Prescription Purchasing Power

Prescription drug costs and health care coverage (or lack thereof) have been high profile issues in the U.S. for several years now. As the November elections draw closer, it is almost impossible to go a day without hearing a sound byte on these topics. I'm lucky enough to have a comprehensive health plan through my employer. While this doesn't cost me much each month, I know it costs my employer an astronomical amount. I've often wondered what factors have pushed the cost of obtaining any health care related service so high. Perhaps I will research that in the future, but for now I'm reporting on another interesting phenomenon I took advantage of today: Paying the cash price for a prescription rather than using my insurance coverage saved me 66%!

Wal Mart was the first company I saw offering a number of generic prescription drugs for $4 for a 30 day supply, or $10 for a 90 day supply. I thought that was pretty cool, but figured it wouldn't help me out because my health plan charges either the cost of the drug or a $15 copay for a 30 day supply of generics, whichever is cheaper. I avoid shopping at Wal Mart (it's an unsettling experience to be mixed in with the other shoppers) and there isn't a store nearby, so I had no reason to look into the program. Then I noticed stores like Target and Fred Meyer offering similar prices on over 300 generic drugs. Since these stores are somewhat close to my house, I decided to check and see if anything I buy was on the list. Sure enough, I found one.

I was a little suspicious at first, thinking maybe the $4 / $10 deal was after insurance picked up the rest of the bill, but it really is just the price. So I had my prescription transfered from the insurance company's own pharmacy (only place my insurance works) to the local Fred Meyer. I had been paying $30 for a 90 day supply of medication through the insurance company (they waive one $15 copay if you order a 90 day supply by mail). Now I can get the same thing for only $10 from Fred Meyer. While this requires that I go to the store to pick it up, I no longer need to remember to order a refill online a week in advance so it can get to me in the mail before it's too late, and I can pick up other things while I am there.

Here's the part that is most interesting to me: The medications mailed by the insurance company state both the amount I paid, as well as the full cost of the drug. A 90 day supply of this particular generic drug costs my insurance company $66. "Wow, that's a big difference!" I thought after discovering I really could just buy the stuff on my own for $10. How can these companies buy medications for less than 1/6th of what my insurance company gets them for, and then charge me less than a copay on a good insurance plan while still making a profit? Are these cheap generic programs a money loser for the stores? Is it some sort of public service they are providing? Do they hope you come in for other prescriptions that they can actually make money on? I asked the pharmacist, and she said that Kroger, Fred Meyer's parent company, has so many outlets across the U.S. they were able to contract directly with the manufactures of the 300 covered generic drugs, leading to extremely low prices. I'm impressed, saving $80 a year is nice for me, but imagine the difference that will make for low income families with kids who probably have to fill a lot more prescriptions than I do? Especially if they don't have medical coverage. They may have ended up paying the full $60+. It's excellent to see one part of the health care arena where costs have actually dropped recently!

Now the big question: Why can't my insurance company get similar prices on these drugs? True, Kroger, Wal Mart, and Target are nationwide, and probably have a much higher market share (proxy for market power) than my health insurance company. But, my insurance company is a major player in the Pacific Northwest, and covers enough people that I imagine they deal in substantial volumes of these common generic medications. Do they simply not care if their patients end up paying more, or not mind if their patients are siphoned off by commercial pharmacies to get the cheap drugs? Maybe they don't have the right people doing the negotiations, or maybe they are 6 months behind the other guys in securing contracts?

I'm really not sure what the explanation is. It just strikes me as very odd to know that I have good insurance coverage, something many people don't have and desperately need, but when it comes down to it, I can save myself a significant amount by bypassing my coverage all together and paying cash. Sure is a lot easier for me than trying to get claims paid properly, and deductibles satisfied!

I am hoping that this is a sign of things to come in the health care sphere. Eventually we may reach a point where it's reasonable for a person to cover the basics for themselves, and only insure against catastrophic health events. We certainly are not going to get there anytime soon when it costs upwards of $175 to see a doctor for 10 minutes! But, $4 and $10 generic prescriptions may be a glimmer of hope.

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Car Talk Staff

Did you know that Car Talk has over 600 staff on its payroll? Neither did Tom and Ray! Clearly a staffing review is in order.

My Favorites
1. Jamaican Document Security Expert: Euripedes Upmann
2. Bungee Jumping Instructor: Hugo First
3. Used Car Salesman: Alexis Itznot
4. Fact Checker, Mexico City Office: C.S. Verdad

Trusty Garage Employees
Director of Guaranteed Repeat Business: Lucinda Boltz
Brake Adjuster: Schlomo Quigley
Romanian Emissions Tester: Vlad the Inhaler
Bolt Tightener: Tilda Plierslip
Chairman, Federal Lubrication Board: Alan Greasepan

From the Car Talk Financial Division
Repair Cost Consultant: Bill M. Moore
Chief Accountant: Candace B. Rittenoff
Credit Counselor: Max Stout
Customer Credit Officer: Noah Wayne Hellman
Director of Accounts Payable: Bill Shredder
401 K Advisor: Hugh Don Wannano

Grunt Workers
Russian Intern: Igor Beaver
Staff Intern: Lois Rung

Double Duty
Gastroenterologist: Cameron Diaz
Manager, Donkey Based Video Equipment: Cameron Diaz

From the Tokyo Office
Libel Defense Director in Tokyo: Sosumi Areti
Personal Hygiene Advisor from the Tokyo Office: Oh Takashawa

Former Politicians
Secretary of Halogen Headlamps: Made-A-Lane Allbright
Staff Temporary Housing Specialist: Condo Leaser Rice
Surgeon General: C. Everett Koop DeVille
Timing Director: Benjamin Not-Yet-You-Yahoo!
Chief of Tire Technology: Yessir Itsaflat

Department of Getting Away With It on NPR
Self Defense Instructor: Nina Cahones
Staff Groper: Manny Bumsfeldt
Transgender Studies Expert: Ben Her

Employees of the Month
Director of Employee Loyalty Program: Upton Leftus
Ornithologist in Training: Luke A. Boyd
Poet Laureate: Robert Defrost
Puzzler Tester: Otis S. Hard
Staff Meteorologist from the Seattle Office: Wayne Goaway
Staff Alpinist: Arianna Topyet
Airline Reservation Manager: Will Price Randomly
Safari Planner: Sarah Anne Getty
Chairman, Underemployment Study Group: Art Majors
Assistant Director of Moral Support: Hugo Gurll
Director of Firestone Tire Recalls: Ivana Michelin
Defense Dept. Consultant: Major Error
Director of Global Warming: Nomar Winter
Head of Security: Barb Dwyer
Emergency Preparedness Director: Ron Lykell

Listen to Car Talk on KUOW 94.9FM from 9 to 10 AM on Saturdays, or via Podcast. And check out the Personnel Department to find your favorite workers!

The Tappet Brothers are also having a look alike contest, but I hope nobody reading this thinks they should enter!

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Elevator Etiquette Errors

Working in a sky scrapper is kinda cool and it has it's perks: Nice views, most meetings are in the building, there are lots of places to get food and coffee right there. But, it does require you to spend quite a bit of time riding elevators. I take two elevators (and usually two escalators) just to get downstairs to get a coffee refill. With all this time spent getting into, riding, and getting out of elevators I have observed some common elevator etiquette errors. Here they are, in increasing degree of annoyance. Please, for everyone's comfort and safety, try to avoid these behaviors:

The surprised cellphone cutout victim: Generally spotted boarding the express elevator while on their cell. As the doors close and the elevator starts to move, the victim will get a confused look, say something like "WHAT?? Hold on, I'm in an elevator. I can't hear you! Huh?!" The call will either be dropped, resulting in frustration to the victim, or be resumed after a period of glitchyness when the victim exits the elevator and says "Can you hear me now?" I could look the other way on the foul of using a cellphone in an elevator, but being shocked when your phone cuts out inside a fast moving metal box which is encased in a concrete shaft in the middle of a marble, concrete, and steel building? That's something you should see coming.

The failed hand chop: Everybody is in the elevator, the doors are closing, and just at the last second, what happens? A hand comes shooting through the gap between the doors waving up and down trying to trigger the sensor so the owner of the hand can join the party. Sometimes this does not have the intended result, like when the elevator is already angry due to an overabundance of prior successful hand choppers, or when the chopper misses the sensors. Depending upon who happens to be standing at the controls, the sight of wildly chopping hand may trigger a panicked reaction, such as the incorrect button press discussed below. After all, who wants to see someone's hand get hacked off in the doors and travel down with you? That's just awkward. However, I have never seen anything like this happen, as chopping hands have an amazing ability to be withdrawn at the last possible instant. Other prevalent versions of the hand chop include: The purse swing, the briefcase uppercut, and the manila folder slice.

The holder: Curiously, the holder's goal is to demonstrate uncommon levels of proper etiquette, which is precisely why they are so annoying to me. The holder is the passenger who immediately places their arm against the open door in a "Look at me, I'm helping everyone out by holding the doors open for you!" fashion, dawns a smug smile, and motions for everyone to exit before they, as the last person to leave the car, remove their helpful arm and allow the mighty doors to close. They seem so gratified. As if they have done everyone such a service. Well, I've made many a successful exit from the elevator without a holder, and would rather not feel I should give them my gratitude. Sort of like the homeless dude who splashes dirty water on your windshield at a stoplight and expects you to give them money for the service. I always want to say "Thannnnnks. That's greatttt." But really, no thanks! The holder can execute the extended hold by exiting the car while pivoting the arm around and holding as people refill the car as well. It should be noted that the holder's services are at times welcome when they amount to a reverse hand chop, delaying an elevator from leaving that you otherwise would have missed. But there is a limit, as this may result in an undesirable delay for those already aboard.

The incorrect button presser: You can always tell when you have been inconvenienced by the incorrect button presser. They may be internal or external. Telltale signs of an internal incorrect presser are elevators stopping on floors where the button is lit up, but nobody exits. Some kindly admit their wrongdoing, while others look silently at the floor in shame. External incorrect pressers are most frustrating because often the perpetrator is completely unseen. They stand in the lobby as the elevator arrives, but don't board because they mistakenly pressed up instead of down, or down instead of up. Hey, it can be hard to know which direction you are headed these days. I must admit I did this today, and could feel the rage of unjustly delayed downward bound passengers spilling from the gaping doors as I hid in the corner and waited for my second and correct choice: up. Internal incorrect pressers can also commit errors that don't have any impact, such a the panicked reaction to a chopping hand in peril. This, ironically, is more often than not to press the button they are most accustomed to pressing in a hurry, door close, rather than door open. The most interesting variation I have ever witnessed involved an incorrect press of the alarm button rather than door open. Thankfully the mistake didn't stop the car, but the security guards on the intercom did want to know what was going on.

The premature enterer: These folks don't seem to understand that everyone is going to need to get out before the elevator can be turned around. They wait eagerly, right in front of the doors. The struggle against the current of exiting passengers to get in before everyone has disembarked, invading your personal space as they squeeze by. I want to say "Oh hi! Welcome aboard. Mind if I get off your elevator here?" or perhaps "Get out of my freakin' way!" Exit blockage by a premature enterer bound in the opposite direction is annoying, but it doesn't usually cause a major problem. The entry blocker, however, can really wreck your evening. They don't seem to have anywhere to be after work. Perhaps they have an unnatural affinity for the express elevator lobby. Whatever the case, they waddle slowly right in your path toward the waiting elevator, but don't get there in time. You know they could have made it, meaning you could have made it, meaning you wouldn't have to run down the hill and see your bus pulling through the intersection and leaving you behind. This always seems to happen on a day when I am leaving just a little bit early to catch an earlier bus, but then end up leaving early only to wait an extra 15 minutes on the street for my regular bus. Damn!

There you have it. Three(ish) years of frequent sky scrapper elevator usage experience all boiled down to some handy guidelines on what not to do. Thankfully, I am past the stage where I would need to complain about elevator etiquette errors in the dorm elevators, such as the one floor wonder. Ahh, all those troubles seem so far away now. Interesting fact from another post on elevator etiquette:

In Japan elevators offer a smoother ride than those in the U.S. One industry spokesman says, "Japanese elevators are very smooth because the Japanese are very sensuous people, whereas the people in the Western world are more in a hurry and a smooth ride isn't considered as important."

Just remember: ...if there's a fire, use the stairs!

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