Hi Don - Almost all prescription costs are stunning to me. Until I remember these are "List Price" - which in the case of big pharma has nothing to do with reality. There are all kinds of non-transparent moving parts.

For example, it is cheaper for Walgreens to dispense some of my meds to an uninsured person than to me as an Blue Cross/Medicare patient. The pharmacist explained that the price is agreed to between the "Pharmacy Benefit Manager" (PMB) employed by Blue Cross, following Medicare rules, and is actually set above the usual retail price for some generics. Under Walgreens corporate agreement with the PMB, he must charge me their price, not the cheaper one, or BC may delist Walgreens as a covered pharmacy. If I look at my explanation of benefits, I see the retail drug price, a much lower "allowed amount" and my copay.

Another wrinkle - for my neb solution, Walgreens charges differently for the identical med in Minnesota than in Texas, because they have a different PMB for the same nationwide policy! It is cheaper to order the Rx mailed from Texas than to drive 2 miles to get it. And our mail order pharmacy is under yet a different PMB, so each year I have to compare all the prices of our meds and decide where to fill each prescription.

To make new, high-cost meds affordable, the pharmas offer their own discount programs, often charging only a few dollars for new drugs, to get docs to prescribe them. Or if the artificially raise a price (Epi-Pens, insulin) they will offer "price supports" when the public screams loudly enough and legislatures start asking questions.

Finally, some docs are in the mix too, as "testers" or "sponsors" to get the drugs prescribed - and they get a stipend for it. In my clinic, docs have no fiscal incentive to prescribe the higher priced new drugs because their contract doesn't allow them to participate financially.

It's enough to make me run away screaming! And to think this is just one small piece of our medical system...
Sue

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