CAPE CORAL, Fla. - A Call for Action investigation reveals you could be paying more for a generic version of a drug, if you don't know to ask the right questions.
"I have been having to get medications and drugs for a long time," explained Cape Coral resident Marianne Rardin.
Living with MS for 30 years has forced Marianne to take great care of her body and her pocketbook.
"I called the pharmacy to find out if the drug was ready. I asked the cost and they hit me with $85 and I was shocked," she said of her recent experience at a pharmacy picking up a new prescription. "Naturally I asked, is that-- what does the generic cost? They said that is the generic."
Marianne spent the rest of the day on the phone with the pharmacy, the medicare office and with her doctor's office, trying to find out why the generic was so expensive when she knew normally generics would cost her five dollars.
"I talked directly to a pharmacist at the store here and they did find out that there's many, many many different manufacturers of that drug," she finally discovered.
And those different manufacturers made different forms of the drug: a capsule was one form and a tablet was another.
"The price [the pharmacy was] giving me was for a capsule... they tell me you can get it in a capsule that's $85 and a pill that's five [dollars]," recalled Marianne. "When that's an $80 difference, that really ticked me off that I wasn't told that it could be and would be less money out of my pocket."
Tablet versus capsule isn't the only issue here. Our investigation uncovered a fight in Tallahassee over certain chemotherapy drugs. Some insurance companies will cover them only if you get an IV, not if you take a pill.
Lawmakers could resolve that fight for cancer patients, but for the rest of us, medical billing advocate and president of Lifebridge Solutions and attackmedicalbills.com, Sheri Samotin says this is all the sign of the times.
"It's buyer beware, consumer be the expert," she told us. "If you are not on top if it, you can't expect anyone else to be."
In Marianne's view, the pharmacy should have caught this discrepancy in price right away so she wouldn't have had to play detective.
"The consumer is not getting a fair shake on this," she said.
But according to Sheri, consumers should expect to keep playing detective.
"In a perfect world, the pharmacist would have time to [look up other options and costs for drugs]. The reality is, it's not the pharmacist's job," she explained.
So what can you do as a consumer? Sheri says it all starts in your doctor's office.
"I think the most important things to ask your doctor when a new medication is prescribed is first and foremost, what is this called? And what is it for?" she said.
Other questions Sheri said you should be asking in your doctor's office are:
--Why are you giving me this?
--Why are you choosing this one as opposed to any other one that may be available to me?
--Is this branded or generic? And if it's not available in a generic, again, why are you choosing it? Because in every plan, the brand name drug is going to cost the consumer more than a generic.
--Can I substitute a generic if the brand is too expensive? And if not, why not?
--What else do I need to know about how this drug can interact with anything else that I'm taking?
Sheri also says it's a good idea to write down the questions you want to ask, before walking into your appointment. And don't be afraid to ask questions at the pharmacy either.
"It's always reasonable to ask the pharmacist, 'Hey, before you fill this prescription, can you tell me what it's going to cost me?'... and if it's expensive and you feel it's too much that you can't handle the payment, it's reasonable to ask the pharmacist is there something else my doctor could substitute?"
By taking matters into your own hands and by asking lots of questions, you too could become an expert consumer, like Marianne.
"80 bucks is a pretty big difference and I'm sure [consumers] could decide they could swallow it, more ways than one, the tablet rather than the capsule," said Marianne.
Sheri also says you need to get to know your prescription drug plan. She says look for something called a formulary. It's a list of what is or what is not covered by your drug plan. It comes in a printed form like a book, or it's online. If a drug you are prescribed is not on the formulary, it's going to cost you more.
Also, if you are able, consider using a smaller pharmacy where it may be easier to develop a relationship with the pharmacist.