The US medical insurance system can be such a stupendous clusterfuck of ridiculousness. Almost to the point where there’s almost no difference in having insurance and not having it. Today’s case in point. I’ve been taking a particular medication on a daily basis for I would say probably over a decade now. And unfortunately it’s not cheap; it was more of a specialty medication with no generic equivalent at the time. After a few years, my parents, who travel back and forth from Taiwan on a regular basis, realized they could buy the medication cheaper in Taiwan. It still wasn’t cheap, but significantly cheaper than in the US and they could afford it so they didn’t mind. Recently, I discovered that this medication has had a generic equivalent available for years now, since 2013 after the original company lost their patent to it. So I figured ok, well the generic’s gotta be way cheaper than what I used to have to pay right? So I told my folks that I could start purchasing the medication myself again here in the US. When I spoke to my doc about submitting a prescription for it to the pharmaceutical provider that my health insurance uses (CVS), she looked at me and said, “You sure? They’re going to be pretty expensive.” And I was like, well there’s a generic formula for it now, how bad could it be? Ha ha, famous last words.

So she sends the prescription off to CVS mail order pharmacy and of course, we have to first wait a few days cause they need to get the prescription approved. Fortunately that went off w/out a hitch and after another day or two I got a message and a call from them cause they wanted to confirm that I wanted to go ahead with the order because the cost to me would be almost $800. For a one month prescription. Of a generic. They must be out of their minds. That was pretty much what I was paying for the branded version of the drug like a decade ago. WTF. Now, I have one of those high deductible HSA health plans, as I’m sure many others in the US do since that’s the type of plan that employers and medical insurance companies have been pushing onto employees for years now. And most people will choose it because it takes the least out of our paychecks up front but in turn will take a bigger chunk out of our wallets when something serious medically actually happens. So with the high deductible HSA plan, my annual deductible amount for family is $4500. Thus the first $4500 that we need to spend on health/dental/vision a year comes out of my pocket before the health insurance starts covering from their end. The HSA portion of the plan is supposed to help w/this deductible amount since you’re putting a portion of each paycheck pre-tax into the HSA. I don’t usually put $4500/yr into my HSA since historically we never come close to that amount on medical/dental/vision a year. So if I were to actually start paying for my medication again through my health insurance and CVS, I would probably have to start maxing out my HSA since I’d hit my maximum deductible after ~6 months just paying for the medication alone. Sure, any further cost afterwards would be minimal since the medical insurance would start covering it but at least for the remainder of this year, I wouldn’t have enough left in my HSA to cover the medication. Plus I don’t really want to put that much into my HSA each year to begin with.

So I went back to my doc and she was like, “Yeah, those PBMs (pharmacy benefit managers) are a scourge, they’re just in it to make as much money as possible. I don’t know why they still treat [my medication] as a specialty drug, especially since it’s now generic; and for the people who need it, they have no other drug options that are cheaper.” But, she did give me options: namely Goodrx, Amazon pharmacy, and Cost Plus. She said she’d send a prescription over to Costco and that I should look up my medication at Goodrx, print out the coupon, and use it when I went to pick up. Which is what I did.

When I went to pick up at Costco pharmacy, they said I had to call CVS cause my health insurance didn’t cover the medication from Costco. I told them that I wasn’t going through my health insurance but was using a coupon from Goodrx instead and paying out of pocket. After they took the coupon info they came back and said, ok your cost will be ~$58. You still want it? And I was like, “Fuck yeah I’ll take it.” I didn’t realize until after they gave me the order that $58 was for a 3 month supply. So one month’s medication was less than $20. $20 vs $800. Seriously guys? Afterwards, I looked up how Goodrx works and you’re basically just paying the out of pocket “cash” amount for whatever drug you’re interested in. So in my case, the cash cost of my generic medication was $20. And CVS wanted to charge me $800 for it. I generally don’t like to cuss out people or companies but man, they’re making it reaaaaaallly hard for me not to in this case.