For chronically ill patients, decisions about whether to pay or go without medications are life-or-death battles that must be fought over and over again.
When Caiti Derenze, a lawyer in Jersey City, N.J., went to Walgreens to refill her insulin prescription in July, she was met with a nearly $300 bill.
“I was like, ‘Oh my God, I only paid like $50 last month. What happened?’” Ms. Derenze said. “It feels like a punch in the gut, to be told a medication you need to live costs so much money.”
Trying to find the answer set in motion a wild-goose chase. Walgreens directed Ms. Derenze to her insurance company, Aetna. Aetna sent her to Express Scripts, a pharmacy benefit manager. Express Scripts said it needed prior authorization from her doctor.
“I deal with these issues on, if not on a monthly basis, every two months,” Ms. Derenze said. “You have to call so many people just to figure these things out.”
In the last decade, as prescription drug prices have steadily risen, patients have increasingly experienced this kind of sticker shock at the pharmacy counter. For people who are chronically ill, decisions about whether to pony up the cash or go without aren’t frustrating, one-off predicaments; instead, they represent life-or-death battles that must be fought not once, but over and over again.
Pharmacies are quick to blame insurance companies and vice versa, tasking patients with the burden of trying to find a cost-effective solution via hours of back-and-forth phone calls.
Worse, for diabetics and other chronically ill patients who will need these medications forever, they stand to face the same issue all over again the next time they need a refill. By then, a new insulin might be the preferred brand covered by insurance.
Brooks Bellman, an immigration paralegal in Atlanta, recalls an incident last year when his insurance company switched its preferred long-acting insulin from Lantus to Levemir. He needed a higher dose of the Levemir to keep his blood sugar in a healthy range and went through it more quickly, but his insurance company wouldn’t account for that change and prevented him from refilling it early.