Flat Co-pays and the Public's Inability to Understand Them

(This is the last of my old posts, republished. Anything published from here on out will be new material. Enjoy!)

A man comes to pick up a prescription today. It was a refill that we had faxed his doctor on, for Avodart. The doctor only approved #15 capsules because the patient had not had an appointment in over a year. His insurance company charges a flat $60 copay for this non-formulary medication for a montly supply, and #15 capsules cost $56.99 because they just charged him the cash-Rx price instead of the $60 copay.

He yelled at me, saying that me and my company were screwing him. He hardly let me get a word in edgewise. He kept asking “What about the other 15 capules?” He claimed that my company was overcharging him and no other pharmacies did this and he was calling the Better Business Bureau and whatnot.

I had to tell him that there were no other 15 capsules, his doctor had only authorized 15 and that is all I could fill. I didn’t set his copays, I billed claims to his insurance and they tell me what to charge. He thought that 1/2 prescription should have 1/2 copay (or $30) no matter how many times I told him it didn’t work like that. I told him he was welcome to call his insurance company and ask them about it.

After he left, I sat here fuming, wishing I would have said this:

“Listen up, if anyone is at fault for this high copay on only 15 capsules it is not the pharmacy. Let me tell you the three entities you should be blaming.

Number one: YOURSELF. Last month your doctor’s office told you that you need an appointment, that it had been more than a year. You ignored them. Now, when they only authorize 15, you have only yourself to blame. If you had made an appointment, they would have authorized a month or more.

Number two: your doctor’s office. Most doctor’s offices know that there are flat copays on brand name drugs, and that you will have to pay the same copay no matter how many you get. Even if you haven’t had an appointment in more than a year, they should still authorize 30. Unless it’s a controlled substance.

Number three: your insurance company. They are the ones that you should call and bitch about copays to, because I have absolutely NO CONTROL over them. You might as well bitch at yourself because you’re the one that picked the plan. Oh, and your doctor, too, because he’s the one that prescribed that non-formulary medication for you.

I, on the other hand, was nice enough to fax your doctor three times for the refill on this prescription. As you can now see, me and my pharmacy had nothing to do with this situation, and if you still can’t understand why there is nothing more I can do for you.”

Thanks, I feel better now.