Monday, December 28, 2009

Copaxone Price Shock

Presently, I cannot complain with how much I pay for prescription medication, but it is just a matter of time I will have huge out of pocket deductibles for my medications. I am fortunate to have the benefit of getting most of my prescriptions filled at a Military base pharmacy at no charge. However, I noticed prescriptions I take are slowly being phased out and I have no choice but to go to an outside pharmacy. In the past my co-pays use to be $3.00 generic and $9.00 brand. My co-pays are now $3.00 for a generic, $9.00 for a brand formula drug and $22.00 for a brand non-formula drug. If you are thinking most of my drugs are now brand non-formula...ding ding you are correct!

I made a conscious decision to not become dependent on the many drugs MS'ers are prescribed for every nuisance the disease bring our way. Yes, my neurologist did not like me taking most of my drugs as needed. My rationale to her dislike is...I am the one living with MS and I know my body better than anyone. I am not trying to play doctor, but I do know that I feel a lot better taking medication as I need it than taking it every day when the MS symptom or symptoms are no longer present.

However, Health Care Reform is definitely needed in America. Although, IMO what is being called Health Care Reform is a bunch of BS...KO eloquently tells you WHY! Washington needs to stop the RAPE of American citizens from the fraud and abuse of the Health Care and Big Pharma Industry...AND Washington needs to stop the BS political games at our expense! We are being raped with higher deductibles and co-pays because of the bullshit I just discovered. It is a damn shame how one pharmacy chain can charge almost twice as much for Copaxone and not be held accountable to WHY they are charging more than another reputable pharmacy chain.

Case and point, for years I have been filling my Copaxone prescription at the grocery chain Kroger Pharmacy, until December of 2008, I decided to have my Copaxone filled at Walgreens. Now I know how Walgreens can afford to have a pharmacy on every corner in about every state. I always assumed my insurance was paying Walgreens the same as they did Kroger after my co-pay until today. Express Scripts never sent me an Explanation of Benefits before today. They were not doing me any favors, what they were doing was soliciting me to mail order my Cymbalta through them; Which I plan to do because I can receive three months supply for $22.00 a month. Duh, who would not want to save $44.00? The SHOCK on the EOB was the amount TRICARE was paying Walgreens after my co-pay; I thought it had to be some sort of mistake. Therefore I went and pulled my 2008 prescription profile to see if Copaxone had a 100% price increase.

I discovered in November 2008, after paying my $9.00 co-pay at Kroger's for my Copaxone, my insurance paid them $1,783.00, which was an increased from 1,666.97 three months prior. However, in December 2008, I discovered after paying my $9.00 co-pay at Walgreens for my Copaxone, my insurance paid Walgreens $2,806.00 that is a freaking $1,023.00 difference. ..WTF!

Here is the industry BS according the EOB from Express Script I received today. Walgreens submitted a bill of $3,005.51 for my Copaxone, my insurance allowed amount is $2,562.19, I paid my $9.00 co-pay and TRICARE paid Walgreens $2,554.53. That amount is still MORE than what Kroger charges. Walgreens is pricing their drugs pass the allowable amount, knowing they will get paid the maximum amount allowed by my insurance...I have a bridge to sell you if you do not think the system is broken! It does not take a rocket scientist to see what the eff is going on with the industry.

Hell, its just a matter of time I will be paying for this fraud and abuse. It does not make any freaking sense how one monthly disease modifying drug cost $30,746.28 a that rate a cure will never be found. TRICARE should have never paid Walgreens that much money. TRICARE would have been more cost efficient and proactive in their efforts of informing ME the drug I depend on daily to slow the progression of my MS cost them $21,396 a year at Kroger Pharmacy.

TRICARE listen up, I am going to save you $9,350.28 a year...I am switching my Copaxone prescription BACK to Kroger Pharmacy. How about a THANK YOU!


Lisa Emrich said...

I am laughing and crying at this concurrently. Crying because so many people don't care (if their copay is low like yours) and crying because the insurance companies who are supposedly keeping costs down by negotiating AREN'T.

Laughing because the following is what I posted on my Facebook profile today:

Excuse me Virginia Hospital Center, but a bill which simply says "Hospital charges = $17,784; Carefirst payment = $10,477; Carefirst discount = $6,224; Balance due = $1,083" - isn't good enough. Need detailed bill for prescription assistance program to pay you for my out-of-pocket copay requirement. Even my neuro's office provides a detailed bill, down to the IV tubing and saline, when I get Solumedrol.

And BTW, how the hell do you get off billing $17,784 for ONE Rituxan infusion, really?!! And Carefirst, you quoted me an 'allowed rate' of less than $6K for the Rituxan vials alone (arguably the most expensive part of the outpatient infusion). What happened?!! Too late in day to traipse up to hospital billing office. Maybe tomorrow.

(and added a bit later)
OK, I'm a bit cooler now. I knew this amount was coming, just waiting for the official bill to know how it broke down. What I had been told was going to cost abt $5600-5700 for the Rituxan alone, is part of the $9818 called "prescription drug services" approved by Carefirst (as seen on their website). This does not show up on my hospital bill.

I'm afraid that this is probably correct and that somehow the steroids (two doses), benadryl (oral and IV), tylenol (oral), saline, Rituxan, and pharmacist services to mix and deliver the above is the reason for the $9818. It disheartens me that the amount Carefirst ends up approving for "prescription drug services" is $4K greater than I expected. I need a detailed bill from the hospital.

I'm really fortunate here, however. Unlike my regular drug coverage (capped at $1500 annually), I am covered 90% for hospital/IV drug/even PT costs. That's a blessing.

At this rate, Rituxan will cost the healthcare system $46,000 (4 infusions each year) for me alone....and Copaxone now lists for $33,000 each year (for which I must maintain an income below 200% FPL to receive from NORD). Somehow I can't in good conscience do both, even if my neuro ends up wanting me to.

The infusions will end up costing ME less than a copay for a series of MRIs. But it still doesn't make me happy that so much money is being shuffled around on paper for this.

Right now, I just need proof of what 10% of Rituxan costs so that the drug company will pay the hospital on my behalf. Then I must repeat the process when the 2nd infusion is finally settled between hospital/Carefirst.

(this will become an article or blogpost when I know more)

loveable_homebody said...

Thank you so much for posting that bit about knowing your body more than anyone. Doctors can be so arrogant. Your comfort isn't necessarily their priority.

Andaje said...

Wow - I could not imagine the stress of having to go to Pharmacist and pay for the required MS medicine.. always thinking about prices, insurance coverage etc.

I am fortunate enough to live in a EEC country, where there are rules and laws regarding MS medicine - no country within the EEC can refuse me my medicine, and I get it for free at the hospital.

Neither Copaxone nor Avonex worked for me, so now I am on the Tysabri - and yes we have HIGH income taxes, but I know that in return I get my medicine without having to worry about prices etc.

Blinders Off said...


Looking forward to reading the article.

@Loveable Homebody,

Some doctors are arrogant, but I am fortunate and have a wonderful neuro and primary doctor. I tell people all the time you have to shop for a doctor like you shop for the perfect black dress.


It nice not to worry about the cost of health care. I use to not worry about my health care out of pocket cost. Unfortunately, I am starting to worry because of the uncertanity of the US Health Care Reform outcome. Wow, you all can get free FREE medicine at the hospital...that will never happen here.

finefroghair said...

Thanks for acknowledging my poem over at field negros blog what an eye opener the price comparisons between the two pharmacies. what's up with insurance companies paying twice as much at one pharmacy over another don't they compare prices. This just proves the whole rotten edifice of health care in this country is a sham. We voted for change but all I see is the same game played by new players. This health care debate really sucks and would seem entirely unneeded doesn't everyone need health care you can't even be born without it. This country is really depressing
my brother married a women from England while he was there he got an ear infection went to the doctor and got a prescription cost like $9.00 meanwhile when her daughter was visiting from England she developed a upper respiratory infection went to the doctor cost her $500 dollars x-rays, drugs office call etc.. Ruined her vacation and embarrassed me to no end how can people in this country think we are great when this example clearly shows that America is a failure. I have heard it said that people from Canada are scared to travel to the US because of our health care system the lies that are told to Americans about foreign health systems are utterly despicable but than again all the lies we are told are pathetic. Keep those blinders off and your eyes wide open that is the only way to live.

Black Diaspora said...

You'll be waiting a long time for that "Thank You."

Big Pharma, like health insurers, are going to play the system for all it's worth, because they get to write the rules, and officiate the game.

In recent weeks the Dems had a chance to rectify years of Big Phama excesses, greed, and the gouging of Americans.

They folded, saying that pharmaceuticals purchased from foreign sources may not come up to our industry standards.


This, too, can be regulated. Further, like health insurers, Big Pharma should be reformed as well.

Sadly, we'd have as big a fight on hand with that as with health care reform.

Diane J Standiford said...

OMG, I just switched to Walgreens, and just started a new Ins Co. Essence, it is all so confusing (and meant to be so) to me that I give up. I'll fight the bridge when I get dumped by it. You said it: THIS IS the problem and NOBODY is watching the hen house. And YES WE WILL pay for it. Commenters all correct---Dems caved. $%^&*()

Blinders Off said...


Thanks to you for finding your way to comment at Fields with your poems and thanks for stopping by. My blinders been off for a long time when it comes to our government.


I know I will be waiting for eternity :). To me it is the principle of the matter, I refuse to continue purchasing my prescriptions from Walgreens now that I know what they are up to. I thinking about forwarding this post to MSNBC to do an investigative report on large and small retail pharmacies.


I talked about how the Dems are spineless and we are in bigger trouble if the Repub's gain control in 2010 over at BD's site.

We need more Independent politicians who are really for the PEOPLE. It would be nice to get rid of every last incumbent Repub and Dem because they are all bought off and do not give two rat cents about the people and saving this country.