Adventures In Crazy Birth Control Pricing

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?

Comments

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  1. Applekid ┬──┬ ノ( ゜-゜ノ) says:

    Drug tiers are how they determine your copays, so all Tier 1 drugs have the same copay, Tier 2, etc.

    • Andy S. says:

      Incorrect.

      Tiers are they way that insurance companies indicate how much of kickback they receive from the pharmaceutical company that manufactures the drug.

      Tier 1 drugs – they receive large kickbacks to encourage their insured to choose those drugs.
      Tier 2 drugs – smaller kickbacks.
      Tier 3 drugs – no kickbacks. Insurance company discourages their use.
      Tier 4 drugs – insurance company can’t even buy these at wholesale prices. They are going to foist off most of the cost to the insured.

  2. Vanilla5 says:

    Go online to Medco’s site, price the medication (both generic and brand name) @ 30 days (you should see retail and mail-order options) and see if it gives you the same prices. If it does, it COULD be a keystroke error, but I’d look further into why the formulary is that way for Yaz (escalate the call).

    This seems odd to me and I worked at a PBM for a while.

    • Bottoms_Up says:

      I know for my BC I can only get it one month at a time so that doesn’t work for me. My BC is not the pill, it is the NuvaRing so maybe it’s different.

      • Vanilla5 says:

        Hm…I have a teammate who uses Nuvaring and gets hers in 3-month refills. Perhaps different insurance coverage has different rules on non-pill filling procedures.

      • Captain Sassypants says:

        The NuvaRing is temperature-sensitive (the hormones don’t leach out when it’s cold, but they will when the ring is warmed to your body temperature or higher). Many prescription benefit programs only offer 3 month supplies via mail and some benefit programs won’t cold-pack/overnight medications for shipment. If the rings get too hot in transit, they could be ineffective by the time you receive them. If that’s the case for your insurer, it would explain why you’re not able to get a 3 month supply via mail.

      • ahleeeshah says:

        You can probably only get one at a time because that’s the way your prescription was written. I use Nuvaring as well and if I wanted to do a mail order I’d have to get my doctor to rewrite the prescription to allow for it.

  3. SixOfOne says:

    This kind of BS is why I’m glad that my gyno gave me a coupon for the pill so that I don’t pay anything higher than $24/month. Prior to that, I also had to pay $35/month for another brand.

    • Marshmelly says:

      Do you know if all doctors give these out? I’m currently paying $35/mo but $24 is sounding pretty good to me right now lol

    • You Can Call Me Al(isa) says:

      I like it when they give me free “samples” of Nuvaring. Last year, the Dr I went to gave me 10 months worth of samples. It saved me A LOT of money since I didn’t have health insurance that covered birth control at the time.

    • qualia says:

      The coupons end up increasing everyone’s premiums because even though you’re not paying more than $24 a month for brand name, your insurer is still paying the full price $-24. Your premiums go up because your insurance company is still paying twice as much and the only way it had to steer you into getting less expensive brands and generics is making sure you knew when you were getting a drug that was $200 a month instead of the $60 alternative.

      • gStein_*|bringing starpipe back|* says:

        not quite. i get Freestyle test strips – let’s say that the “actual cost” is $200. my copay is (supposed to be) $50. the insurance company pays $150, i pay $15, and Abbott (the manufacturer/distributor of the strips) pays the remaining $35. no higher premiums.

        • DoubleBaconVeggieBurger says:

          BUT, what if there is a generic for Freestyle, which costs $120. Your insurance company wants you to get the generic strips, so the copay is $20, and they pay $100. Your coupon makes you request the name brand, because it’s cheaper for you, but your insurance has to pay $50 more. If everyone does that, premiums go up. That’s why Freestyle gives you the coupon.

  4. badachie says:

    If you have an endocrine disorder and you doctor can verify that Yaz helps, the drug may be classified in a different tier. I currently take Singulair, which my insurer classifies as a Tier 3 if only taken for allergies. But since I take it for asthma, it’s a Tier 2. Does this make sense? No. But it might not hurt to ask.

    • FatLynn says:

      The same is often true for Retin-A depending on whether it is for acne or wrinkles.

    • ossuary says:

      I also had that problem. My doctor would have to write a hand-freaking-written note to my insurer (who the hell requires that these days?) every time I was going to get a Singular prescription filled. I luckily (?) had asthma in my younger years and so it was on my medical record and he was able to use that as reason for me to get it “for asthma” even though it was really for my allergies (in combo with Allegra FTW!).

  5. eccsame says:

    I didn’t know Alison Moyet had branched out into pharmaceuticals.

  6. mythago says:

    re the OP’s problem: Medco has had issues in the past (any by “issues”, I mean “paid millions of dollars in settlements”) regarding shady practices in medication pricing. I would be very surprised if your pharmacist had anything to do with this; they’re probably just reading the numbers off what Medco sends them. Keep after Medco on this.

    re birth control: keeping your encounters same-sex, condoms and surgery, pretty much in that order ranked by foolproof-ness and convenience. YMMV, of course.

    • Zeniq says:

      “re birth control: keeping your encounters same-sex, condoms and surgery, pretty much in that order ranked by foolproof-ness and convenience.”

      Agreed on the same-sex encounters for birth control. All the pleasure, none of the worry!

    • Courtney Ostaff says:

      We had Aetna in 2007, when they used Medco for their prescription benefits. I hated being forced to use their mail order business, especially when, if you read the fine print, they don’t promise to be any cheaper than your local pharmacy. They’re in it to make money, and the BS about 90s being cheaper is just that – BS. My favorite part was when my doctor faxed in my prescriptions (because I *couldn’t* fax in a prescription, only my doctor), and Medco would leave my scrips sitting on a desk for week before they filled them, while I paid out-of-pocket for my drugs at my local pharmacy. Never again will I consent to any mail order pharmacy!!!

  7. nbs2 says:

    does MedCo offer a by-mail drug program? Cigna has one, and it is cheaper for us to get long term same dosage medication through that than go to the pharmacy, I think by $5. The only issue is making sure that you aren’t going to get a dosage change.

    • aloria says:

      Yes, they do. I get my BCPs this way. They send me three packs at a time, automatically, every three months. They even call my gyn when time comes to refill. It’s super convenient.

    • Brunette Bookworm says:

      That’s how I do mine with Medco. Actually, I’m FORCED to do it that way or pay way more. Perhaps the poster could look into mail order options to see if it’s cheaper. Maybe something on her plan changed.

    • Kimaroo - 100% Pure Natural Kitteh says:

      Living in Texas, I made the mistake of trying mail order for my birth control pills. Most people don’t realize that BC pills are temperature sensitive (or at least, all the ones I’ve ever been on are) they degrade in temperatures higher than 75. I don’t know about you, but I don’t want something as important as BC degrading at all. Anyway, one summer my doctor insisted that mail order was the way to go, but my pills sat out in the mailbox and in 100 degree weather in a black metal mailbox.. well.. let’s just say I won’t ever do it again. I just don’t trust the mail for temperature sensitive things.

      I didn’t end up with a baby out of the deal, but the pills were definitely not right for those three months.

  8. Thyme for an edit button says:

    I’d see if they have a copy of the prescription formulary on their website, or call and ask for a copy. That should show you what “tier” different medications are in. Your insurance policy should explain what level of coverage you have for different tiers.

    I recommend the website: http://community.livejournal.com/birthcontrol

    I think you have to be a member if livejournal to discuss things there (easy to create). They know pretty much all there is to know about birth control and may have some insight on generics and insurance.

    You might be able to get the brand version cheaper with a discount card. I know some manufacturers offer them. Might also hold true for generics through discount cards some stores offer. I know Rite Aid has a discount card of some kind. I have no idea if there is a card that works to discount Yaz or its generics, but it would be worth looking into.

  9. Darkrose says:

    My kid takes a drug that the generic version is NOT covered. So we pay $20 for the name brand, or $50 for the (non-covered) generic.

  10. catchthefever says:

    I have Medco as well. My doctor wrote my Yaz prescription for 3-month refills, costing $62.50 (for 3 months of pills) via mail-order. Have your doctor write the prescription for less frequent refills for better savings.

  11. odarkshineo says:

    This same thing happened to my sister…seems to be the new scam.

  12. hattrick says:

    The new health reform legislation said that preventive medications and treatment should be fully covered without co-pays, including ones only for women’s health (Thank you, Sen. Parry Murray!).

    Right now, right-wing Republicans are trying to make birth control an exception to this–they are being aided by the Catholic Bishops, who are religiously opposed to all forms of birth control (even for married people) as well as national abstinence groups.

    I strongly urge anyone who is tired of shenanigans like these to contact your member of Congress and tell them that family planning and birth control ARE preventive care!

    Planned Parenthood has been doing a whole campaign on this: http://www.plannedparenthoodaction.org/get-involved/take-action-725.htm

    • ZeshawnWhiles says:

      Natural family planning is free

    • Putts says:

      Sorry, but unless it’s being taken for reasons other than birth control, those meds have no reason to be covered 100%. It’s completely optional that somebody would need to use birth control, just like it’s completely optional for someone to have sex.

      “Preventative care” refers to preventing disease and illness. Pregnancy is not an illness, as much as those clowns at Planned Parenthood would like you to believe so.

      • My Sister's Keeper says:

        Actually, pregnancy is an abnormal state of being. That’s why most women spend upwards of 3/4 of their reproductive years (defined as 15-44) to prevent it.

        http://familypact.org/Files/FactSheet_Female_Contraception.pdf

        Plus, most women are sexually active for over 3 decades but only want 2 kids. Just because something’s natural and only very, very rarely wanted doesn’t mean is shouldn’t be prevented the majority of the time. Pregnancy and birth are physically exhausting and kill people on a regular basis. Those of us in economically privileged countries forget that because we have better medical services AND better preventive care so that women can get pregnant when they can handle, emotionally AND physically.

        http://www.guttmacher.org/pubs/tgr/06/5/gr060507.html

        • smo0 says:

          Shh shh… one day – they will learn. Otherwise, you’re competing with Jesus on this subject!

      • evnmorlo says:

        No matter what you call it or how low your sex drive is, pregnancy results in substantial medical costs, which are in the insurance company’s interest to prevent.

        • aloria says:

          Exactly.Which is cheaper, a couple decades of birth control prescriptions, or several rounds of prenatal care and hospital visits from a woman constantly getting knocked up?

      • AnthonyC says:

        “Pregnancy is not an illness”

        It is when insurance companies spent years refusing to allow pregnant women to buy coverage.

      • hattrick says:

        “Sorry, but unless it’s being taken for reasons other than birth control, those meds have no reason to be covered 100%. It’s completely optional that somebody would need to use birth control, just like it’s completely optional for someone to have sex.”

        You’re right, I should be totally abstinent until I hit menopause. Except for the times that I’m trying to get pregnant or, I guess, when I’m actually pregnant. It is totally reasonable to expect that in our society the only women men will be having sex with are women who are or about to become pregnant, or women over the age of 45 or 50. All other sex is totally, completely, abnormal, and we should not treat it as part of normal preventive medicine.

        We’re supposed to believe that in a country where 95% of fertile women use birth control, it’s not a routine part of preventive medicine? It’s less preventive medicine than, say, vaccines? I mean, who needs a tetanus vaccination, all you have to do is avoid rusty nails. Who needs a flu vaccination, all you have to do is compulsively wash your hands and wear a mask all the time. Is this a joke?

        And yeah, being pregnant is a medical condition. I think it’s the only medical condition that millions of people are thrilled to get, but it’s a medical condition for sure. That’s why us pregnant chicks go to the doctor all the time. Seriously, how can the #1 cause of admission to hospitals (labor, the end of pregnancy) not be a medical condition?

        • operator207 says:

          Nope, you should have all the sex you want, and all the kids you want, just not on everyone else’s dime. Yep thats right, everyone pays for this gov’t healthcare. Which means if this goes through, and BCP gets put on as a preventative drug for BC (not for other illnesses) I am paying for you to be “care free” when it comes to getting pregnant.

          You come off like it is a right to take BCP’s, and the gov’t *must* pay for it. it’s not, stop thinking it is. Or at least stop posting like you think it is.

      • Eyebrows McGee (now with double the baby!) says:

        $1 spent on birth control saves $4 in later tax-supported health care costs in my state. That does not, of course, include the money spent privately, just public dollars. Approximately half of women of childbearing age in my state who wish to use birth control cannot afford it or have no access to it.

      • littlemoose says:

        Birth control pills are also used to treat other conditions, in addition to preventing pregnancy. They are often prescribed for recurrent ovarian cysts, endometriosis, severe menstrual cramps, menstrual headaches, and even severe acne — anything affected by the hormonal cycle. I think preventing or mitigating these conditions falls well within the purview of preventative medicine.

      • mythago says:

        Let me guess – you’re a guy.

    • lemortede says:

      Does this mean that I should get my Condoms for free as well? What about sponges, spermicide, ball gags….

  13. bcsus83 says:

    I have a Paraguard T IUD. My copay was just what I would normally pay for the office visit when I had it placed. It lasts 10 yrs. Done. :)

    • Hermia says:

      Same here. Though I went through insurance hell getting it. My rider indicated that it was fully covered (both IUD and insertion), but after they were billed my insurance company covered the IUD but denied the “office visit” to insert it. After 9 months of arguing and finally contacting my State Rep the insurance company conceded the error and reimbursed me for it.

      Another scam – insurance companies denying coverage even though what you’re getting IS covered, and making you fight for the reimbursement. If my State Rep hadn’t intervened I’d probably still be out the $500. They finally said it was a “customer service error” and that the rep had been “educated” on the proper procedure. Obviously an IUD needs to be inserted by a doctor, you can’t do it yourself, which is what the rep who denied it tried to state as the reason for the denial.

    • selianth says:

      Same here – just the office visit co-pay to get my Mirena IUD. It only lasts 5 years instead of your 10, but has the benefit of completely reducing my periods to literally nothing, saving me even more money in sanitary supplies.

    • wenhaver says:

      Ditto me. I think I paid all of $12 for mine, it lasts 5 years, and I haven’t had a period in almost 9 months. I don’t have to think about it, don’t cramp, don’t bloat, and it was so incredibly cheap (although a little uncomfortable for the rest of the day after it was inserted). IUDs FTW.

      • mythago says:

        FTW? YMMV.

        • thesadtomato says:

          Yes, YMMV, but most women have been needlessly scared off of IUDs because of the Shield issues in the 1970’s. That isn’t a problem anymore, and IUDs are (potentially) a non-hormonal BC is that’s your bag, and if you prefer the hormonal IUD your chances of having a very light/no period at all are pretty good. I like that fact that like the ring, the hormones are “on site” and are therefore at much lower doses than if I was on the Pill.

          Also, yeah, really cheap and lasts 5-10 years.

    • Courtney Ostaff says:

      I have a Mirena, and it kicks butt! Love, love, love it! I had the normal co-pay for my insertion, but I asked the nurse how much it cost, and it is $800 out of pocket. That averages out to $13.33 per month for the life of the IUD, with a 99% efficacy rate, which is a lot cheaper than pills. Plus, it uses very little hormone, which is especially nice to those of us who are sensitive to such things.

    • hattrick says:

      Would love to have one of these, but I have endometriosis. Lots of women, especially as they get older, have cysts, fibroids, etc. Bad periods and IUDs do not mix.

      Still, so glad that this option is working well for so many people here! Good for everyone to have the choice that works best for them.

  14. ChicagoAndy says:

    Doesn’t Walmart and Target sell $4 generics? Try going there and paying cash.

    _Am

    • Jfielder says:

      Not for yaz, and not for any birth control pills…. They do have sprintec and tri-sprintec (generic for ortho cyclen and ortho tri-cyclen) for 9 dollars a month. Still the best deal around for uninsured folks…

    • dragonflii says:

      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!

  15. cheepers says:

    The price on my Yaz went up to $60 this month too. My Humana rep was actually really nice about it and we did a conference call with a very irate Walgreens associate who told me I refused the generic and had signed all sorts of paperwork so they were charging me the extra. It turns out she was at a regional depot, not even my local Walgreens. Of course I hadn’t signed anything, and the local Walgreens didnt even know the generic existed. They let me switch it out in the end, but it was irritating being yelled at someone who wasn’t even in the same location as the transaction occurred.

  16. shepd says:

    If only you lived in Estonia!

    http://store.businessmonitor.com/article/336207/

  17. Anonymously says:

    If the generic is truly more expensive than the name brand, have the doctor write a prescription that disallows generic substitution.

  18. props_nyc says:

    just an aside here…

    i’ve found that quite often you can find coupons online for a lot of name brand prescription drugs that makes it cheaper than the generic or even free.

    as long as your insurance will cover name brand, you can use whichever makes more sense.

    i’ve done this in the past where there was no generic available and my copay worked out to something like $2.50 a dose

  19. ARVash says:

    Ask your doctor to simply require you to use the name brand. It’s as simple as her signature.

    They’re required by corp policy to use the generic if there is ever an opportunity to do so, and it’s like this across all pharmacies as far as I can tell. It’s odd that they would charge more for the brand name though.

  20. simplekismet says:

    This is an insurance issue and not a Walgreens issue, but usually the pharmacy technicians know what’s going on and can explain it better. Unfortunately, you’ll have to escalate up the insurance/Medco ladder in order to find someone who can explain it – the first representative definitely won’t know anything.

    Insurance companies regularly make contracts with drug manufacturers that result in the brand name copay being less than the generic copay. Of course the generic costs less overall – but your insurance company is getting a rebate from the brand name manufacturer, so they’re willing to pay out more to Walgreens in order to get that eventual rebate. To encourage you to use the brand name drug instead of the generic, they make the copay for the brand name drug cheaper. Again, it’s not that the brand name itself is cheaper than the generic itself – it’s that the brand name COPAY is cheaper than the generic COPAY.

    My favorite (read: least favorite) insurance pricing substitution is that state-funded Medi-Cal covers Xopenex (a newer version of albuterol, levalbuterol) but not cheap, generic albuterol. The two drugs are NOT interchangeable so every time a Medi-Cal patient comes in with a prescription for albuterol, I have to track down the physician and get approval to change to Xopenex so that insurance will pay. Pain in the ass!

    But it’s not weird at all. It’s pretty common.

    -a pharmacist intern

    • pythonspam says:

      “Insurance companies regularly make contracts with drug manufacturers that result in the brand name copay being less than the generic copay.”

      Ah, the free market at work… Its good to know that the insurance companies and Phrma are working together to make medicine cheaper for all of us.

      • johnva says:

        Sounds like an anti-trust issue to me, if our government had the guts to actually investigate that sort of thing.

    • badachie says:

      Actually cheap, generic albuterol is no longer cheap or generic. A few years ago, the FDA required drug manufacturers to stop using CFCs to propel the medication. Probably a good thing for all concerned. However, the change in the way the medication was dispensed (not in the medication itself) allowed it to no longer be classified as generic and resulted in me paying more each month.

      • Courtney Ostaff says:

        Ditto! Ticks me off el-royale!! Until recently we had Guardian Health Insurance, and they refused to pay for the non-CFC albuterol inhaler, period, saying that I should buy the generic – which would be great, if it were available. But they stopped making it for US sale years ago!!!

    • Courtney Ostaff says:

      WV state law requires that generics be used unless the physician specifies otherwise. Cuts out on those pesky contracts like that — which may be why we have lots of independent pharmacies?

    • LuckyLady says:

      I want to say THANK YOU for doing good work. Your patients appreciate it. :)

  21. BridgetPentheus says:

    This has happened to me many times times with brand vs generic (with many times the brand being same price as generic) The absolute worst and if there had been an adequete FDA category to complain was me mailing in my prescription to MEDCO with my doctor’s DO NOT SUBSITUTE, MEDICALLY NECESSARY (after having an allergic reaction to the generic at the drugstore) them sending me the generic, along with a letter saying my doctor had agreed to the substitution (WHICH HE HAD 100% not agreed to in his medical files, a very small office so the nurse and him would remember) I hate US drug insurance companies and am glad to say goodbye to them, that said, I always ask the generic price vs the brand and refuse to pay otherwise. Generics do not equal brand, the formulation make up is different and can cause different reactions which is why in other countries the generic has to market under a name

  22. lemortede says:

    I have had the same crap happen with Medco. I have been very unsatisfied since my company switched our insurance to them.

  23. FatLynn says:

    In the future, make Walgreen’s look up the price for both the generic and the non-generic before making the decision.

  24. BrianneG says:

    yes, purchasing birth control sucks, plus the prescription plan of my Blue Shield HMO has steadily been getting worse as the years go by. Originally, I paid $30/month for a regular prescription and $15 for a generic. (I think there’s a higher level for regular prescriptions too.) Then they added a $150 prescription drug deductible that you must reach before you get to pay the $30/month price, but that deductible was waived if only purchasing generics. Luckily, my birth control pill (Yasmin, same maker as Yaz) went generic a couple years ago so I only pay $15/month, no deductible.

    Also, my doctor prescribes me a set of three packs at a time (so I’d only need to pick it up every three months), so that I can take it like Seasonale. Unfortunately, Blue Shield refuses to do that because I’d end up with more than 12/year (which you should anyway since there are technically 13 4-week periods in a year). Usually, they just make the prescription last for 12 cycles and then won’t give me more refills. This time, they used the number of refills he set (3 refills) but only give me a month’s worth so it won’t even last the year. They’ll have to call and bug him every month now.

    Fortunately, I get it all back through my HSA, but it’s still annoying. if I were only using it for the birth control aspect, then we would switch to solely using condoms because they are only $13.50 for 36 at the local Target. (Also refundable by HSA) But w/o the pill I would miss a day of work each month due to heinous cramps.

    • Nigerian prince looking for business partner says:

      You might want to do some research regarding how Health Care Reform impacts HSA plans. I was under the impression that OTC drugs, contraceptives and things like bandaids will soon no longer be reimbursable with a HSA.

    • Not Given says:

      The insurance guy that came out to tell my husbands work about the differences in next years rules said that OTCs will not be reimbursable through the cafeteria plan next year. I don’t know if the HSA rules are different but he said it was because of the government health care ‘reform.’ I just know, now I will have to get prescriptions for other drugs in place of some of the OTCs we use in order for the copay to be covered in pretax dollars by the cafeteria plan. Right now we could get prilosec, pepto bismol, condoms, bandaids, neosporin, naproxen, benedryl, etc reimbursed. What we spend on this kind of thing over a year’s time can add up.

      • Courtney Ostaff says:

        Most of that you can get at seriously reduced prices through a bit of clever couponing. Check out sites like hip2save for suchlike. (No, I’m not affiliated and do not get kickbacks or anything). After doing this for a few months, I refuse to pay for personal care items when I can get them for free!!

    • deadbird says:

      I had exactly the same health problems as you. A few years ago I got a new OBGYN who told me this was not normal and I shouldn’t have to suffer this way. Because it made it hard for me to keep a job she was able to write me a script that states I am to take this continuously, and throw out the placebos, so I get about 18 a yr. It took a while for insurance to understand this and honor it but my Dr is great and really helped by writing a few short letters/emails. The trick was to clearly state these pills were not for birth control but to help control my developing endometreosis (sp?) and PMDD- which is just fancy talk for painful periods that disrupt your life! Also, look into endometrial ablation if you want a permanent solution w/out drugs!

    • Courtney Ostaff says:

      Look into options other than the pill. I love my IUD, but you can only get one after you’ve been pregnant, because your uterus needs to be stretched out a bit. (Yes, having an abortion does allow you to get an IUD). That averages out to $13 a month.

      I did the NuvaRing for a while, and loved it, but it’s still once a month. I did the patch for a while, and it was OK. The NuvaRing & Ortho-Evra patch’s effficacy are comparable to the pill – AKA about 99% effective. The patch, like the pill, sends hormones throughout your whole body, so you’re more prone to whole-body side effects. All three are comparable in price ~ $30/month. FYI, unlike the pill, which can be adjusted by weight, the NuvaRing & Ortho-Evra Patch have a weight limit of 220lbs.

      I didn’t like Depo-Provera because it really messes with your hormones, and it commonly causes irregular periods. It’s about $35 to $250 for the exam, plus $35 to $75 for the shot itself, plus any follow-up visits. And, oh yes, if you get your shot late, you’ll need a lab pregnancy test for about $20.

      I’ve never done a diaphragm, because I didn’t think it was reliable enough (85%-95%). An examination for it costs from $50 to $200. Diaphragms average from $15 to $75. Spermicide jelly or cream costs from about $8 to $17 a kit.

      Likewise, I didn’t feel the sponge was reliable enough (60%-90%, with women who have given birth being more likely to get pregnant again.) A package of three sponges costs $9–$15.

      Ditto with the cervical cap (70% – 85, with women who have given birth being more likely to get pregnant again.) An examination costs from $50 to $200. Cervical caps average from $60 to $75. Spermicide jelly or cream costs about $8 to $17 a kit.

      Again with the female condom (69%-95%). Plus, those suckers are expensive!! And they don’t teach you how to use them in health class, either.

      Vaginal contraceptive shields are merely a type of spermicide, which some women have a reaction to (I think they smell HORRIBLE) and they’re only 74%-94% effective. When used together and properly, spermicides and condoms combined are about 97% effective in preventing pregnancy. Still, you lose spontaneity, which is an issue.

      I got my 17-year-old ward Implanon, because it was long lasting (3yrs), didn’t require you to be pregnant first, didn’t require you to remember anything (like taking a pill every day), and was 99.5% effective. It’s a bit scary to get an implant, but the local anesthetic takes care of it. It ranges from $500-$800 dollars, which works out to $14-$22 per month. Usually insurance will only charge a regular co-pay, because it requires an office visit. This way, when she turned 18, she still had really good birth control, even though she wasn’t on our health insurance.

      • outoftheblew says:

        Many doctors WILL give you an IUD if you’ve not been pregnant before (some won’t, and if someone encounters that and wants an IUD, she should find another doctor) … it just hurts more. But it’s not because of the uterus; it’s because the cervix has never been dilated.

  25. ColHapablap says:

    “What do you budget for birth control and what do you think is the most cost-effective way to go?”

    1. Don’t use any.
    2. Have your mother run for Vice President.
    3. Sell any and all aspects of your life to the highest bidder.

  26. AuntieMaim says:

    My guess is that Yaz cut some kind of deal with Medco to make brand-name pricing more appealing in order to sell more units. Make it favorable to Medco to give a lower copay on the brand-name version, and all of Medco’s customers will choose the brand-name one once they learn of the tier switch. The makers of Yaz get to keep some of their market share, Medco probably gets a sweet pay-off, and the customer gets … screwed at the till and then gets the runaround from a Medco CSR who probably was never informed why the change was made.

  27. Mike says:

    Sigh. Just another reason to hate our private health care system. I never had these problems in Canada, the ironic part? As an American I didn’t qualify for prescription drug coverage so I had to pay out of pocket, but the drugs were price controlled with the rest of the Western world, (sans the US of course) and I paid less than my co-pay for drugs here.

  28. smo0 says:

    Wait, medco still insured you for monthly refills? WOW.

    Medco oftens sends me threatening letters after every perscription, first time or not – stating that if I wanted to continue to have it insured, I’d have to order through their online or by mail system or I’d be responsible for 100% of the cost….

  29. Miss Dev (The Beer Sherpa) says:

    I ordered 3 months worth from Kaiser’s mail order service. 4 packets cost the same as 1 at the pharmacy.

    Of course, then the pills caused me to get a pulmonary embolism, and I’m stuck with 3 packets and thousands in hospital bills. So, it wasn’t really a bargain in the end…

  30. johnva says:

    My wife’s birth control is seemingly a different price (sometimes wildly so) every month because the insurance company is constantly tinkering around with how they reimburse for it. So it’s always a guessing game how much it will be. Frankly, I think that kind of insurer practice should be illegal and punished under racketeering laws.

    • Nigerian prince looking for business partner says:

      But negotiated rates are one thing that keeps prices down. I have an HSA, so I pay 100% out of pocket. Negotiated rates for drugs (and services) are typically 40-50% less than billed rates. This is because Blue Cross, Aetna, etc. buy in bulk and can get better rates than an individual.

      One of the reason why the Medicare Rx plans are so expensive is because it was written into the law that prices aren’t negotiated for. This resulted in a multi billion dollar hand out to the pharmaceutical industry.

      • johnva says:

        So let’s have all drugs get negotiated for by the federal government for everyone, through a single-payer system (kind of like how the VA medical system works for that). We could get an even better price by that theory because it would be even more people. And it would no more be a price fixing issue than what’s currently going on at the corporate level. We would just be using our collective buying power even more strongly.

  31. selianth says:

    A similarly annoying problem is my husband’s Prevacid. The patent recently ran out, so just like Claritin and Prilosec did, they started selling it over the counter at half the dosage (along with all the generic versions of it.) So of course, because it’s available over the counter, our insurance no longer wants to pay for it. His doctor recommended just buying them OTC and taking two at a time to get the dosage he was taking before. This would end up costing $30 for a 21-day supply. No thank you. Instead, hubby insists that the doctor write the required letter to the insurance company every three months asking them to cover the higher dosage from the pharmacy. $15 for a 30-day supply. Slight inconvenience of having to call his doctor about it several times a year, but much cheaper in the long run.

  32. nosense22 says:

    Sometimes, the drug maker will subsidize the member’s copay to encourage usage. Usually, this happens with a coupon at a point of sale display, but maybe this is/ was a built-in coupon?

  33. mwshook says:

    *Technically* there’s no such thing as generic birth control pills. Several companies may make competing versions of the same pill after the original patent runs out. BUT when you purchase BC pills, you are also paying for the fancy packaging they come in. (I know of no BC pills that are sold in the orange pharmacy bottles).

    Generic Yaz is being marketed as Gianvi.

    Why is Gianvi Tier 3? To screw you.

    (Disclaimer?: I am a doctor, but not your doctor.)

  34. msbask says:

    Am I the only one stuck on “Walgreens eventually let her return the expensive pills so she could buy the cheaper ones”?

    Walgreens lets you return prescription medication?? That seems… unsafe at best.

    • Etoiles says:

      Birth control pills come in a sealed packet that visibly shows if any pill has been moved or tampered with, unlike, say, a bottle of amoxicillin where you could have done god-knows-what to the 30 pills inside.

      • CPhT0519 says:

        I’m a tech at Walgreens. If a customer is allowed to return an RX it is NEVER resold. Even if it’s BC in a sealed box. Once it leaves the pharmacy it’s considered compromised. If the pharmacy manager (in my state it’s his call) allows a customer to return meds, it gets salvaged and he/Walgreens eats the cost.

    • wonderkitty now has two dogs says:

      Most likely, Walgreens ate it on the pills for the sake of good customer service. Pharmacies *can* be like that. I don’t think they’re supposed to put the pills back, but again- sealed packaged.

  35. AT203 says:

    I’ve seen this before with another medication, and confirmed with my physician. What happened was that the patent to the brand-name drug had expired. The patent-owner/manufacturer started producing a generic version, but priced it higher than the brand-name (before other manufacturers could ramp up manufacturing). My speculation is that the manufacturer was trying to confuse consumers by convincing them that the generic was more expensive. Their hope being, that once another manufacturer started producing a generic (at a cheaper price) that some consumers would make a decision based on their prior price experience, and not compare prices with the new more cheaply manufactured generic.

    • tchann says:

      I don’t know how long these patents typically last, but the generic Yaz just went on the market maybe two years ago. =

  36. erratapage says:

    Back in the day, I took birth control for a pretty nasty case of endometriosis. I paid as much as $70 for a three month supply, $110 if I didn’t have insurance. I always resented that more than a few people thought that my prescription was somehow about birth control, which, many people felt was a sin. I mean… there’s more than a few women who have been denied birth control pills based on the pharmacist’s religious convictions.

    The truth was, I couldn’t have gotten pregnant if I wanted to. And hormonal treatment was my best hope of avoiding seriously invasive surgery. My birth control cost my insurer something like $40 for three months’ supply. My hysterectomy cost my insurer over $100,000, after two failed surgeries which cost in excess of $75,000.

    Hormone treatment did not work for me, but I understand that it works for many, many women. I say we give out free birth control pills to anyone who wants it. If you guys want condoms, I’ll vote for that to be included as well.

  37. sponica says:

    back when I was on my mom’s plan. a generic cost 5 dollars a month, and a name brand 15 dollars a month….and the same for mail order. I could pay 5 dollars for 3 months worth of the generic or 15 dollars for 3 months worth of name brand.

    I miss that plan :(

    When I ran out of birth control, I just stopped taking it all together. Sure it’s super fun being on the roller coaster ride of hormones…

  38. tchann says:

    I take Ocella (generic version of Yaz) and I pay the $8 generic prescription copay my insurance company calls for. Before I had good insurance, however, I had joined Sam’s Club because their higher-tier subscription allowed for pharmacy discounts, and that brought Ocella down to $28 a month. Anywhere else, it ran about $48.

    But a long while before Ocella came out, I was on Yasmin, which went from $30 to $60 in the span of a few months, which is why I ditched it for Ortho TriCyclen, which was an absolutely horrible experience. But that’s a story for another time…

  39. sweaterhogans says:

    Whoa! $60 for birth control?! What is so special about Yaz that makes it Tier 3 anyway? It seems to me that all oral contraceptives are pretty much the same with only slight variants in percentages of ingredients. Mine only costs $15 for generic.

    • tchann says:

      The hormone balance is the big deal. While I don’t know the specifics, I will say that I far prefer Yaz to the traditional pill. Coming off the ortho tricyclen was like swimming out of a depression – I was opening my eyes and finally seeing the sun. It messed with me that bad. :(

  40. Bottoms_Up says:

    I am on the NuvaRing and I pay $60/month. That is a pretty steep price for BC, but really, it’s A LOT cheaper then the alternative.

    • You Can Call Me Al(isa) says:

      I used to pay that much, (before I got better insurance) too. The funny thing, to me, is that while I was in Australia I could get it for $30/month, no insurance needed.

  41. cottercutie says:

    My insurer uses Medco too. I just went through this with Protonix. Thankfully the nice pharmacist at CVS helped me out and told me that the generic was not even covered while the brand name was. She also told me that by law they have to give the generic to you unless your MD checks the “Dispense as Written” box on your RX. It’s probably the same thing that Rebecca has to do.

  42. lostdisk says:

    Medco will give you a discounted rate for a few months, usually up to 3, and then increase the cost of a generic to get you to use the Medco by mail instead. If you want the cheaper price you need to mail order the drugs, instead of going to Walgreens.

    I had this happen, and I think it’s a joke.

    So, because I want to pick up my prescription from Walgreens each month, my insurance will charge me more. I’m guessing something like this is happening to the gal in the article.

    • smo0 says:

      I posted my comment pertaining to this…. did you get the threatening letters too?!

    • wenhaver says:

      We have this issue with a drug, too. Here’s the problem – it’s for adderall. Which is basically speed, and therefore controlled. So it’s a giant PITA to get them the script every month, wait for them to fill it, and then someone has to be home to sign for it. We can’t have it delivered to work, because it’s against policy. So basically, we pay $30 every month for a drug that would cost us $10 if we did mail order, but we can’t. I would still pay $30 than have him unmedicated, however. That’s just not pretty.

      • lostdisk says:

        I was on Adderall, and now I’m on Vyvance, and have the same major PITA. Since you have to sign for the medication, someone has to be home. So, I have to pay a bit more to get my script from the local Walgreens.

        Good news now, is since I’m now on Vyvance, I can get a discount coupon so I only pay half my copay.

        Jenn

  43. anime_runs_my_life says:

    While I haven’t run into the problem with my BC pills (I take Micronor, so it’s a fairly cheap refill), I did run into a similar problem when I was prescribed Ambien for a sleep problem. Walgreens was willing to sell me Ambien, or I could get the generic for less. It ended up being expensive either way.

    I eventually ended up going with the generic 90 day refill at Sam’s club. It was significantly cheaper than Walgreens and a few other local drug stores. Maybe checking out other places, like Sam’s Club could be a cheaper alternative.

  44. yankinwaoz says:

    I think I know why. NPR’s “This American Life” podcast had an episode earlier this year that had a segment that looked into the crazy pricing.

    The gist of the article was that drug companies are are getting around the insurance company’s demands that only generic products will be covered by going directly to the customer and offering them a coupon that makes the name product cheaper than the generic.

    Here is a link to the story that examines an example of this. It is very worth reading and will open your eyes to how truly screwed up our medical system is in the US.
    http://www.npr.org/templates/story/story.php?storyId=113969968

    Anyhow, after I read that story, I figured it wouldn’t be long before the pharmacies decided to get in on the game and demand that for themselves. Sounds like Walgreens has done that.

  45. xxmichaelxx says:

    Stick to oral; it’s cheaper.

  46. msgogo says:

    I just ran across the same thing with Necon 7/7/7. (Generic of Ortho-Novum)My pills jumped from 12 dollars a month copay to 35. The pharmacist said it looks like getting my prescription switched to the name-brand should make it cheaper, but ‘couldn’t say for sure’. I have yet to brave entering the UHC labyrinth to see if I can get a solid answer.

  47. FiorellaMajumdar says:

    As my doctor is fond of saying, these crazy price determinations are made in response to whichever Big Pharma company gave the Medco (or CareMark or Express Scripts) rep the priciest hooker. It’s not uncommon for drugs from one manufacturer to be priced differently on your prescription plan from those manufactured by others. I was taking a binary drug that was half the cost of the two separate drugs–manufactured by the Pharma of choice of course–when sold separately (I was on Advair and moved to Foradil and Asmanex for half the copay). Made no sense because my plan was charged $400 per month MORE, so my doctor’s view may be dead on.

  48. abberz3589 says:

    All of you people whining about paying 35/month for birth control need to get over yourselves. I’m from good ol’Alabama and my insurance doesn’t cover birth control, and I’m on Seasonique, so that’s 200 bucks every three months.
    /worth it, since a kid would be SO much more expensive, but still sucks to kiss that money goodbye.

    I used to take Yaz and the generic at Walgreens, starting about two years ago, and it took you this long to get the generic?? And they don’t stop carrying the original medicine. I switched back and forth once to see if Ocella (the generic) was causing some other medical problems I had.

    • boops@cox.net says:

      The generic of *Yasmin* is Ocella actually. Barr (well, Teva now but it still says Barr on the packaging) is producing the generic of Yaz, called Gianvi.

  49. careerpurgatory says:

    Try purchasing this prescription without your insurance dictating the price. I bet you can purchase the supply in a 30, 60, 90 day supply out of pocket for less money without the insurance company, you simply have to ask the pharmacy what the price will be. I know people who have purchased 90 day supplies for less cost than the insurance co-pay. The insurance companies are making their cut on these pills now, and spreading that extra cash around to other more expensive prescriptions.

  50. Bremma says:

    Birth control is a drug you take over and over again so Medco likes to have you used their mail order service for it. I used to get it from my supermarket, but the 3rd pack went from $5 to 30or something because they only covered 2 non mail order co pays. I get the Yaz generic (Ocella) for 12 per 3 month supply from the mail order, though this may vary depending on your coverage.

  51. RLars says:

    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.

  52. misslisa says:

    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.

  53. quieterhue says:

    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…

    • Thyme for an edit button says:

      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.

  54. LunaMakesThings says:

    I have no insurance and pay $12 a month out of pocket for a BC pill called Trinessa. So far, so good, no babies.

  55. ipokedmyeyeoutagain says:

    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?

  56. Eyebrows McGee (now with double the baby!) says:

    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.)

  57. sheriadoc says:

    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.

  58. MarsVolta187 says:

    $400 Vasectomy copay.

    Never pulling out again: priceless.

  59. smeuchel1 says:

    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.

  60. chocolate1234 says:

    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.

  61. wonderkitty now has two dogs says:

    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.

  62. legolex says:

    Birth Control so ridiculously expensive. Why can I get Adivan for $10 for 3 months but I have to pay $75 for Ortho?

  63. the atomic bombshell says:

    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).

  64. pot_roast says:

    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.

  65. Doc S says:

    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.

  66. J Brill says:

    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.

  67. J Brill says:

    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.

  68. 4Real says:

    You can get free birth control at Free Clinics in your town..

  69. StitchPirate says:

    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.

  70. Awesome McAwesomeness says:

    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.

  71. dragonflii says:

    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!

  72. ManagedCareRPh says:

    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.

  73. Celany says:

    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.