TheReader Posted March 30, 2017 Share Posted March 30, 2017 I am trying hard to remain grateful that we actually do have insurance. And it does help pay for our prescription drug costs, making them affordable for us. I KNOW there are plenty of people who don't have such coverage, and plenty of drugs that simply aren't covered anyway (my MIL is on some of those). I know this. I do. I know that, in the grand scheme of things, we have it really, really good. But I am annoyed and frustrated, because insurance companies are basically crooks, I've decided. My middle son was diagnosed on Monday as having Influenza Type A; he was prescribed Tamiflu, and given the generic in capsule form. We paid our bottom level co-pay for this, $15, which we pay for all generic drugs. Cool. Today, my youngest son was also diagnosed with the same flu, and also prescribed Tamiflu. However, since he has developmental delays, he cannot yet swallow pills, so our doctor wrote the Rx for the liquid version of the drug. Which only comes in the name-brand so far, no generic available. Which *should*, if the insurance company wasn't just a bunch of crooks, then fall under our "name brand Rx" co-pay, the middle slot, which is $40. But it did not. It fell in some category called "non-formulary drugs" basically meaning it's a non-preferred drug, and so it's Top Tier co-pay, which is $55. When I asked the pharmacist what this 'non-formulary' thing is, I was told to call the insurance company. So I did. And when I asked them what that category even means, the representative actually said, "Usually it is when there isn't another alternative available for an expensive drug, that's when they classify it as non-formulary." Seriously. I repeated it back to her, and asked, "So, seriously, if there is literally no alternative, and we have no choice but use this drug, that is when the insurance company decides it's a good time to charge more??" yep. Because they're trying to encourage you to use something else. What something else, I have no idea, since we already just established there IS NO something else. Apparently, our doctor could submit a "Tier Exception Request" but the agent explained that, "Of course, that won't help you right now, because by the time that goes through, he won't need the medicine anymore..." And apparently, no one there can override it based on, I don't know, the fact that there simply is not a children's version in a generic, so basically we're being punished for the fact our kid caught the flu as, well, a kid. Now, I realize, this really only cost me $15 extra dollars (because it would have been charged at the name brand rate anyway), and I still saved nearly $300 over the price of the actual medicine if I were paying out of pocket, and according to my other thread about doctors, there is apparently also some non-Tamiflu thing we could have been given instead (and maybe this is part of why that other medicine is given instead, besides the side effects...), but I just cannot get over the whole "...when there isn't another alternative, they put the drug in this highest category and charge you more for it..." right there out of the mouth, word for word, from the representative. Insane. Absolutely insane. *on a side note, please be nice to me if you disagree. You may disagree, and you can even say you disagree, but just please be nice....I have one kid recovering from pneumonia, two with Influenza A, a husband on the verge of probably also getting the flu, and Sunday, Monday, and tonight & tomorrow I'll be waking up at alarms every 3 hours to dose fever meds so I'm still kinda sleep deprived, worn out and cranky. So....this isn't a JAWM post, but it is a "please disagree nicely" post. pretty please. 1 Quote Link to comment Share on other sites More sharing options...
maize Posted March 30, 2017 Share Posted March 30, 2017 (edited) This is exactly why I did not fill our tamiflu prescriptions when the flu went through my household a couple of years ago. Not the only prescriptions I have opted not to fill either. (((hugs))) hope everybody feels better soon. Edited March 30, 2017 by maize 1 Quote Link to comment Share on other sites More sharing options...
Spryte Posted March 30, 2017 Share Posted March 30, 2017 I'm sorry. That really stinks. It makes no sense (on their part, not yours, you are making sense). I hope you all start to feel better soon. My goodness, your plate is full. It's so hard when everyone gets sick at once. Hang in there and baby yourself, you need some serious self-care. Wish we could all drop off some soup and ginger ale for you (on your porch, of course - it would have to be a ding dong dash, since no one wants your germs! You poor thing!). 1 Quote Link to comment Share on other sites More sharing options...
TheReader Posted March 30, 2017 Author Share Posted March 30, 2017 I'm sorry. That really stinks. It makes no sense (on their part, not yours, you are making sense). I hope you all start to feel better soon. My goodness, your plate is full. It's so hard when everyone gets sick at once. Hang in there and baby yourself, you need some serious self-care. Wish we could all drop off some soup and ginger ale for you (on your porch, of course - it would have to be a ding dong dash, since no one wants your germs! You poor thing!). LOL! That made me laugh, thank you. I am enjoying a nice, cold Coke and will watch some fluff TV in a bit. I've started a chart to track everyone's medicine doses (when given, what was given, etc.) so I don't get mixed up. There is juice in the fridge, everyone has his own water bottle, and they're happily ensconced watching movies and playing video games on the couch, and thank goodness, all old enough to mostly entertain themselves. I just check temperatures, hand out meds, and refill water bottles. :) 1 Quote Link to comment Share on other sites More sharing options...
LMV Posted March 30, 2017 Share Posted March 30, 2017 Now, I realize, this really only cost me $15 extra dollars (because it would have been charged at the name brand rate anyway), and I still saved nearly $300 over the price of the actual medicine if I were paying out of pocket, and according to my other thread about doctors, there is apparently also some non-Tamiflu thing we could have been given instead (and maybe this is part of why that other medicine is given instead, besides the side effects...), but I just cannot get over the whole "...when there isn't another alternative, they put the drug in this highest category and charge you more for it..." right there out of the mouth, word for word, from the representative. Insane. Absolutely insane. *on a side note, please be nice to me if you disagree. You may disagree, and you can even say you disagree, but just please be nice....I have one kid recovering from pneumonia, two with Influenza A, a husband on the verge of probably also getting the flu, and Sunday, Monday, and tonight & tomorrow I'll be waking up at alarms every 3 hours to dose fever meds so I'm still kinda sleep deprived, worn out and cranky. So....this isn't a JAWM post, but it is a "please disagree nicely" post. pretty please. Zanamivir is the other Influenza A/B antiviral. This one is inhaled [and not recommended in patients with underlying lung disease because of increased bronchospasm risk] so I'm not sure if that would be an option--could your son use the disk inhaler with good efficacy? Quote Link to comment Share on other sites More sharing options...
TheReader Posted March 30, 2017 Author Share Posted March 30, 2017 Zanamivir is the other Influenza A/B antiviral. This one is inhaled [and not recommended in patients with underlying lung disease because of increased bronchospasm risk] so I'm not sure if that would be an option--could your son use the disk inhaler with good efficacy? I don't know; we went ahead and filled the Tamiflu, so we could start it tonight. I'm just peeved that the insurance co flat out admitted they charge more 'cause they can. If he gets sick again in the future, and still can't swallow pills, I'll ask about this other option though. Thanks for mentioning it. Quote Link to comment Share on other sites More sharing options...
Guest Posted March 30, 2017 Share Posted March 30, 2017 I get it. It is crazy. A doctor (not our regular) prescribed tamiflu for all my kids when one kid tested positive. I went to pick it up and it was $700!!! I said "no thank you, we'll just get the flu" (we didn't). Insane. 1 Quote Link to comment Share on other sites More sharing options...
Anne in CA Posted March 30, 2017 Share Posted March 30, 2017 Honestly, this is why they get low level people to answer these phone calls. So that is doesn't bother the conscience of any of the top level people who are partying in Hawaii with their 401K's bursting at the seams. They don't care what they do to people. Quote Link to comment Share on other sites More sharing options...
SKL Posted March 30, 2017 Share Posted March 30, 2017 That is stupid, I agree. But ... flu medicine costs $300??!! Time for me to scurry back into my hole .... Quote Link to comment Share on other sites More sharing options...
Twigs Posted March 30, 2017 Share Posted March 30, 2017 :grouphug: :grouphug: :grouphug: Quote Link to comment Share on other sites More sharing options...
Guest Posted March 30, 2017 Share Posted March 30, 2017 I am sorry. :grouphug: Insurance companies are crooks. So are most pharma companies. I will save you my Tamiflu rant and simply say, I hope everyone recovers and you get some sleep and rest yourself soon. When everyone is on the mend book yourself a nice massage! You deserve it! Quote Link to comment Share on other sites More sharing options...
TheReader Posted March 30, 2017 Author Share Posted March 30, 2017 That is stupid, I agree. But ... flu medicine costs $300??!! Time for me to scurry back into my hole .... The price before insurance, for just the liquid (name brand) Tamiflu, was going to be $353. Now, the price for the generic capsule form, before insurance, was going to be $145 or so, according to what Walgreen's printed on my receipt. The Rx cough medicine, also a generic, was going to be around $70, if I remember right, but that was for a huge bottle of it (enough for me to dose both the coughing kids, since the other doc in the practice didn't send anything for the 1st one on Monday). Granted, this was Walgreen's, where Dayquil is $13 for a normal sized bottle.....inflation on Rx drugs may be similarly ridiculous, I don't know. But....yep. I'm grateful we have the (crooked, robbing, thieving) insurance, I really am. Much easier to pay $70 for the 2 meds yesterday (+ the $15 for the first set of Tamiflu) than $430-ish. Definitely makes me realize a level of privilege we have, that I hadn't really fully appreciated before. Quote Link to comment Share on other sites More sharing options...
TheReader Posted March 30, 2017 Author Share Posted March 30, 2017 I am sorry. :grouphug: Insurance companies are crooks. So are most pharma companies. I will save you my Tamiflu rant and simply say, I hope everyone recovers and you get some sleep and rest yourself soon. When everyone is on the mend book yourself a nice massage! You deserve it! Aww, thanks :) I've booked myself a "Friday Night Sew In" at my local quilt shop for tomorrow night....4 hours of laughing, chatting, sewing, being with other women (and not one sick person)....it's going to be wonderful. :) Quote Link to comment Share on other sites More sharing options...
Guest Posted March 30, 2017 Share Posted March 30, 2017 GoodRx can be helpful Quote Link to comment Share on other sites More sharing options...
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