Cash Flow

Fountain at the Alamo in San Antonio

“You tell that doctor to write me a prescription for something affordable!”


My medical assistant glanced up at me with a shocked look on her face. There was no need to repeat the conversation. I had heard every word.

“That does not make any kind of sense. It is a generic medication. It should only cost $40. Max. Call his pharmacy and find out what that med is going to cost him there.”

Later in the day I read the computer message that said it was going to cost $340 for a one month supply. Hell. I wouldn’t even pay that. 

I typed out a quick message and routed it back, asking why it was going to cost that much.

It is the brand name. If you want them to fill the generic you have to write for the generic. 

Except that I HAD written for the generic. I always write for generic. 

I sent back a stongly worded message pointing this out and telling them to fill the frickin’ generic. 

This was followed by a string of other patients with similar complaints all from the same pharmacy chain. Insurance companies refusing to cover prescriptions that patients had been getting without issue because the pharmacy chain was filling brand name instead of the generic option. It makes them more money. I would have never known this was occurring if the insurance companies had not denied coverage. 

From a drug coverage standpoint we love to hate on insurance companies but pharmaceutical company and pharmacy shenanigans are one of the reasons healthcare costs in the US are skyrocketing out of control. 

So I tell patients to be aware of what they and their insurance companies are paying for. If there are significant changes, please ask questions. Shop around to other pharmacies. The variability of cost from one pharmacy chain to the other is astonishing. AND, talk to your doctor. The only way I find out about these kinds of things is from patient complaints.

Just maybe don’t yell at my staff… 


93 thoughts on “Cash Flow

  1. Pingback: Cash Flow | Behind the White Coat | Fighting alzheimer's disease

  2. I learned about the shop around aspect a few years back from my MIL, who saves a ton by getting one of her scrips filled at a different location.
    There have been times I have laughed at cost variations. Tammiflu, or however you spell it, $40 one year, $200 the next. Haha! Uh no.
    Moo’s nasal spray, from $35 to $156. Haha! No way!
    So yeah, MIL taught me to call around πŸ˜‰

    And then there are the epipens… No Hah available. 😦

    Liked by 1 person

    • It is a frickin mess. I have patients stable on asthma meds who were forced to change to whatever was on the formulary last year and are now having to change to something else on their new formulary this year. Silliness.

      Liked by 3 people

    • My 14 year-old grandson has to carry the epipen because of an allergy to wasps and bees. His family is not wealthy, but to save his life they pay out the money. If only there were a way to prosecute the criminal element in our healthcare system!

      Liked by 1 person

  3. Everybody has their hands in our pockets … and they think we won’t notice. Assholes. But not you or your staff.

    I sound like a broken record — but you need another sign in your office!

    Liked by 1 person

  4. Thanks. I hadn’t realized that was an issue. With the title, I was expecting you to talk about the idea of offering government medical cost support to low income people in the form of tax credits. If you are a low income family, being offered a reimbursement at the end of the year doesn’t make it easier to get medicine—the pharmacy won’t wait. And, what good anyway is a tax credit if you don’t make enough to itemize deductions?

    Liked by 1 person

  5. Wow! Thanks for posting this. The other day my doc prescribed something that she was pretty sure the same thing would happen. When it did, she called me and we decided we would use a compounding pharmacy. The same prescription that the pharmacy wanted to charge me over $350 now cost me $33. Its all so frustrating for everyone but insurance and big pharma.

    Liked by 2 people

  6. I use a topical NSAID that my insurance company won’t pay for because they only allow it on lower body parts and it was prescribed for shoulder pain. Then the pharmacy won’t fill it because I show an allergy to NSAIDs. I explained that I am allergic to some NSAIDs but not all, and that my doctor thought the topical cream might work, since the pills affect my digestive track.

    Of course, the pharmacist had to hear that from the doctor. The insurance company won’t list to either of them, or me, so I pay full retail price for the cream – which actually does work!

    I don’t know how they can make this worse, but I’m sure they will come up with a way.

    Liked by 1 person

  7. Frustration runs deep at times and sometimes it’s the first person someone speaks with that feels the brunt of it all.
    There is too much cynicism and mistrust in the medical/insurance/pharmaceutical field among patients. I don’t know how that gets resolved, or even made better.

    Liked by 1 person

  8. Wow, I recently had a huge price change in my meds. I thought it was bc I had to meet a deductible for the new year, but I don’t remember paying that much last year. If it continues to be this costly, I will have to start asking questions or shop around or both!

    Liked by 1 person

  9. I hate it when they yell at staff over things that are outside of their control! I once rang a customer back and made them appoligise for being so yelly and rude to my office staff just because she happened to be the unfortunate one to pick up the phone. They reluctantly did it and that after I bent over backwards to sort their problem out πŸ™‚ I now have a very loyal customer who is extremely polite to office staff πŸ˜‰

    Liked by 2 people

  10. Excellent post – and I like how you are fostering the patient/doctor dialogue. Quite often Doctor’s don’t know about the systemic challenges that patients face and this can create distrust and negativity about the entire healthcare system. I think the greatest utility in healthcare is the patient/doctor interaction.
    Bravo! Harlon

    Liked by 1 person

  11. I live in Canada. I had the opposite experience today. My pharmacy called to say my insurance would not pay much towards my partner’s (brand name) Alzheimer medication now that there’s a generic. The pharmacy is allowed to switch to the generic without calling the doctor, but needed my permission. Kudos to you for prescribing generics. I’ll update the doctor next time we are in.

    Liked by 2 people

    • The pharmacy is allowed to switch to generic without calling the physician here, too. In fact, I always assumed that unless I wrote “brand name medically necessary” that generics were always what was getting filled. What a fool I was.

      Liked by 1 person

  12. I detest working with mail order pharmacies, but I have no choice. They are terrible. I could go and on with horror stories but this is the newest. My shot for my psoriatic arthritis right now is ridiculous. The first shot, the co-pay was $50.00. The next shot is supposed to last three months. ONE shot, same dosage as the first shot only you do not take another for three months. They tried to hit me up for a $150.00 co pay. This same shot…. if I was on Medicare would be a $3000.00 co pay. I have no idea why, Makes me feel so excited about going on a insurance system I paid for my whole life.

    Liked by 2 people

      • Indirectly, in the sense that I have no idea about Sales and Marketing. But even when I was in practice I got the reps to spill the beans about those aspects too. For eg., most pharma companies sell the same product as branded AND generic; it’s manufactured in the same plant and the only difference is the package the drug goes into. The price difference can be in the range of 1000% (no extra zeroes there).

        Liked by 1 person

  13. We have four medical people in our immediate family and I hear such stories all the time. One really sicko fact is that previously cheap medications have now been pattented to make them cost more than 100 times the original price. Take the epi pen (sp.?) and daily gout medicine. One very young distant relative quit his gout medicine because his insurance would not pay the increased price and now he is facing kidney replacement–not just dilation.

    Liked by 1 person

  14. I was taking Advair for years and finally switched to something else because it was ruining my voice (I used to be able to sing). It also costs nearly $300 for a three month supply, and there’s no generic. Paying to breathe is not something I ever wanted to do, but I never blamed my doctor.

    Liked by 1 person

  15. Good post. We have had to learn to do this, except there are a couple of generics that didn’t work for me and I had to go back to the real stuff. We now have a pretty good pharmacy, and Medicare is Medicare.

    Liked by 1 person

  16. That’s awesome of you. Lots of people think that the doctors are the villains in the US healthcare calamity, but often times that isn’t the case. One would not think that the pharmacies were riding dirty, but when it comes to money, corporations are always worried about their bottom line; and the concerns of the customers/patients don’t matter because do they really have the power to change things?? And the questions remains, do we?

    Liked by 1 person

    • Physicians do get blamed and we guilty on some level, though not the way most people think. We are guilty of allowing all of this to happen when we had the power to change things. Now I am not sure we have any control left.


  17. That is awful. I have my own pharmacy in a small town and we do everything we can to save our patients money. The only two times we dispense brand name when a generic is available is on patient or physician request (DAW 1 or 2) or insurance requires brand name so the copay is cheaper for the patient. It can bring tears to see some copays charged ny Medicare plans. Actually now we are seeing more and more underwater reimbursement were we lose money when billing the insurance. It’s hard to lose money but I can’t have my patients going without so as long as we can afford to our patients will get the meds they need.

    Liked by 1 person

  18. Cost of medicine is sky rocketing. Huge size-impression packaging for two pills. And labs write off lush dinners and presentations with docs to R&D expenses…
    I would suspect labs make 60 or 70% of their income in Europe where there are strong health systems. So, in fact, their sales are picked up by the state… But the European governments do nothing to curb the labs’ greed. 😦
    Now, here in Mexico? There are known pharmacy chains who sell “generics” of doubtful composition…
    (Sorry for the rant)

    Liked by 1 person

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