(u2acro)
Rebecca experienced the wrath of the birth control pricing gods on a Walgreens visit, discovering that the generic version of her pill, Yaz, was suddenly more expensive than the name-brand version. She braved her insurer’s customer service hell to track down some answers but only got more confusion.
She writes:
I’ve been taking Yaz for several years. It’s pricey birth control but I have an endocrine disorder so it’s worth it. My copay is $35. I appreciate that it’s not more. Last month it was randomly $10. When I asked why the pharmacist at Walgreens told me that the pricey pill finally had a generic version. Great news! I run with it.Tonight, I go to get my prescription and the generic costs $60. I am surprised. I ask why. Walgreens says that my insurance — Medco — sets the copay. There is nothing I can do. I ask if I got the regular Yaz if it would go back to being $35. They say, “Oh, of course not. It will cost much more to get the premium version. You’ll have to call them and ask.” I need the pills to take one tonight so I reluctantly pay. I dread the long phone call that will inevitably take place but I really would like to know why the price jumped $50 in a month.
I call the # on my insurance card–it’s the wrong one. All told it takes me about 30 minutes to get to human being that can help me. The Medco customer service rep explains that last month the generic was “Tier 1″ and now it’s “Tier 3″. I have no idea what these terms mean and when I ask she has no real answer. I ask her to look it up and she says that the original version of Yaz is “Tier 2.” Meaning that the generic has been categorized as more expensive than the original. I laugh. I tell her that that seems absurd. She is unmoved. “I’ve seen stranger,” she says! She notes I will have to take it up with Walgreens for discouraging me to get the premium brand. At no point does she suggest that perhaps she should flag this issue or offer to escalate because, obviously, the entire point of generics is to save both of us money. I tell her, “So some sort of keystroke error on somebody’s part in your company cost me $50 this month.” She says nothing for a moment and then notes that it’s *that* odd for a generic to cost more than the original version of the pill!
So I hung up. And called Walgreens. Left a message but since I left with the pills I’m going to guess they are going to say the onus is on me to find out if the generic really is less expensive than the premium. Of course, Walgreens often stops carrying the premium brand after they get the generic in stock, in my experience. So now I guess I have to special request the non-generic? It’s crazy-making.
Rebecca said Walgreens eventually let her return the expensive pills so she could buy the cheaper ones.
What do you budget for birth control and what do you think is the most cost-effective way to go?
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Aetna’s RX home delivery is pretty sweet. I pay $15 for three months worth of Aviane, the generic Ortho-low. They require reoccurring scripts to be written in 90-day supplies and fulfilled through their home delivery or they won’t cover a pharmacy visit for the script. They also provide a one-time “go fill it at the pharmacy” if you forget to do your on-line order. Only had problem with them once – sent it to the wrong address twice, tried to charge me for re-shipping the order, and take away a refill.
As soon as I got out of college and got my first job that offered health insurance, I had a tubal. For only $750, I’ve been free from ever worrying about this crap for almost 20 years now, thank God.
Call me crazy, but I think it’s high time they started selling birth control pills over the counter or “behind the counter” (buy from the pharmacist, but don’t need an Rx from a doctor). I am sick and tired of being held hostage by my need to buy the pill. Besides the convenience factor, the advantage of over the counter medications is that you don’t have to put up with insurance companies to get them. Not only does that make budgeting for medications less complicated, but you’re not forced to go to the pharmacy at the end of every month to pick up next month’s supply. And they wonder why there are so many unintended pregnancies…
I agree. There was an Op-Ed about this recently in the NY Times. I think there was also a piece on Newsweek’s website recently.
I have no insurance and pay $12 a month out of pocket for a BC pill called Trinessa. So far, so good, no babies.
On a related note These Drug Tiers drive me DAFFY!!! As a Medical Clinic Manager I frequently get pulled to deal with patients that have issues with thier meds by the Insurance changing thier formularies and tier pricing- which affects the patients copay price. I’m convinced that that the drug companies fall all over themselves to undercut a competitor by a penny so that they can be on the preferred tier,- until someone else undercuts them- then the cycle continues…. We don’t even try to keep up with which med is on which formulary for which insurance anymore, Many of the glaucoma drugs we use in Ophthalmology are not avail as generic. and NO – Marijuana is not a viable glaucoma drug( though it’s often joked about) Yea it may lower your eye pressure while your smoking it- but when your done it goes right back up again. Even the most diehard dopeheads can’t use that much get a true meaningfull effect. Hey Ben haw about a story on drug and insurance tier priceing strategies?
I budget nothing, and use my personality as birth control. 100% effective!
(This would be a funnier joke if my profile picture didn’t have my baby in it.)
I pay $9.49 for Tri-Sprintec at Target since it’s part of their cheap genetic program. I don’t have insurance, so it’s really helpful.
$400 Vasectomy copay.
Never pulling out again: priceless.
Does this take any consideration that the Yaz generic (ours is called Giavani at wmart i think) is going to be yanked soon bc Yaz’s patent isnt expired? Yaz is Bayers big money maker right now and they are fighting to get the generic pulled since their rights on it havent expired yet and technically there shouldnt be a generic available yet.
The SAME thing happened to me, and a generic version of my medicine suddenly was more expensive than the (already expensive) brand name version. It also had to do with tiers. As far as I know, there’s nothing that you can do about it.
If Walgreens wants to keep the OP as a customer, they will start stocking the pill she can afford. Having worked it a pharmacy before, I know this can happen. If Walgreens doesn’t, then she should go to someone who does. Also, almost all pharmacies price match, since it’s such a competitive market. I do commend Walgreens on taking the expensive pills back. They didn’t have to do that, but also the pharmacist or the tech should have done something before she left.
Birth Control so ridiculously expensive. Why can I get Adivan for $10 for 3 months but I have to pay $75 for Ortho?
I’ve never paid more than $45 or so for 3 month’s worth, even when I don’t have insurance.
Of course, since I’m Canadian that still boils my potatoes. No one should have to pay for birth control (also I think men should be able to claim their girlfriends’ birth control, because even if she doesn’t get his insurance otherwise, if they have a kid his insurance will be paying).
Sounds like the common problem here is Medco. :/ Our company switched over to them on January 1st and we immediately noticed that our prescriptions were more expensive.
For the OP: Check with your ob/gyn. My wife is in ob/gyn and they always have tons of sample boxes of Yaz. At the very least it might help cut your bill down a little bit.
We were on Medco for a number of years, and ran like the wind as soon as another option presented itself.
Here’s how their “tiering” seems to work. They re-tier their formulary 3-4 times a year, every few months, in other words. This makes tracking your extended medication costs nearly impossible.
Their criteria seems to be this: whatever drugs are the most frequently prescribed get the highest copay tier, even if they’re generics. Even if the name brand is many times more expensive in list price. Also, within a class of drugs (SSRI’s, for instance) they’ll up the tier on the most frequently prescribed version.
Then, when everyone shifts their prescriptions to the cheapest option for that period, then the utilization numbers go up for those drugs. Next re-tiering period or so, then THOSE become the most expensive options. Repeat ad nauseum.
Totally infuriating. No logical explanation for it whatsoever apart from discouraging use of the plan for long-term medications. We jumped over to Kaiser when it became available and never, ever looked back. Medco’s the shadiest Rx plan administrator Ihave ever had the displeasure of dealing with.
CVS screwed me over the same way. Also with MedCo by the way. The generic cost way more than the brand. I didn’t get a refund from CVS. Then everytime the prescription gets refilled, CVS automatically fills the more expensive generic. I have to tell them “NO, I want the cheaper name brand!”
Lesson: ANYTIME the generic is not a Tier 1 copay, find out what tier the brand is. Make the pharmacy refill it if the brand is cheaper or same price.
CVS screwed me over the same way. Also with MedCo by the way. The generic cost way more than the brand. I didn’t get a refund from CVS. Then everytime the prescription gets refilled, CVS automatically fills the more expensive generic. I have to tell them “NO, I want the cheaper name brand!”
Lesson: ANYTIME the generic is not a Tier 1 copay, find out what tier the brand is. Make the pharmacy refill it if the brand is cheaper or same price.
You can get free birth control at Free Clinics in your town..
I had a similar, weird, issue at CVS recently. I also take Yaz, and as I do not have a prescription plan, I usually paid about $80 a month for it. Two months ago, I only paid $60. I was confused, but then I saw that I was given the generic instead. Great! I was thrilled. Last month, I went to pick up my pills, and they were $75. I asked what was up, and the pharmacist said the price of the generic went up, and would likely continue to fluctuate for a while. Something about other companies developing their own versions of Yaz.
I hate Medco. They pulled a scam on me where they were trying to get me to order a med that is a $4 generic (at Target or Walmart though them.) I said no. They called my doctor and told him that I agreed to it. They then sent it to me and promptly charged me $90 for a 3 months supply that would cost me $12 at Walmart. The refused to take it back and told me I couldn’t get more meds until it was paid for. They are crackpot scammers.
I have been having the same issue with Ortho-Tricyclen- Lo. I was on it and got the generic, with no insurance, for over a year for $10. Then, I guess they stopped making the generic and the cost went up to $60. I finally got back on my health insurance and now they’ve raised it to $35 WITH insurance because it’s now a Tier 2 drug… what??? Same problem with my Protonix… it went from a Tier 1 last year to a Tier 3. It’s ridiculous how much we are getting ripped off for medicine that we pay insurance to help cover in the first place!
There are a lot of background factors that go into this type of situation, and although odd, it’s not uncommon that a generic may cost more than the brand for a variety of reasons. In this case, there is a unique spin because the manufacturer of brand Yaz (Bayer) is currently in a lawsuit with maker of generic Yaz (Teva), who currently markets their “generic” under the brand name “Gianvi”. More details on the lawsuit here: http://www.reuters.com/article/idUSLDE6501SV20100601
Perhaps breaking down some of the factors may help:
1) When generics first hit the market after a brand’s patent expires, they are oftentimes not that much cheaper than the brand name medication. It is only after several months to a year or so that the market adjusts and the generic medication cost decreases.
2) In this case, Teva released their generic Yaz BEFORE Bayer’s patent expired, thus illegally infringing upon Bayer’s patent. The patent was set to expire July 2011; Teva released their generic product June 2010. Because Teva illegally released their generic drug early, Bayer may have consequently arranged a contract with the insurance companies that would allow higher rebates for the branded Yaz, which would yield lower cost to the consumer (see point #3).
3) For simplicity’s sake, we’ll say that an insurance company contracts with the manufacturer for a drug price. In this case, Medco and Bayer enter a contract to determine at what price the drug will be sold to the consumer, and what copay will be required. Oftentimes, the insurance company will receive rebates and discounts from the manufacturer (and thus can make a profit when selling the drug to the consumer). Branded drug companies may offer better rebates than generics, and thus the net cost to the consumer is GREATER for the generic drug, simply because the branded drug’s rebates were significant enough to offset the actual cost of the drug.
4) Drug tiers are designed to limit the use of high-cost medications. In general, there are three tiers of drug payment. Tier 1 includes all “preferred” drugs, which means drugs that the insurance company will cover, no problem. This usually includes generics because in GENERAL, these drugs are cheaper than brands. Tier 2 includes more expensive drugs (e.g. preferred brand drugs) that will usually a) cost more, and b) require prior authorization from the physician. Tier 3 drugs are usually the non-preferred brands and tend to be most expensive. The determination of which drug belongs to which tier is based on clinical research and clinical outcomes that look at the cost-effectiveness of the drug.
In this case, all of these factors may have an impact on the pricing of generic Yaz being more expensive than the branded Yaz. My guess is that because Teva illegally released their generic before Bayer’s patent expired, Bayer entered into a contract with Medco that forced generic Yaz into Tier 3 in exchange for a better rebate. In other words, branded Yaz remained Tier 2, but since Bayer offered a really good deal on the price of their branded drug, Medco decided to put generic Yaz as Tier 3, thus costing the consumer more money.
So why did Rebecca get generic Yaz if it’s Tier 3 (non-preferred status)? ….because generics are nearly ALWAYS cheaper than brand, and so by default, insurance companies AUTOMATICALLY substitute a brand drug with the generic version (automatic substitution).
Again, a ton of factors are probably behind this abnormal pricing, but hopefully this explanation cleared up some of those things.
IUD.
$350 up front, lasts for 10-12 years, which comes out to $2.92 a month, after 10 years.
No hormones, no needing to remember to take something, stick something on, pull something out, stick something in. All I need to do is check the little string every month & I’m golden.