is 94% cheaper than using coupons from GoodRx to obtain my prescriptions. However, that is not my true cost. To obtain my true monthly cost I would need to divide my $1,000 deductible by 12 and then add my monthly premium to the expected monthly cost of $143.50. This brings my out of pocket monthly total to $876.83 which is still 37% cheaper than using GoodRx. Long story short, using my insurance at Fred Meyer is financially the smart play for me at the moment.

Since I’m a nerd who wants to provide my readers with interesting information, I spent a considerable amount of time researching manufacturing costs for each tablet I take. This proved harder than I expected and I wasn’t as successful as I had hoped. That said, I feel confident in the per tablet manufacturing cost for my Nucynta ER so lets take a look at that.

According to GoodRx, the retail price of my Nucynta ER is $1,180.67 for a months supply. That math’s out to $19.68 per tablet. I found an National Institutes of Health (NIH) study that listed the manufactures cost as $1.5612 per tablet. To put it another way, in the 10 years I’ve been prescribed Nucynta ER the manufacture has made a net profit of $130,455.36 from me. Its good to be in the pharmacy business.

Many argue that if we had better price transparency that would solve the high cost, they are profoundly wrong. Their theory being consumers (I don’t care what anyone says to call patients consumers is insulting) would flock in mass to the cheapest price. This is simply not true. Chronic patients, such as myself, mainly make our pharmacy choice based on availability and access to a pharmacy. I’m not going to drive 40 minutes to the other end of Boise just to save $5, that’s both a waste of my time and gas. In addition, most patients like myself have multiple prescriptions. Yes, I might be able to save $20 if I was willing to drive 40 minutes out of my way for 1 prescription, but health doesn’t work like that. I have to look at the cost for all of my meds and then put that pharmacy’s name into my pain management contract.

To gather this information I have roughly 10 hours of research invested into this post now. Since I’m unemployed I have the time and intrigue to do this. But lets think about this for a minute. My life consists of moderate to severe pain 24 hours a day, 7 days a week. Even if my prescriptions work perfectly, a “good” day for me is when I’m a 5 out of 10 on the pain scale (mind you my 10 out of 10 was the night I fell rock climbing and needed 10 screws/plate in my left wrist and 6 staples in head to put my back together). Also, please keep in mind that pain pills don’t cure my pain, they only mask it. That means my body is still experiencing the stress of pain, my heart is still being worked hard which is probably the basis for my afib. My point, why aren’t more people offended that our “healthcare system” forces use to put in this kind of time and research in order to try and find the best possible price for our meds? This is why I think we don’t have a healthcare system, we have multiple healthcare systems.

As a nation we love to brag about our commitment to life. We take comfort every time the news covers a kid ringing the bell to indicate they have beat cancer thanks to a new “miracle” drug. Medical manufactures are celebrated for giving a soldier who lost their leg in battle the ability to run again on an artificial limb. However, at some point we get bored of these stories and revert back to stigmatizing patients like me who use treatments like opiates in order to remain a high functioning member of society. The culture goes back to using diseases as punchlines in stupid comedies instead of bring attention to these multiple healthcare systems that often only help those that meet a certain income level or predetermined profit requirement.

In the end, my quality of life and for too many, the actual life of chronic patients are dependent on their own personal skill at navigating these complex, multiple healthcare system’s. The goal of this post was to remind you of the absolute weirdness and ridiculousness of the world of prescription drugs that patients like me have to navigate often on a hour by hour basis. Maybe that should be rewritten to chronic and rare disease patients are directly dependent on the absolute weirdness and ridiculousness of the world of prescription drugs that we have to navigate often on a hour by hour basis.

Thanks for ready about another aspect of my patient story!