I was reminded of this when I went to refill a prescription this month for an asthma and allergy medication for my 9-month-old son, Holden.
The first time I filled his prescription for Montelukast granules — the generic version of Singulair from Merck — my insurance co-payment was $15. A month later, the co-payment had risen to $30 (and my insurance was paying $85.94, rather than $118.53).
Why? My insurance coverage hadn't changed. My son's prescription hadn't changed. Our pharmacy was the same. Why was I now asked to pay twice as much out of pocket?
I asked the CVS pharmacist. This happens all the time, she replied. Call the insurance company to find out why.
Consumers are navigating a health care system in which they pay an increasing share of the cost but often have insufficient information to make the right decisions. They assume that pharmacies are charging them the right co-payments, that insurance companies are paying the correct share. But as health plans' rules for prescription drugs become more complicated, it's harder to tell.
*To read the full “One Drug. Two Prices. A Reporter Struggles to Find Out the Cost of His Son’s Prescription” by Charles Ornstein, highlight and click on open hyperlinkhttp://www.propublica.org/article/a-health-reporter-struggles-to-find-out-the-cost-of-his-sons-prescription?utm_campaign=bt_twitter&utm_source=twitter&utm_medium=social
Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration
This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.