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Priced out of prescriptions

Photo of Poet Taylor, the host of a popular Washington, DC radio show. Thursday, Nov. 16, 2017. (Lisa Fletcher, WJLA)

Millions of Americans with health insurance still pay out-of-pocket for medications. And the cost can reach hundreds or even thousands of dollars a year.

But what many drugmakers and pharmacies don't want you to know is that you could lower your medication costs, sometimes by as much as ten-times, by simply walking across the street to a competing pharmacy.

On a recent fall morning, ABC7 News caught up with Poet Taylor, the host of a popular Washington, DC radio show. As she regaled her listeners with stories and witty banter, you wouldn’t have guessed she suffers from asthma. Her job and her well-being depend on her ability to control it.

“Asthma is a very serious, serious diagnosis,” said Taylor. “The wrong medication could result in me having an asthma attack and not being properly medicated."

But Taylor, like millions of Americans, is in the center of a tug-of-war between insurance providers and drugmakers.

Big insurance companies threaten to take popular medications off their coverage list unless drugmakers reduce the price. It's a multimillion dollar game of chicken and the drug companies don't always flinch.

Taylor recalled a recent, surprising trip to her pharmacy. “I put in my normal refill. I’m feeling good. And I get a call from my pharmacy and the pharmacy is like, ‘nope, your insurance doesn't cover that.’ Yes they do, I've been on it almost a year now. I know they do. They were like, ‘not anymore.’"

Taylor was forced to switch to another brand of inhaler that she and her doctor agree, doesn't work as well for her asthma. Taylor says she feels like a pawn in the game of trying to force pharmaceutical companies to lower their costs.

“A company that would wager my life on, I don't know what kind of extra money you get at the end of the year, it just reads loud and clear: We don't really care about you. We care about the money that we make off of you," said Taylor.

ABC7 News checked. If Taylor wanted the medication that works best for her she'd be out of pocket as much as $433.99 a month. We asked if that’s something she could afford.

“No,” said Taylor. “That would be the cost of my car insurance, my car payment and my phone bill."

But what Taylor and millions of others like her didn’t know is that you can comparison shop for drugs just like you would a car, a bed, or the paper towels in your kitchen.

“The crazy thing we see every day is that the same drug, same exact prescription, different pharmacy, much better price,” says Shawn Ohri. Ohri works for ScriptSave WellRX, a pharmacy benefits manager, or PBM.

There are about 30 PBM's in the U.S. and they negotiate prices on prescriptions for their members.

Ohri says insured or not, everyone should comparison shop.

"Twenty-eight million people that we know are uninsured today, You've got 20 million people that are on high-deductible health plans in 2016 and that number's growing year-over-year, and then you've got 10 to 20 percent of the people that have great coverage, but that particular drug that they're using isn't covered,” says Ohri.

One way to shop around is to call every pharmacy in your area. Another is to use an app.

Ohri’s company came up with one called “ScriptSave WellRX." There are a handful of others and each is likely to find different deals for you, depending on how they negotiate with the pharmaceutical companies.

Using Script Save, ABC7 News compiled the most popular prescriptions in DC, Maryland and Virginia and compared prices among the top 10 pharmacy retailers.

The antibiotic amoxicillin is the No. 1 most purchased drug in Maryland. It’s three and a half times more expensive at CVS than Walmart.

The high blood pressure medicine amlodipine besylate is one of the most popular prescriptions in Virginia. It's nearly six-times more expensive at WalMart than it is at Kmart.

And in DC, the second most prescribed drug, sildenafil, used for high blood pressure in the lungs, or as a generic form of Viagra, is more than eleven-times more expensive at Walgreens than Costco...at $195.00 versus $17.60.

“It pays to shop around, even with these types of programs,” says Ohri.

And that’s something Taylor won't soon forget as she tries to outmaneuver the insurance and drug companies.

“I’m a person who wants to live a healthy, happy life,” said Taylor. “I don't know why you would want to stand in the way of that. And I would hope an extra thousand dollars, or extra million should not matter more than me living, me breathing, me being here."

Remember that depending on what app you're using, the prices can vary - sometimes by a lot.

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