That’s Just the Way It Is

Today I planned on writing about my Face Book withdrawal symptoms, and I guess this is one of them. If I was political at all on Face Book, it was all about health care. So, here’s a story I would’ve put on Face Book.

First, some backstory.

I have high cholesterol. Not an unusual condition in this day and age, but I’ve had it for so long that I’d been taking cerivastatin for 18 months when it was taken off the market in 2001 for causing deaths. My doctor tried a variety of ‘safer’ statins, but the new and improved meds caused painful side-effects. Enter Zetia, a non-statin cholesterol lowering drug.

For years, my co-pay for a month’s worth of Zetia was $50, with my employer’s insurance paying the rest. Okay, $600 per year out of pocket—but I was working, had a paycheck, could afford it.

When I retired in 2014 and went on Medicare, I discovered that my plan D wouldn’t pay for Zetia. I had to self-pay, and the price with a Good Rx coupon climbed to more than $950 per month.

Yeah—you read that right. Just under $1,000 per month. Why? Because Zetia was about to go generic, and I imagine the manufacturer wanted to make hay while the sun shone.

So I waited, and did without for three years. It went generic in 2017 and on my plan’s formulary in 2018.

Finally! With my scrip in hand, I trundled off to Walmart and they charged me $75 for a 30-day supply. When I complained, they lowered the price to $62, while warning me that the price could and probably would fluctuate, month-to-month.

I came home and looked up the Good Rx coupon. At a local grocery store, I could get a 30-day supply of ezetimibe (the generic Zetia) for $10.65. Well, that seemed reasonable.

Except the coupon states, essentially, that anyone on Medicare is not eligible to use the coupon.

Really?

Two calls later, one to Good Rx and one to my insurance company, and this is what I’ve learned.

The company supplying the coupon to Good Rx also contracts with the government. They have a different price for government recipients of plans like Medicare and Medicaid. Folks without insurance can get the med for $11 but retired folks—most on reduced incomes–must pay about $60 more per month.

My insurance company told me the generic is a tier 4 medication, which means they’ll pay a miniscule amount, if anything. And that the price could and probably would fluctuate.

And the answer to the question, why? Or the bottom line, if you will?

That’s just the way it is.

I know that y’all know that the whole healthcare issue is a bucket of pits in a world full of cherries. Until the donkeys and elephants stop arguing about insurance and focus on healthcare, nothing much will change. But we need to stop fooling ourselves about the quality of healthcare available in this country.

So do something. Write or call or email your representative and ask him or her to make healthcare affordable for everyone.  And tell them they need to focus on healthcare instead of insurance. Use my mantra–I offer it freely–

People Not Profits.