Imperial Valley Press
Some pills are hard to swallow – and cost less – because…
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.