Doctor-to-Patient Medication Program

Retail Pharmacy Gouging of $482.89 for $15 Generic Medication

My patient needed a 90 day refill on a prescription and I sent in the order. But, Walgreens initially told her Blue Cross Blue Shield (BCBS) required pre-authorization. Pre-authorization for a drug she has been taking for years. Like all of our members, she is well-educated and pushed back at the unusual response from the pharmacy. She asked Walgreens and BCBS to fax pre-authorization request to my office, getting a physician’s take on the situation. Either BCBS or Walgreens relented and filled in the prescription. A little misunderstanding and everything was fine again.
That is when it got even stranger. Walgreens combined with her insurance wanted to charge her $482.89 for the 90-day supply. The previous time was nowhere near that amount. The total amount paid for all the previous prescription fills was nowhere near that amount. But the combined forces of retail pharmacy and medical insurance companies decided that the $482 was the new price. Doing some additional research this drug that was $20 on GoodRX or $15 with Scriptco, not across town, but just at the next pharmacy across the street.
There is a Better Way
In a more perfect world I could dispense it for $5/month from my clinic. However, that is currently restricted in Texas. 46 other states allow for direct dispensing from the doctor’s office. This practice could greatly reduce costs in Texas. Imagine getting simple drugs from the doctor as he prescribes them to you. No second trip to the pharmacy. No additional administrative burden on you. Legislation is proposed to allow this change. But, its being resisted by various lobbyists who profit by the rest of us paying the $450 extra. We have a chance in the next Texas Legislative session to make several key reforms making medicine cheaper, better, and more available to all Texans.