ACA Database: The High Price of Specialty Drugs Is (Literally) Killing Me

flying cadeuciiJoyce J wrote in with this to say after reading Steve Findlay’s post on Medicare’s 50th Anniversary last week.

“Just yesterday, I was on my last and final rant relative to the price of not only specialty drugs, but also Tier 3 drugs! So much of a rant that I considered writing my Congressman Tim Murphy. After much thought, I decided to suck it up, pay the price and let my congressman work on bigger issues.(before reading your article today!)

I realize that I am not he only pathetic one that this drug price debacle affects, but for some reason, as a hard worker my entire life (in, none other than the healthcare profession), an upstanding, tax paying, law abiding citizen, somehow I feel I am being raped by the system.

I am 66 years old. I am a widow for 20 years. I am on Medicare part A and part B.(?$104/month) My secondary insurance is Highmark PPO Blue. ($605.89/month). After retirement, I maintained my husband’s health insurance as my supplement because of 1 tier 3 drug that I currently use. Due to Multiple Sclerosis, Lupus, breast cancer (none of which I chose to have) I could essentially be using multiple specialty drugs. I’ve declined all, except for the one Tier 3 drug, brand name, Provigil.

It has been a miracle drug for me relative to severe fatigue and loss of concentration and overall, daily function.”

My basic complaint I guess is, up until October 2014, I was paying a $60 dollar copayment/month. November 2014 Highmark cut the prescription coverage in half allowing me a 15 day supply, thus increasing the copayment to $120/month

I suppose being and upstanding citizen, hard worker doesn’t account for much these days. You see, in retrospect I rightfully could have chosen disability at age 27, but didn’t. Continued to work till age 65, continued paying into Medicare and social security, only to be treated like the drugstore pharmacist has to pay for my pill out their own pocket.

My best regards,


P.S. Two weeks ago, I’m in the throes of an MS exacerbation. My neurologist attempted to prescribe Acthar Gel injections, to slow the progression, upon approval by Highmark.DENIED!

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1 reply »

  1. The best way for you to find out how you could save overall would be is to go to Medicare.gov. Then go to Find Health and Drug plans. You can put in your zip code, and then your drugs anonymously, and it will give you the costs for all of the plans in your area except medicare supplemental plans. You will see Medicare Advantage plans, but you need to know that they are mostly HMO or PPO plans with limited physicians. Medicare Advantage plans are generally less expensive than regular medicare with a supplemental plan.
    If you find a part D or Medicare Advantage plan that covers your medication at a reasonable rate, don’t join yet, but jot it down. Then type in “Medigap plans” in the search in Medicare.gov, and pick which level of plan you would like. Then see how much the monthly premium will be. The annual costs are for average costs which include the premium and any copays that the average person might have. Then you can compare costs, and it should be less than what you are paying.
    However, if you take the brand name Provigil, you will pay much more than the generic drug for any plan.
    Also, you will have to be careful about when you change plans, since there are only certain times that you can without penalties. You will need to contact Medicare.
    Make sure you are signed up for Medicare A and B first.
    In addition, you have to see if the drug plan you have now is “creditable” per medicare. If it is not, then you will have an additional penalty. You will need written documentation from your plan that the drug coverage is creditable.
    Also, the plan you are using as secondary will pay little or nothing towards the 20% that Medicare does not cover as part of doctor visits, etc.
    Of course, all of this can change next year.
    Simple, no? Good luck!