WASHINGTON — Years ago, when my daughter was in the first stages of treatment for a brain tumor (thankfully not a glioblastoma), I went with her to the pharmacy to get 11 pills that were part of a partially filled prescription she had received earlier.
When the pharmacist returned with the medication, I asked, out of curiosity, how much they’d cost if not covered by insurance. He looked up at the line behind us and said very quietly, $7,000. I gasped but not as audibly as the woman who was next up. “For 11 pills? Did I hear that correctly?”
“Welcome to the world of modern medicine,” the druggist said.
Such costs, of course, are a big reason health care has become the thorniest of all issues _ and why a solution to our nation’s health care ills is still pending and will be for some time. More and more life has begun to depend on chemistry.
My eyes were further opened just recently when my respiratory problems began acting up and I was prescribed a drug taken four times a day through a special inhaler. My cardiologist warned me that the drug and another he was giving me were expensive. He said he would order them through a specialized pharmacy. When the pharmacy called me to get some personal information, I said I had been told the inhaler medicine would be costly if my insurance wouldn’t cover it.
“That’s right,” the druggist replied. “Depending on what level you take, it is $13,000 to $15,000 month, or as much as $150,000 a year.”
After being doused with water and helped off the floor by my significant other, I stammered around for a few minutes before weakly croaking that if my supplemental insurance wouldn’t cover it — even if my life depended on it — “Don’t bother calling me again because I won’t be here forever.”
“That’s why I’m calling,” he replied. “We need prior approval from your insurer before we can issue the drug. It will take a few weeks and hopefully the supplemental plus Medicare will keep you alive and solvent.”
Fortunately, that was the case. Because there was a medical device involved, the treatment was 100 percent covered between Medicare and the supplemental insurer.
The next drug my cardiologist prescribed was a bit easier in cost but still far from affordable. I would have to pay $2,170 for a 90-day supply and then pay $590 for each refill until the first of the year. Then I would have to cough up (no pun intended here) another $2,170 so I could cover the next co-payment. If this sounds like gobbledygook to you, it did to me too. One would need a math degree to keep up.
At any rate, even my doctor was amazed. We’re still working on it. You should know, however, that the cost without insurance runs $11,000.
Mind you, the drugs being mentioned here are for rare conditions. But what happens if a person with such maladies doesn’t have insurance? They don’t get these drugs, one of my doctors said.
That, and much more, will obviously be discussed in the congressional debates to come. It would seem to me that cutting back on Medicaid, the state-shared coverage of the indigent, is not the answer. A solution may lie in expanding a prescription plan for those with low incomes.
Don’t turn blue waiting to hear promising news on this front, though. Coming up with even partial solutions is sure to take time.
Meanwhile, the very expensive pills my daughter Lisa received have played a role in sustaining her for the eight years since they were first prescribed. A precious life still burns brightly.
Dan Thomasson is an op-ed columnist for Tribune News Service and a former vice president of Scripps Howard Newspapers. Email at firstname.lastname@example.org.