On Consumerism: Avoiding a 582% price increase

Eight days ago I phoned Allison at the Sugar River Pharmacy in Newport to arrange for three-month supplies of all eight prescriptions used by my wife and myself. (Three bottles of pills, two ointments, one topical solution and two inhalers.) I always call a week in advance.

Soon after the order was placed, Allison phoned back. She had started processing the order but discovered that an inhaler I use, called Flovent, would require a copay of $818 and change. Last time I picked up a three-month supply, my copay was $120. That nearly sevenfold price hike amounts to a 582% increase.

It should be noted that these dollar figures are set by the insurance provider, not by the pharmacy. Also note that Allison’s phoning me was a courtesy call and not required by law. Would a national chain-pharmacy have called with this heads-up warning? Somehow I doubt it. Chain pharmacies don’t phone you unless it’s via a robot that can’t answer questions.

Allison said the price increase was due to the insurance provider’s trying to persuade me to use CVS or the U.S. mail instead.

“Persuade?” I responded. “Coerce is the word I would use.”

We agreed to hold off on that medication until I could speak to my insurance company and decide whether I still wanted Sugar River to process the order.

So I phoned my insurance provider, Anthem Blue Cross/Blue Shield; the policy is bought a year at a time via the Affordable Care Act (Obamacare). After refusing to speak to a robot, I reached a polite woman who explained I needed to speak to IngenioRx. She forwarded the call to IngenioRx, which is a unit of Anthem and a prescription benefits manager.

Pat, of IngenioRx, answered my questions. Yes, the price would now be $818 and change for a three-month supply. Unless I went to CVS, where it would be $100. Or unless I agreed to have the post office deliver it, in which case it again would be $100. Or unless I opted out of the de facto part of the contract that called for having to use CVS or the post office.

Pat said if I opted out of the pertinent part of the contract, then the price Sugar River would charge me would revert to $120.

So I opted out. I thanked Pat and hung up.

Then I called Sugar River. Laurie picked up on the first ring. After hearing my update, she reprocessed the Flovent order. It was now requiring a $120 copay.

So today (Nov. 6) the missus and I are going to Sugar River to pick up the multitude of prescriptions (and to receive our flu shots).

Publicly traded companies, including Anthem and CVS, focus foremost on generating profits and pleasing shareholders. Thanks to a contract between CVS and Anthem, they both make more profits when consumers pay $100 for a refill at CVS than when consumers pay $818 for the same refill at any other pharmacy. (The extra $718 would end up in the hands of the drug manufacturer.) So Anthem’s IngenioRx has set up the rules to urge people to take their business to CVS.

No matter what the giant drug companies and the giant health insurers claim, they care more about their profits than the cost to consumers.

A consumer without the intelligence to understand, without the organizational ability and time and patience to make phone calls and make the proper requests, will either get stuck paying exorbitant amounts, or (more likely) meekly take their business to CVS, which is what Anthem wanted all along.

Note that I am paying $120 for the three-month supply of Flovent at Sugar River. At CVS it would be $100. Consumers without the means to pay the extra $20 would take that prescription — probably all their prescriptions — to CVS. Again, to the delight of Anthem.

But to me, the extra $20 is money well spent. Remember, that’s a three-month supply. So it’s an extra $6.67 per month. In exchange for that extra money, some good things happen:

— My money stays in the community, instead of being funneled to a corporate giant whose executives have never heard of Sullivan County, New Hampshire.

— I am giving my business to a pharmacy where, whenever I phone them, the call is answered by a human being. To me, this is a big deal. The major pharmacies long ago stopped allowing humans to answer the phone. Instead, the caller reaches a robot, whose reason for existence is to prevent you from reaching a human being. It will try to handle your concern itself, and it will try to convince you to put down the phone and conduct your business or ask your question via computer.

— I am having my prescriptions filled at a place that is pleasant to visit and where service is usually immediate. At the local major-chain pharmacies, one must wait in line for one’s turn, and the waiting spot is always right beneath a speaker that is pumping out pulsating music that is so painfully loud it often compels me to cover my ears. (It’s not the fault of the workers. Each corporate giant dictates how its stores operate.)

I have nothing against CVS. I’m happy to make occasional purchases there of items they shelve. But I’d rather not give them my prescription drug business. And I object to Anthem/IngenioRx manipulating the process so more people use CVS.

This business of “opting out” is an ongoing game I long ago wearied of. Every year I opt out. But with each new year, the opt-out vanishes and one must opt out again. Although I recall opting out six or seven months ago, for some reason my opt-out had been given the boot. Without asking me, they had opted me back in.

At least there is relief in sight. In only about 2,000 days the missus and I will qualify for Medicare. Which I will eagerly welcome.

Arthur Vidro is one of the Eagle Times’ recurring financial columnists. His “EQMM Goes to College” appeared in the May/June 2021 issue of Ellery Queen’s Mystery Magazine.