Part D Problem: How much should eye drops cost?by Denise Early on Nov. 08, 2011, under Health
A client of mine sent me an email about a problem he ran into with his Part D coverage. The problem involves his prescription for Azacite, which comes in the form of eye drops. Eye drops, or any liquid medication that is measured by “drops”, can present problems because the actual number of doses can be difficult to calculate. Here is an email I received from Don last week. He gave me permission to put it in my blog.
Here’s a recent experience of mine that I think your clients might benefit from. It’s necessarily a bit detailed, so please bear with me.
Yesterday, for the fourth time this year, I refilled my prescription at Walgreens for Azacite, an eye medicine. I was charged $85 for it. I knew that was way more than I’d paid previously, but you either pay or you don’t get your medicine. So I paid, went home and called UnitedHealthcare. They couldn’t explain why, even though each of the four purchases was for 2.5 ml of medicine, the copay jumped from $45 to $85. So they checked with the pharmacy and called me back. Here’s what happened:
Even though the label on the medicine indicates the quantity purchased as 2.5 ml, the insurance company makes the pharmacy compute how many drops are in a 2.5 ml bottle and then, based on the prescribed frequency of usage – eg., once a day — come up with the number of days the 2.5 ml should last.
If the computation shows 30 days or less, you pay the minimum copay (in this case, $45). If it computes to more than 30 days, then you must pay for an entire additional month’s copay (in this case, $85).
The record shows that on my first purchase, in Feb., they computed a 10-day supply; the next two purchases, they computed a 25-day supply, and on yesterday’s, a 37-day supply. That bumped me up to the two-copay level.
When I presented all these facts to Walgreens today, they refunded the difference between one-month and two-month-supply copays. They could not explain how they came up with a ten-day supply, then a 25-day supply, then 37 when filling the exact same prescription.
I think the lessons for consumers of medicine are:
(1) Always save your pharmacy receipts.
(2) If it’s a liquid, make sure the pharmacy doesn’t give you more than a one-month (one copay) amount unless your doctor specified more than a month’s supply. (In the case of pills, the days-of-supply figure always given, but not for liquids, so you have to ask!.)
(3) If the price of a medicine you take regularly suddenly goes up, find out why. If the producer upped it, you have no recourse, but it might be the pharmacist’s mistake and you can get a refund.
(4) If the first person you speak to at your insurance company doesn’t give you a satisfactory explanation (as happened with me), hang up and call again so you can talk to a different person.
Has anybody else run into a similar problem?