[Quixote]

In 2003 came the passage of the Medicare Part D Prescription Drug Plan to go into effect in 2006—a fantastic piece of legislation, I felt—for the insurance and pharmaceutical industries—and not particularly for seniors. By now those of us covered by it are well familiar with its deductibles, denials, and donut holes. I’m almost embarrassed to realize that after living with this program all these years, I just learned something about it that shocked me but, in the end, didn’t surprise me. Here’s my story in specifics:

My physician changed my cholesterol med from Prevastatin ($0 co-pay) to Rosuvastatin (generic of Crestor) that will be better for my needs. The local pharmacy cannot check what the cost will be of a prescription without having it in their hands ostensibly to fill it. I did not have the scrip yet, so I called the insurance company directly and asked, and they told me $141 for a three-month supply. I double-checked with the local pharmacist, who told me he has a ‘back door’ through which he can get the costs the insurance companies charge us, and he verified that mine would be $141.

Now comes the shocker. The pharmacist asked me if I would consider simply filling it for its cash price, which he explained to me could be (though not necessarily have to be) lower than my insurance co-pay? He checked for me, and the cash price for filling this identical prescription is—ready for this?!—$51—indeed lower! Remember, this is a generic; certainly the pharmaceutical company that developed its original—Crestor—earned back its research and development costs and then some. What does this mean?

Two seriously significant points:

1. My insurance company is charging me nearly TRIPLE the cash price (without using any insurance) for this generic drug Rosuvastatin. And here I thought they were certainly making enough for their shareholders with premiums, deductibles, and fair co-pays without doing this! Yet we are fined if we choose not to elect prescription drug coverage, even though it might cost us less NOT to use insurance. (Is this even conceivable?)

2. By charging such inflated prices, some of us are driven into the coverage gap known as the “donut hole” so much sooner, as the insurance company is the one who sets the prices we pay for our medications if we use our Part D Plan. I now check EVERY prescription I am given to make sure I’m not spending more than I have to.

However, in the end I purchased this medication from a Canadian mail-order pharmacy. Please see thread titled ‘THE LAW AND CANADIAN MAIL-ORDER MEDS.’