“Why aren’t you gonna pay for my prescription! My doctor ordered it!!!!”
This is a sad but true story about the moral hazard induced by spending Other Peoples Money (OPM).
Lady gets prescription from her doctor and takes it down to the pharmacy. “Sorry lady the prescription won’t go through, it’s denied” says the pharmacist. “Ask your doctor if he can prescribe something else.”
So now the lady, really mad as hell, calls the PBM instead of her doctor. “Why aren’t you gonna pay for my prescription! My doctor ordered it!!!!”
“The plan won’t cover Duexis, it’s too expensive and there are cheaper alternatives” responded the PBM.
“I don’t care what it costs, my doctor ordered it! I want it covered” screamed the formerly nice lady.
“Its expensive, real expensive” said the PBM rep., “Its $28,000 per year, does that bother you?”
“I don’t care. I pay a lot of money for my insurance. That’s what insurance is for! And, my doctor ordered it! I want it covered!” panted the now really mad formerly nice lady.
“Listen, calm down. Duexis is ibuprofen (advil) and famoditine (Pepcid) which are both cheap generics and also OTC. There is no difference in the OTC versions except for the strength. The ibuprofen in Duexis is 800 mg and you’d have to take 4 OTC to equate. Both meds are available in the exact strengths via generic as well for about $10 combined. Duexis is a brand combination tablet that costs about $2400 per month at 3 per day. Used for ‘pain with stomach protection’ so the pain med is not so hard on the stomach but at $33 PER PILL!” explained the ever so patient PBM rep.
“This is a common trick of drug manufacturers to take two products that are generic and combine them to be one patented brand tablet (miracle cure for back pain with stomach protections) and charge more. And your plan is self-funded. That means you and your co-workers are paying for this. Does any of this make sense to you?” asked the PBM rep.
“NO, I WANT THIS COVERED. MY DOCTOR ORDERED IT!” screamed the now desperate victim of the system. “I’m going to the press, television station, and write my congressman about this! What’s your name!!!!
Editor’s Note: I have to repeat this again: This is a true story.
