Watchdog Report: Couple struggles with prescription pricing

When Reta Rochelle started paying attention to the prices of the prescriptions she has been filling for her husband and herself, she was surprised to find the cost for each medication varied among local pharmacies – and sometimes from month to month at the same pharmacy.
“We think the prices are competitive, and they are not,” she said.
She shared her experience with trying to decipher the costs of the multiple medications her husband takes as well as the few medications she herself takes in hopes of encouraging other senior citizens who are on a fixed income to pay attention to their own pharmaceutical costs.
Rochelle and her husband are in a somewhat unique situation in that they have a private medical insurance plan that was part of her husband’s retirement package from his company. They pay up front for all their prescriptions until they reach their annual deductible and are reimbursed for 80 percent of the costs.
“It’s a stage in life when the average couple is living tight on a budget, even though we have insurance,” Rochelle said.
In recent months, Rochelle has requested print-outs of all the prescriptions she and her husband have had filled at local pharmacies, including at Safeway and Nob Hill. She also began calling around to different pharmacies to check the cost as well as searching an online site called GoodRx.com.
Rochelle said for one drug, the pharmacist suggested that the couple get 10 milligram pills and cut them in half since her husband’s dose was 5 mg. The cost for a 30 day supply of 10 mg tabs of the particular drug was $130 while 60 of the 5 milligram tabs cost $251. Unfortunately, one of the medications for which she could cut the tablets in half now comes in a capsule form.
She said for one prescription she had filled at Safeway, the pharmacy had been charging her $99 instead of the $39 she should have been charged for the generic drug. She wrote a letter to Safeway and was reimbursed for $1,100 in over-charges.
Rochelle noted that 80 percent of the refund will go back to her health insurance, but it helped lower her out-of-pocket expenses.
“They corrected it,” she said. “They can make errors, both ways. You should check anytime you are going.”
For seniors who have Medicare coverage, they have a resource in sorting through prescription drug benefits with the Health Insurance Counseling and Advocacy Program, a program funded through the Seniors Council Area Agency on Aging. The program offers support to San Benito and Santa Cruz counties’ residents.
Beth Hyytinen said her office fields calls from patients that are confused about Medicare coverage in general who want to understand the best options for them. Through Medicare Plan D, patients can select from different prescription coverage plans that offer varying copays and premiums depending on how many medications the person takes. Residents have an option of meeting with a counselor from HICAP or they can visit Medicare.gov to plug in their prescriptions in a search site along with their preferred pharmacy to compare which plan offers the best coverage for them.
For Medicare patients with Plan D insurance, they pay a monthly premium and copays that range from $1 to $50 per prescription depending on what medications they take. The Medicare website will give patients their annual out-of-pocket costs for prescriptions annually.
“I do suggest that patients do that plan search,” she said. “For most people that is a very doable thing so there shouldn’t be any surprises.”
Patients enrolled in Plan D can change their plan once a year during an open enrollment periods from Oct. 15 to Dec. 7. Hyytinen said she encourages patients to review their plans each year because the drugs covered on each plan change year to year or the prescriptions they take may change.
Hyytinen said even those with private insurance may want to meet with a HICAP counselor to see if they can save some money on insurance.
HICAP staff and counselors will visit Hollister on Oct. 23 at the Jovenes de Antano Senior Center in Hollister to go over options. Patients can also make appointments with a counselor, with someone visiting the Hollister center once a month.