Big Pharma

This could get a little complicated, so please bear with me as I unwind my way through my pharmaceutical experience from a couple days ago.

I'm kinda hoping this is a cathartic moment for me, but we'll see.

It all began with my annual visit to my cardiologist (Even now I can't believe I can say "My cardiologist." Holy moly. That's what old guys say.) I am being treated for atrial fibrillation, a heart condition we discovered that I had about six or seven years ago. It's where one of the atrium's in my heart beats out of sinus rhythm.

I may have had this condition forever, especially since I never suffered from any known symptoms — no fatigue, no palpitations, etc. If doctors didn't tell me I have it, I wouldn't know I have it.

But if left untreated, my chances for a stroke increase five-fold, or something like that. That's because the blood in that particular atrium isn't being pumped efficiently, could pool, clot and move to my brain. Thanks, heart.

Nationwide, this is actually a fairly common condition. Apparently, millions of us have A-fib. I am not alone.

I'm being treated with pills, including daily doses of a beta blocker called Metoprolol and a cholesterol tamer called Lovastatin. I use a 325 mg aspirin as my blood thinner. And that's it. Both drugs together (not the aspirin) cost me a total of about $5 a month. Thanks, Part D.

Here's where we go a little crazy.

Last week, my cardiologist (there I go again) told me that it's time to think about changing my blood thinner, and she suggested either Xarelto or Eliquis. It's not so much because the aspirin isn't working as it is my body is simply getting older. It's not imperative that I switch right now, but she wants me to ditch the aspirin before I'm 70. I'm currently 66.

I actually find it encouraging that we are seriously talking about being 70. 

Anyway, neither of us knew how much the new thinner would cost (I elected Eliquis) with insurance, so she made out a prescription. Go to the pharmacy in a couple days, she said, and see how much it costs.

But a day or two later I got a notice in the mail that my Eliquis request was denied because "...your Medicare Advantage plan does not cover outpatient prescription drugs."

Whaa??? Something wasn't right. To make a long story short, I flew back to my cardiologist's (ahem) office and talked to the nice woman behind the glass window named Angie, who had now morphed into my HR go-to person. She looked a little confused, too. "We took care of this yesterday," she said. "There was no denial. I don't know why they mailed you this."

Angie promptly got on the phone. She immediately talked with an office colleague. A few minutes later, she told me to go to the pharmacy.

So I did. I told them I had a prescription for Eliquis and could they tell me how much it costs?

The nice pharmacist got on the computer, banged out a few keystrokes. "It's expensive," he said. "It looks like it's about $300."

"Gulp," I replied. "With insurance?"

"Yes."

"Per month?"

"Yes."

I didn't need anymore yesses. I went home and called my cardiologist (never mind). I told Angie what the pharmacist said. She told me she'd get back to me.

In the meantime, I got on the laptop and typed in "Cost of Eliquis."

Holy smokes. Even with coupons, even at Wal*Mart, it's still in the high $300s. Some vendors were $400. It's about the same for Xarelto. My insurance actually was the low-ball price. The whole experience is enough to put me into heart failure.

Even more discouraging, neither drug has a generic. Not yet, anyway.

And I know I'm not alone. Other people have similar cost-of-drug stories, no doubt worse than mine. It was just culture shock for me to suddenly go from $5 to $305. That'll take a bite out of my Social Security. Thanks, Martin Shkreli.

Later in the day, I got a phone call from Angie.

"For the time being," said Angie, "the doctor said to keep you on aspirin."

For the time being, that's cathartic enough.