In the Beginning... of the co-pay

May 7, 2017
2 min read

A lot of very useful medications have been developed since 1980 so, as recently as a decade ago, the vast majority of these were brand name only and rather expensive. A typical medication for high blood pressure or high cholesterol would cost $4-$5 per pill. For medicines taken daily (or worse 2-3 times per day) this could add up very quickly. This is especially true for a person taking 5 or 6 medicines daily for a number of chronic diseases. Drugs started to become a significant portion of people's medical costs, so insurance companies stepped in and offered plans that would cover a number of these medications, albeit with many restrictions. Under these plans, the patient might only be responsible for a $10-$20 monthly copay instead of the regular $100- $150 monthly cost per medicine.

Times have changed.

Now a lot of patents have expired, and many of the medicines that are commonly prescribed by doctors are generic and much less expensive. Medications that used to cost pharmacies $400 for 100 pills now cost pharmacies anywhere from $1-$10 per 100 pills. That's right: Even though many medicines got more than 100 times cheaper, what they sell them for, is entirely their business.

Most pharmacies realized that it wasn't in their best interest to tell anyone that drug prices were dropping. With everyone used to using insurance to buy their medication, the pharmacies could just continue to charge the same copay, and make a substantial profit without ever having to bill the insurance company.

In the meantime, the insurance companies were happy because people still bought prescription drug coverage for these medications, believing that they were saving money when, in fact, they weren't. It cost the insurance company nothing. Everyone won except the customer. The copays are still based entirely on the insurance plan so the same medicine in the same pharmacy might cost $5, $10 or $25 for a month’s supply, while you agree to pay whatever you decide to pay based on your prescription plan.’

All this for a product that often brings more side effects than help?

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