A money-saving question

By ARTHUR VIDRO
There is one question every consumer should ask the pharmacy when making the initial purchase of a new prescription.

But we tend not to ask questions.

We just slap down our cards and wait for a computer to tell the cashier how much money to collect from us.

Earlier this month, I was given a new prescription by my doctor. If it proves helpful, it’s something I might take perennially. Of course, until you get to the pharmacy, neither you nor your physician knows how much the drug will cost, how much your health insurer will chip in for it, and how much you’ll be expected to pay out of your pocket.

I don’t like surprises at the cash register. I prefer to know my costs long before I reach the checkout counter. But with the pharmaceuticals industry, there’s no way around it. And I don’t blame the pharmacies – they’re as hamstrung by the rules as are we consumers.

So I went to the local Sugar River Pharmacy to get my first month’s dosage of this drug. (If it improves my health, then I’ll label it a medicine.)

Though I didn’t know it when I entered the shop (doctors don’t automatically mention these things), there is a generic version available. Therefore, the purchase would cost me much less than I had feared – about $22 and change out of my pocket for the month’s supply, said the pharmacist.

But before paying, I asked the one question that all consumers should ask when starting a new prescription:

“How much would it be without the insurance?”

Normally you can expect a great difference in drug costs between a person with health insurance and a person without. That difference could get magnified manyfold if there is no generic version of the drug available.

I’d guess that about 90 times out of 100 the cost for the insured consumer is lower, sometimes considerably lower, or at least that there is no difference at all. Ah, but that tenth time … every once in a while, the insured consumer ends up paying more. (Don’t ask why. There’s no rhyme or reason to the pricing of our drugs.)

The pharmacist happily obliged my request by researching the answer. Without insurance, the cost would be $13.50 – which, you’ll note, is about nine dollars less than the rate for purchasing the very same drug in the very same dosage in the very same quantity at the very same pharmacy than if I were to have the purchase processed through my health insurer.

“Oh, dear,” I replied. “I seem to have left my health-insurance card at home. Would you mind ringing this up without applying my insurance?”

Good ol’ Sugar River Pharmacy obliged me.

I’ve asked around. Seems that many pharmacies are not permitted to alert you up front on those occasions when it would cost you less if you circumvented the insurance. They are under a type of “gag order” implemented by some of the pharmacy benefit managers that act as a sort of subcontractor for the health insurance providers. However, if you broach the subject, the pharmacy is required to answer your question.

So let’s take a step back and think this through.

Every month, Anthem Blue Cross and Blue Shield (also known as Anthem BlueCross BlueShield) receives $784.98 in exchange for providing me with health insurance through the Affordable Care Act (also known as Obamacare). I am self-employed so there is no employer providing me with any benefits at all. That $784.98 is paid partially by me and partially by the federal government (everyone’s tax dollars). By the way, Anthem receives an additional $784.98 each month for providing identical health insurance to my wife.

In exchange for that $784.98 (and another $784.98 for my wife) that it receives every month, Anthem Blue Cross and Blue Shield has decided to charge the end customer more money for this particular purchase than if that customer had no insurance at all.

Which makes the insurance seem rather valueless.

It doesn’t make sense, and you can’t make this stuff up.

But that’s our meshuga health-care system.

So when you initiate a new prescription at the pharmacy, ask the question: “How much would it be without insurance?”

If you don’t ask, you probably won’t be told.

If you have consumerism questions, send them to Arthur Vidro care of this newspaper, which publishes his column every weekend.