Battling the Cost of Prescription Meds in Hampton Roads

by CoVaBizMag

As Spring arrives, we’re just now escaping (hopefully) a pretty ugly flu season. With that spike in sniffles, sneezes and all-over-aches came many prescriptions by clinicians for oseltamivir, which is commonly known by the more familiar name TamiFlu.

The role and true efficacy of oseltamivir is unclear. Largely, it’s believed to shorten the course of the illness by about a day. And, that’s if it’s administered within 24–48 hours of the onset of symptoms.

I had the flu this season, it was pretty awful. And, even knowing the relative uncertainty around treatment, I considered it beneficial to possibly gain back a day or so of my life. So I opted to take oseltamivir myself. One pill, two times a day, for five days.

Cost? $52 at my local Harris Teeter.

Was that the cost to you? Because in casual conversation with a friend recently, we discovered that she had paid $100 for the same drug. Right here, also, in Hampton Roads.

Prescription medication pricing is big news at times. Maybe you’ve heard of ‘Pharma Bro’ Martin Shkreli, who’s put a face to the plight in the past couple years and recently got something of a comeuppance?

Want to read about a $1,500 medication for…toe fungus? What’s particularly interesting in this article is this quote from the manager at the dermatology practice in-question:

"When our providers are treating patients, we're not treating them based on what the cost's going to be. We look for what's the best care for the patient. If the patient calls and says that's too expensive, then we'll look for alternatives."

Interesting approach in 2018, to suggest that cost-of-care is outside the wheelhouse of providers. Especially given that 95 percent of medical decision-making likely has some sort of gray area.

So, why the different pricing for a ubiquitous drug like oseltamivir? The supply-side process of prescription drugs and pharmacy benefits management is way beyond the scope of this column, so the short utilitarian answer is: Because they said so. (For now.)

For any of your prescription medications, consider using the GoodRx website or mobile app to at least compare costs. And try to understand this simplified explanation:

If you have insurance—let’s say, Happy Rhino Health Insurance—they have negotiated a price with each pharmacy. In my friend’s case, Happy Rhino had negotiated a price of $100 with Big Giraffe Pharmacy. Pay $100 for your oseltamivir at Big Giraffe, and that amount goes toward your deductible.

Through GoodRx, you’re getting access to several other negotiated prices. Whether you’re insured or not. At the very same pharmacy, in fact, you might find the same drug—oseltamivir—for $50. The primary, and important, difference is that the $50 price accessed through GoodRx or other coupon-based discount programs does NOT count toward your deductible (in most cases). It’s like you’re uninsured.

In practice, the risk you take using GoodRx to pay for your meds is that if you wind up with a significant event and meet your deductible—which is uncommon, statistically, especially for the higher-deductible plans that are increasingly found these days—you will "pay more" overall because you wouldn’t have gotten credit for the medications you purchased.

Explore more here. And, shop wisely.

About the Expert

Pediatrician Dr. Bryan Fine has been a physician for more than 15 years, and is the founder of Percentric, an innovative, physician-led health benefits optimizer. Visit to learn more.

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