A perfect example of what is wrong with pharma and PBM’s and insurance:
My patient, Robert Wetherell from Lynn MA, has given me full permission to use his name and this example of outrageous insurance abuse.
My patient has a condition known as pulmonary hypertension, a debilitating condition where you are severely short of breath. Getting worse, I prescribed sildenafil, a standard therapy for this life-threatening disease.
He came back stating he could not afford it, was told his co-pay was going to be $100/ month on top of his other medications. This is absurd, I knew this was a generic. I called around for him, he went to another pharmacy, and paying cash ( ignoring the fact he has a Medicare advantage insurance from Harvard pilgrim) now gets it for $ 40 month!
Yes , he saves $60 month by NOT using his insurance. This insidious practice is why we need congressional action to curb this abuse by insurance/ pharmacy benefit managers/ and pharma. They of course says it’s the others fault.
If you feel your costs are outrageous, demand to know what the cash price is… due to a gag clause, you will not be told unless to demand to know!