Pharmaceutical Negotiations

We ended up back at the doctor last Friday when Andi demonstrated extreme out of sorts symptoms. The indicators were obvious: she who takes no naps, took a 4 hour nap, she who runs and flips, sat out the playground time, she who hungers and thirsts for lunch, ate nothing, and she who fusses and whines commonly, was fussing and whining with uncommon frequency and volume. It was Friday afternoon at 4:55pm. The CVS Minute Clinic beckoned us.

The doctor saw a severely infected right ear. Unfortunately, this meant Andi has been battling ear infection problems for almost a month straight. The amoxicillin they gave her on February 15th for a double ear infection had not kicked the infection out of her little head. Friday-Afternoon-Dr.-Guy and I agreed she needed a different set of meds. Regrettably, I had to give her more drugs, but this was only the second, and hopefully would be, the last time of this season. He explained the children’s dosage of a “z-pack” and I took the script to the pharmacy counter.

The pharmacy tech typed dutifully and after a couple keyboard clicks said to me, “The prescription is going to $79, is that okay?” We do not a co-pay with our new insurance and the only deductible we have to meet is $5000. We are responsible for the whole price of these small prescriptions. No, no, this was not really “Okay”.

I asked the techs to please call back to the doctor and see if there was a more affordable option. I told them I didn’t think amoxicillin would help but hoped there would be something in-between $10 and $79 that would help Andi. There were two families in line behind me. Andi was tugging at my leg asking to read the library book we had started in the doctor’s office. I was uncomfortable asking knowledgeable medical employees to change their minds for my financial benefit. However, I know there’s a profitable business in pharmaceutical sales and I am not interested in aiding any manipulative practices. The two pharmacists talked together, and with the doctor on the phone, for almost 5 uncomfortable minutes. Finally, they hung up the phone and re-presented my options.

They had discovered that if they upped the strength of the medicine and then slightly raised the dosage amount, I’d be buying one bottle of the medicine instead of two. “How does $39 sound?” they asked. “Much better, thank you so much,” I responded. Andi, all the more anxious for the book tugged harder at my leg. I made my move to walk away, very grateful that I had  said something to challenge their first offer.

Andi and I barely made it through the library book before they called us to pick up the medicine. The friendly pharmacist at this point said, “Actually, we got it down to $13.50 because we….” At that point, my memory fails me and I regret not being able to give more medical detail. However, in the moment, I was scrambling to scan my card before anything changed!

$79 turned into $13.50. Despite my discomfort with asking for something different than what a doctor prescribed, I swallowed my fear to advocate for my family. As a mostly “self-pay” patient these days, this encounter showed me I am in charge of my health and the care I receive. I have a say and can humbly, respectfully, and kindly challenge the automatic methods of the medical machine. Most importantly, Andi is feeling much better, all for $13.50.


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