How I Saved $602 on ONE Prescription Medication (It Was My Ohio Health Insurance)

Last week my wife and I took our 18-month old son to the doctor’s because of two different skin rashes he suddenly developed. This wasn’t too alarming since he has dealt with mild skin issues since birth. The office visit was suppose to serve as validation that the rashes were not a result of something more serious. Which it did, so how did we end up with a prescription for a $715 10 oz. tube of cortisone cream?

That’s a great question, one I still don’t have the answer for. However, lets back up a little and set the stage for how this all came about.

As our doctor was wrapping up the examination, she pulled out her little RX pad and said she would be giving us two different creams to alleviate the two different skin irritations, naturally. The first skin rash was a very mild, hereditary condition, so much so I can’t even remember what it’s called. The other was a flair-up of his eczema, for that she was going to prescribe a slightly more potent cortisone cream than she had before.

Needless to say, I left the visit fairly relieved, my son didn’t have fifths disease, malaria or any other kind of third world disease.

It Cost How Much?

You can imagine my surprise when, after dropping my family off at home, I went to go pick-up the prescriptions and the pharmacist told me it would be $104.75. This is one of the only times in my life I had to fight back the urge to launch myself over a counter and tackle another human being.

After successfully avoiding a physical altercation, I calmly, if not shockingly asked, “Is that with our insurance?”

The pharmacist replied, “Yes.”

I kindly (to the best of my ability) asked how much does it cost without?

She replied, “The cortisone cream is normally $715 without insurance.”

I then asked, “There's no generic alternative?”

She replied, “no.”

Needless to say, I quietly slipped my debit card back in my wallet and told the pharmacist to hold on to the prescriptions for a second while I called my wife.

So What Did You Do?

Well... here’s the deal. Speaking as a dad, I’m sure every other dad reading this knows exactly what I told my wife, and to some degree knows how this story is going to end. The details and dialog maybe different, but you’ve had this conversation before.

Now, for every mom reading this, you also know exactly what I or your husband would say, don’t judge us. You also know what ultimately happened.

That’s right, we now have a bottle of cream in the house that costs more than several of our TV’s, computers and tablets.

I’m going to make that $715 tube of cream last until he graduates college.

Why Did You Only Have to Pay $104.75 for a $715 Prescription?

Glad you asked, you are going to want to pay close attention.

It’s the negotiated rate.

This is what I have been calling the best kept secret in health insurance. The negotiated rate works like an unlimited discount for all covered services on your insurance policy. In this case, the cream would have cost me $715 if I didn’t have any insurance, but because Medical Mutual (my insurance company) had already negotiated a rate with CVS (my pharmacy) for that particular medication, I was only responsible for paying $104.75.

Now my feelings on how a tube of cream can cost that much money and why our doctor felt the need to prescribe it aside, this one scenario saved us enough money make our health insurance pay for itself for a few of months.

Do I Have a Negotiated Rate?

Probably, that is if you have an insurance plan that provides you with a network of doctors and hospitals that you can receive treatment from.

According to a story in The Wall Street Journal, a report from Express Scripts stated prices for name brand medications grew 13.3% between September 2011 to 2012, far outpacing overall economic inflation. At the same time, generic prices dropped about 22%.

What does that mean, get generic medications when you can. If you can’t, you're negotiated rate is going to be more important than ever to fight back against these continually increasing prices on branded drugs.

The Bottom Line

It’s not always pretty, but your health insurance is constantly working behind the scenes to help limit your out-of-pocket expenses. It’s important to be aware of these savings and efforts to fully understand the value your health insurance provides, even on a day to day basis.

No one would disagree with you if you said health insurance is expensive, however why not make a little noise about $715 skin cream?

Now I Want to Hear Your Story

I know you or someone you know has had a similar encounter with prescription medications and pharmacists. Leave a comment below telling me about a time you almost threw yourself over a counter at another human?

Did you know to ask what the original cost was and were you surprised how much money your insurance saved you?

Or did you have an experience where you were disappointed in your insurance company’s negotiated rate?

photo credit: http://www.samcatchesides.com/ via photopin cc

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Joey Giangola is an independent insurance agent for Giangola Insurance, located in Ashtabula, OH. He specializes in Ohio health and life insurance and manages the agency's second location in Streetsboro, OH. You can email him at joey@giangolainsurance.com, or connect with him on Facebook, Twitter , Google+, LinkedIn and YouTube to receive daily insurance advice and tips.