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Insurance regrets 'inconvenience,' but that'll be $1 billion, please / Local man says even real prescription co-pay of $1,000 is too much
By CHARLES F. TRENTELMANWASHINGTON TERRACE -- Dave Matthews knew right off that the prescription co-pay bill he got for more than a billion dollars was wrong, but said it might as well have been right.
Shocking as the billion dollars was, he said, the real co-pay is $1,000, and he can't afford that, either.
He has medical insurance, but because the two drugs he needs aren't on the company's approved list and there is no FDA-approved generic, he has to pay half their actual price.
He can't afford it. He can barely afford the insurance premiums.
"It's tough having insurance and not being able to use it," he said. "It really sucks."
Matthews contacted news media earlier this week when he sent a prescription to Walgreens' mail-order pharmacy for two drugs he needs for psychological problems.
On Monday, he got a letter from Walgreens saying the prescription hadn't been filled because he had to pay the co-pay.
"The co-pay for the medication(s) in your prescription benefit is $1,082,228,449.00," the letter states.
It goes on to discuss ways to send in a payment and ends with a standard, "We regret any inconvenience this may have caused."
Matthews said he knew there had to be a mistake, but he had trouble getting the Walgreens customer-service employees to see that.
"I called them because you and I know that's absolutely ridiculous," he said, "but when I asked them about the letter, they said, 'You do have a high co-pay on your medications,' and I said, 'I understand I have a high co-pay,' and then I said, 'Why did you send me a letter saying I had to pay a billion dollars?'
"And they said I have to authorize any high co-pay before they send the medications out."
He went around like that, he said, several times. "And I didn't just say a billion dollars, I said, '1 billion, 82 million ...' " spelling it out.
Finally, he said, he got the customer-service people to look up his file and see what the real co-pay was, which is $1,000 for a three-month supply.
Robert Elfinger, a spokesman for Walgreens, said the letter asking for a billion dollars "was obviously not accurate. It resulted from a computer error, which we've identified and corrected, and we apologize for the mix-up."
Unfortunately, he said, the correct co-pay is something Walgreens can't help Matthews with. Like any pharmacy, Walgreens has to follow the co-pay schedule of the insurance company.
"The two prescriptions that he does get are brand name, there's no generic, and they're very high cost, an unusually high cost and an unusually high co-pay," Elfinger said.
Matthews' wife, Erin Miller, said the bill was shocking because it came at a particularly bad time.
"We have all these things going on. Our basement flooded, I've been out ringing for the Salvation Army, and we've got these jobs to cover for Christmas, and then he calls me and says they want a billion dollars."
She said they transferred their prescriptions to Walgreens to take advantage of a promotion that offered $25 gift cards, but, "We'd have to transfer a lot of prescriptions to get a billion dollars."
Matthews said he's not sure what he'll do next.
Drug companies have ways to help uninsured people buy expensive drugs, he said, "but I don't qualify because I have insurance."
He can't cancel the insurance because he and his wife need other medications that do get paid for.
It's an impossible situation, he said, bordering on funny.
"Not only do I have this huge problem, and this huge expense, but they send me out this ridiculous, computer-generated letter for a billion dollars. It's ludicrous."
Add Your Comment
Well, what do you expect from these greedy Pharmaceutical companies, how else do they expect to pay their C.E.O. tens of million dollars a year salary.
It's to bad we hate socialized medicine.
After all we want every thing de-regulated right?
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