A friend recently shared an expensive lesson about generic medications.

My friend expected the generic medicine for his teenager’s acne to be affordable. This medicine has been on the market for more than 30 years and available in generic form for roughly 15 years.

So my friend assumed that his cost would be the $10 co-pay. Boy, was he wrong.

The first month, the doctor prescribed 20 mg. daily. A 30-day supply was $360.

The next month, the doctor prescribed 60 mg. daily but the pharmacy could no longer get 20 mg. tablets. Instead, it filled the prescription with10 mg. tablets, which meant the teen took six tablets a day. Even worse, the pharmacy cost for a 30-day supply was $1,800.

The third month, the doctor again prescribed 60 mg. daily. The pharmacy was able to get 20 mg. pills again, so the teen only had to take three tablets daily. More important, it cut the cost of the pills in half to $850 for a 30-day supply.

My friend is on a high-deductible health plan with a deductible of $2,500, which was satisfied by paying his share of the $3,010 cost for the first three months of treatment, with another two months yet to go. But he might have been able to pay much less if he had been aware of his options and the cost of medication on a per-pill basis.

Unfortunately, my friend’s example shows the need for transparency in health care. When health care is transparent, people can get information about prices, quality and outcomes before they visit a doctor, buy medicine or schedule surgery.

What other lessons did my friend learn?

  1. Not all generic drugs are inexpensive.
  2. The number of pills issued impacts the cost to the pharmacy – and your cost on a high deductible plan.
  3. Work with your pharmacy to lower the number of pills purchased.
  4. Pharmacy costs can shift from month-to-month along with the pharmacy’s stock room supply.
  5. If you have a high deductible health benefit plan, ask the pharmacist to tell you the medication’s health plan discounted cost BEFORE filling the prescription. Always ask if there is an option that will lower your cost without impacting quality.
  6. If your health plan offers access to a pharmacy benefit management (PBM) website, use it to learn more about how you can use a flexible spending account or health savings account to cover medication costs.
  7. If you get the opportunity, send your teen to pharmacy school.
Alan Williams

Alan Williams

Health Information Manager at The Alliance
Alan Williams joined The Alliance in 1999 as health information manager. His main responsibilities include database development, programming, and data analytics. Alan generates multiple reports to help analyze membership utilization, disruptions, provider/medical grouping, contract performance, quality measures and market share.

In addition to his work at The Alliance, Alan serves on the Wisconsin Association of Perinatal Care (WAPC): Perinatal Data Committee. He is also involved in the Madison SQL Server Users Group and is a member of the official chapter of the Professional Association for SQL Server.

Prior to joining The Alliance, Alan spent more than nine years at WPS Health Insurance, holding roles in data analyst, training, and supervisory positions.

Alan received his bachelor degree in business administration-marketing from the University of Wisconsin-Oshkosh.

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Alan Williams