Imperial Valley Press

Some pills are hard to swallow – and cost less – because…

- RAOUL CONTRERAS THE CONTRERAS REPORT Raoul Lowery Contreras is a former United States Marine, an author and newspaper columnist, a political consultant and hosts the Contreras Report on YouTube, ROKU television and Amazon’s Firestick.

As a senior and a veteran, my prescripti­on drug prices have grown exponentia­lly in recent years. So much so, that I soon found myself driving the 20 miles to Mexico to get bargain prices for my medication­s. For instance, my doctor in San Diego once prescribed me a new medication, but when I went to the pharmacy to pick it up, I was told the cost for a thirty-pill supply would be $300.00. I was astounded. I drove straight to Tijuana where I found the exact item – same company, same packaging, but in Spanish instead of English – for 1100 pesos, or $58.50. More recently, however, I have seen a downward trend in my pharmacy prices; my medication­s in the United States have become more affordable! How could this be?

When a few hefty booklets, which defined my supplement­al insurance and copayments for my various medication­s and medical expenses, arrived in my mailbox, I decided to dive in, do my research, and learn how my insurance actually works.

Since receiving my supplement­al insurance, I have noticed a significan­t decrease in my prescripti­on and copay prices. What used to cost me an arm and a leg is now covered by my plan. It is a striking difference – previously, I would spend a bunch on my monthly medical prescripti­ons, doctor and specialist appointmen­ts, and trips to the laboratory. Now, for example, my quarterly blood work now costs me nothing; it used to cost me $25.

Like most people, I didn’t know the intricacie­s of the health insurance business. However, I do know about the politics of health insurance. Since the early 1960’s, I have paid a percentage of every paycheck into Medicare, knowing that I would benefit from this decision when I was older; and being young, I had very minimal expenses that had little-to-no financial burden. However, as I entered my sixties, my medical needs increased dramatical­ly, and sometimes, exponentia­lly.

Further research led to my realizatio­n that drug companies set the high prices of these prescripti­ons, making life-saving medication­s unaffordab­le. To fight these costs, health insurance companies work with intermedia­ry third parties, known as pharmacy benefit managers (PBMs), to negotiate on my behalf against drug companies to lower the prices of prescripti­on drugs and other services, making my copay and medication­s costs extraordin­arily cheaper.

Essentiall­y, through PBMs, we can count on someone to look out for the average patient and stand up against big pharmaceut­ical companies. For years, I felt helpless, becoming lost in the intricacie­s of health insurance, and I can only imagine most seniors – in fact, most individual­s – don’t have a clue about this whole process. With my newfound knowledge of PBMs and how they mitigate the cost of prescripti­ons to ensure that medication­s are affordable, I realized their life-saving importance for my fellow seniors and veterans, who often pay enormous amounts for their health insurance. To the cost savings I say, Hallelujah!

From the public’s standpoint, and for seniors in particular, having private profession­als negotiatin­g for us is as welcome as it is necessary. Being an average citizen, I do not have the ability to negotiate my own medication cost – the pharmacist would laugh at me for trying.

What we can do is encourage our government leaders to push for more organizati­ons that act as the voice for the working class, disabled, and marginaliz­ed, to protect us from soaring drug prices.

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