Had David’s wife not probed closely, she could have ended up paying $228 for generic Fosamax that could have been easily gotten for $24. He’s sharing the story as a cautionary tale so that other people who are getting their maintenance prescriptions covered by their employer’s insurance don’t end up overpaying for generics.

David writes:

I recently ran into an “issue” which I wonder if other folks may be impacted by.

Basically, my wife’s prescription plan tried to force her into paying $228 for a prescription that is widely available locally for $24!

My wife is covered under my former employer’s (Eastman Kodak) CDHP insurance plan. This is a high deductible plan with $1200 annual deductible that includes prescription coverage. A couple of years ago we did a cost comparison with mail order prescriptions and over the counter at our local pharmacy (Wegmans). We found that it was slightly cheaper overall locally, so switched her prescriptions there.

For 2011, the plan changed prescription policies so that maintenance prescriptions had to be purchased through CVS/Caremark (mail order). The first prescription that she obtained that way was roughly the same as it had been locally. We have no issue with obtaining prescriptions via mail order (I’ve been doing it for years), so she proceeded to have her doctor place all her prescriptions with CVS/Caremark.

The next prescription up was for the generic version of Fosamax (Alendromate Sodium Tablets – 70mg)(I know that there are some issues with Alendromate, but her doctor wants her to continue). On June 11 my wife received notification from CVS/Caremark that they had received the prescription and would be shipping it shortly. My wife went on-line to find the ship date, and fortunately took the extra step to check the cost. The charge, for a 90 day supply was to be $228.06! The previous prescription locally was $24.00. She then called CVS/Caremark and verified that this was indeed for a generic version, and that the price was correct. She canceled the order.

She then called Wegmans and verified that their price was $24 and attempted to have them refill the prescription (the prescription with them had 3 refills left). Wegmans informed her that they could not fill the prescription because insurance wouldn’t cover it. She understood that the only way that their system would allow them to fill the prescription was to delete her prescription insurance information from their system – which she did.

IF, my wife had not checked the prescription cost she would have been charged $228.06! If she had continued to allow CVS/Caremark to fill this prescription, she would have paid $912.24 a year for this. Even if she hit the annual deductible (she is not likely to), she would have had to pay 20%, or $45.61 for a 90 day supply. That’s $185.45 a year. vs $98 at Wegmans.

I checked on the price of this medication on the New York State government website and found a tremendous variation: from $9 (30 day supply) at Wegmans, Wal-Mart, Target and others, to up to $110 (CVS was $55).

I have attempted to bring this issue to the attention of Kodak. After escalating the issue Kodak responded where I was simply read a description of how the deductible worked. Basically I was told that “that’s the way it is”, it is due to the contract between Kodak and CVS/Caremark, and that I was welcome to purchase the medication from anyone I wanted – but it would not count against the annual deductible.

David’s main concern is not about the deductible, but that other plan participants who don’t double-check could end up overpaying for generic medication. When your plan changes prescription policies, it’s a good idea to drill down and make sure the price hasn’t changed on your maintenance prescriptions as well. And be ready to pay out of pocket for the cheaper if that’s the more economic thing to do.

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