I Don’t Understand

Can someone please explain to me why it’s cheaper for me to get some of Hubby’s medicines through Wal-Mart’s $4 prescription program than it is for me to use the wonderful prescription drug coverage that comes with my health insurance plan?
Then can you please explain to me why a three month supply of my hormone patches cost $143 through my wonderful prescription drug coverage plan but I can get three months worth of generic pills with the same active ingredient for $10 at Wal-Mart?  
Why does an insurance company have the right to tell a doctor which drug they will and will not cover?  Wouldn’t you think that your family doctor, who has been treating you for years, know better what would work for you than some clerk at an insurance company who has never met you?
Yes, I’m on a rampage.  I’ve been trying to figure out how to get all the meds that Hubby and I need on a daily basis without it costing a fortune.  I knew that I was going to have to deal with some changes when I changed insurance plans, but some of this stuff is just plain stupid. 
You have to prove that you’ve used the lower cost drugs and that they didn’t work before the insurance company will pay for the higher cost drugs. 
Even if you get special permission to get the higher priced meds, you will have to resubmit your proof every year.  It’s just easier to try and find a cheaper med that will work. 
The hormone patch cost difference is way beyond belief.  The patches really do cost me $143 for a three month supply.  The same basic drug in a different form (pills) is really only $10 for a three month supply.  The only difference is the way the medicine is delivered.  I think the lady at the pharmacy called it a "convenience factor".  That’s a heck of a convenience factor!  
I have spent a lot of time over the last few weeks trying to figure all of this out.  It’s almost a full time job.  The sad thing is, I pay a lot of money for this health insurance and I can’t afford to have the plan cover my medications.  
I think the system is broken but I don’t have any idea how to fix it.  


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2 responses to “I Don’t Understand

  1. Beth

    You said it.  We are being taken advantage of by the big drug companies that have the doctors in their back pocket.

  2. Susan

    The system is SO broken.  I think that is really an understatement.  I wonder if someone really tried to fix it, if it could be done.  Rampage on, Girl, is all I know to tell you to do!

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