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$35 or $30,000 (I think) for a lifesaving drug

By July 9, 2017August 20th, 2017Advocate, ePatient, Leader

Who benefits from the murkiness of finding the prices of prescription drugs? Clearly not patients and caregivers.

Today, I’m taking two potentially lifesaving drugs – azithromycin and rituximab.

According to, azithromycin, prescribed for my pneumonia, has a cash price of $35 with a $10 copay cost to me.  Took me 10 seconds to find this.

I’ve spent more than four hours and I still don’t know how much the rituximab, a chemotherapy infusion for my multiple sclerosis, costs or will cost me. I’m turning 65 next week and I need to select a Medicare Advantage Plan. I spoke with several insurance companies. None can (or will) tell me the cost of Rituximab to them or to me. They differ whether it’s a formulary drug (covered at all). They differ whether they consider it a drug covered under Medicare Part D (see below) or an infusion, covered under Medicare Part B. If Part B it may be included in my premium.

If Part D, the cost is totally unclear. I found only one mention of a specific dollar amount during a 30-minute search on the internet. I found, buried, someone who thought it retails for about $30,000 a dose.  I don’t know if that’s true. I can find no way to fact check. Let’s suppose $30,000 is an accurate retail number. If it’s a Part D drug then the coinsurance is 30%. I’d be paying $9,000 a dose (the 30% is based on retail, not the cost that the insurance company would pay. And they can’t tell me what either is.) Except that when the cost reaches $3,700 (less than one dose) you’re in the coverage gap or donut hole where you pay 40% plus a dispensing fee ($12,000 + unknown dispensing fee) until you reach $4,950. Then you hit catastrophic coverage you pay 5%. Of what? I don’t know. If $30,000 a dose, then $1,500. This repeats every year. Let’s see, $4,950 + $1,500 for one dose and another $1,500 for the second dose? $30,000, $9,000, $12,000, $6,450. I’m so confused and my life is health care. I don’t know if I can afford this life-saving drug. By the way, I also take another drug that retails $1,000 a month (I think). Oh, my. Who creates a system like this? Special interests compromising with each other with patients losing. Though, in fairness, no Medicare drug benefit before the Bush years.  Pharma needed Part D or they’d never receive payment for skyrocketing prescription costs. Is this corporate welfare?

What really bothers me is that all the national health care talk is only about TrumpCare. It’s important, very important. But when the dust settles, we still have to deal with the outrageous cost of drugs and services hiding behind a murky feeding trough of stockholders, investors, insurers, hospitals, doctors, pharma, politicians, and regulators. Read Elisabeth Rosenthal’s An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. It will freak you out.

I’ll let you know how my situation works out. We have to make a decision about Medicare drug coverage within the next few weeks. Today I’m thankful for the $35 antibiotic. It’s saving my life.