Wow, my 100th Post!! And a little story about prescriptions.

I think that my 100th post deserves some confetti and streamers, don’t you?  It’s taken a long time to get to 100, but the fact is that I’m still here, and I’m still Phat.  But that’s for another day.

For my 100th, I’m going to tell you a story.  It’s about health insurance. And Health insurance companies. I make my living in the insurance industry and I’m not proud of this story and sadly I know that this is a small example of what goes on.

Two weeks ago was my regular visit with the rheumatologist. I told him that it was time to think about replacing my right knee.  The one that’s missing half of the miniscus.  It’s been quite painful and disruptive lately and if I’m going to do it, why wait?  He absolutely said that I shouldn’t be doing it yet – I’m too young and active and will wear out a knee too fast.  “Why not try the Supartz injections that we did several years ago?” he asked.

Supartz, aka, joint fluid therapy, is a series of injections made directly into the knee joints. This therapy is designed to reduce pain by improving lubrication in the knee, replacing the synovial fluid that lubricates the knee.  Supartz is made from a natural chemical found in the body and is found in particularly high amounts in joint tissues and in the fluid (synovial fluid) that fills the joints.

I had great success doing this several years ago – I was able to walk down the stairs normally and had much less pain.  My health insurance has changed since that time and I now have a $5,000 deductible.  The first time, this was considered an in office procedure and subject to my standard office copay.  I attempted to do this earlier this year and it’s now considered outpatient surgery and subject to my full deductible and not the office copay.  The doctor had to order the Supartz and I had to pay for the medication out of pocket.  CVS Caremark is who my health provider has me use and they called me, and the cost was $1,463 for the 3 injections.  I thought it was highway robbery and I just wasn’t going to pay it.  OK, my employer does reimburse me for anything over $500 of my deductible, but I still thought it was excessive.

During the discussion with my doctor 2 weeks ago, he suggested he give me a script and I see if I could get it filled for less.  Of course I was enticed by all the Canadian pharmacy online ads but during a visit with my primary care physician in the midst of all this, he scolded me for even thinking about mail ordering to Canada.  So I remembered a good client of mine owns a large, independent pharmacy in the area.  I called him and last week I picked up the script for $600.  Less than half of what CVS Caremark wanted.  Someone is making an awful lot of money on prescriptions and it’s not me.

If you have any wonder why health insurance is so costly, this is only a small example of the excessive costs with medical care today.  Oh, and my large, independent pharmacist cannot supply me with my monthly Enbrel.  No, my health insurer insists that CVS Caremark send that to me.

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2 thoughts on “Wow, my 100th Post!! And a little story about prescriptions.

  1. There’s a lot of money in pharmaceuticals, and a lot of wild pricing. I can’t believe anyone posts the full price. I have a $10 copay for a script that supposedly retails for $180 or so. I doubt insurance pays $170.

    • Cvs Caremark charges somewhere north of $2500 per month for my Enbrel. That seems ridiculous. I should ask my pharmacist client what he would charge for enbrel. Bet it’s south of $2500.

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