Wednesday, May 28, 2008

$75 for three prescriptions? Are you freaking serious?

Of course, that's not what I said at the pharmacy counter--hey, it's not Ahmed's fault that my copay for trade-name drugs is $25 (yes, the pharmacy tech's name is Ahmed; I'm not being a dick. At least not about that). But, having long read Drugmonkey and The Angry Pharmacist's blogs, and being more than vaguely aware of the shenanigans that drug companies get up to, I knew chances were good I wasn't really over a barrel. In fact, I consoled myself, I'm probably getting a really good deal considering what the prices would be WITHOUT insurance (now can you see why I was so freaked out when I thought I'd be off my parents' insurance when I turned 23? Thank G-d the city extended the age to 25. Woot!). And lo, I went to to check the prices; and lo, it turns out that with insurance I pay about 12% of the Average Retail Price of the prescriptions I get. Did you hear that? My insurance is like a 90% off coupon. Which means 1. People without insurance are even more thoroughly screwed than I originally thought and 2. Holy crap, drugs are expensive.
Here's the breakdown (I included some of the other meds I take, even though I didn't have to get them filled the other day and thus they weren't included in the $75):
Depakote ER, 500 mg: 240 for 90 pills
Effexor XR, 150 mg: 250 for 60 pills
Singulair 10 mg: 112 for 30 pills
Lorazepam 1 mg: 15 for 30 pills
Levothyroxine, 150 mcg: 20 for 30 pills
Cytomel, 25 mcg: 50 for 30 pills

Notice how the generics are way less expensive? Seriously, I can't tell you how thrilled my parents were when my Zoloft went generic a few years back. Granted, for us it just meant the copay went from $50 to $10 (though saving $40 a month is hardly chump change). Based on these numbers, I'm sure the people without insurance were even more thrilled. Then again, the people without insurance probably weren't taking Zoloft--they were probably on either TCAs (tricyclic antidepressants), MAOIs (monoamine oxidase inhibitors--nasty things, when you really stop to think about it; granted, they can help with depression, but they also interact with EVERYTHING on God's green earth, including foods. And these aren't "Oh, you'll feel a little weird" interactions. These are "Your blood pressure will go through the roof and you'll stroke out and die" interactions) or the SSRIs that had already gone generic, like fluoxetine.

Interesting side note: Fluoxetine has since been repackaged as Sarafem, as a treatment for "PMDD," or Premenstrual Dysphoric Disorder (known once upon a time as PMS). Don't get me started, but I'll just say that it's more than a little suspect when there's a mental disorder that's predicated solely on what I would consider a NORMAL female state. Yeah, it sometimes sucks to have your period. Trust me, I know. Used to get horrible, I-want-to-kill-myself PMS. And yes, there are certain interventions that help with mood, bloating, etc. But does that mean it's a disorder? American life has become so medicalized...what were once just, meh, parts of living have become illnesses or syndromes (Am I going to get into trouble going into med school with this sort of attitude?). Granted, there are times when intervention is warranted--I'm just saying that pathologizing every deviation from the norm might not be the way to go. 55 and can't perform like you used to? Have some Levitra. Going through menopause and don't have quite the same vim you did when you were 30? Premarin for you. Women who get bitchy before their periods can have some Sarafem, little kids who can't pay attention get Adderall, and people who are made twitchy and nervous by life in general get a script for some benzos.

Also interesting: every time Big Pharma comes out with a new drug for a particular "disorder" it seems like there's a media blitz--not just advertising, but news puff pieces, articles in magazines, earnest editorials in professional journals. Take bipolar disorder in children: drug companies recently came out with approval for use of an existing drug in kids (I think maybe it was Depakote, but I'm not certain) and suddenly there's an explosion of 'experts' telling doctors and parents, "Your kid might be bipolar. It's wildly underdiagnosed!" Pardon me if I'm a leeeetle skeptical. This said as someone who's been on various drugs for severe depression/bipolar disorder since I was 11. I'm not saying it doesn't happen; I'm saying it pays to look at who's giving you your information.


Anonymous said...

Ativan/lorazepam is less than $10 (all inclusive!) at Target/Walmart. Thyroxine is also $4/month. Paxil/paroxetine is also another SSRI that's $4. FYI MAOI's are first line for atypical depression, and there's nothing particularly great about one SSRI over another- other than that escitalopram is the most serotonin-selective of the bunch, but even that doesn't really mean much. Yes, it's all a scam! I suppose you're paying for the marketing pens/dinners/knicknacks taht are abundant everywhere.

keepbreathing said...

It's always interesting to see the new "disorders" come out, like "restless leg syndrome." The pharma companies will take a minor annoyance and jack it up to be perceived as a huge life-altering problem, and then market their solution. It's interesting.

It also makes people think that we can cure them entirely with a pill, when probably as much as 75% of people's problems (generally speaking) are self-created and can only be solved by a change in lifestyle.

DrugMonkey, Master of Pharmacy said...


The incredible price of pharmaceuticals really is Ahmed's fault. Those of us in the profession have been covering for that guy for years now. Seriously.

It's a long story, and one I'm not totally at liberty to discuss. Ahmed is the key though. Please be careful when dealing with him.