It used to be most insurance involved co-pays, the fixed amount you pay for a service. You paid a little, maybe $15 dollars for a prescription, and insurance picked up the rest.
Today, it’s all about deductibles, an amount you must pay before insurance kicks in. In 2006, only ten percent of people who received insurance through work had a deductible of $1,000 or more. Today, for the first time, a majority do. And many have deductibles of $3,000, $5,000, even $10,000.
So when prescription drug companies boost prices by 100 percent, 200 percent and 600 percent, those who rely on those drugs and have deductibles pay more, sometimes a lot more.
No wonder why we’re all paying more out of pocket for health care.
When you add up deductibles, co-pays and premiums, we’re paying nearly 70 percent more in ten years.
No one knows that better than Navy veteran Daniel Rodriguez and his 8-year-old son who shares his name. Life for the father and son is complicated and costly.
“It’s hard sometimes,” said dad. “He has cerebral palsy and epilepsy. So he has seizures and difficulty moving. He has global developmental delay. So he has mental delays and stuff like that. He’s on four different major anti-seizure medicines.”
Paying for life-saving medications can be overwhelming.
“This one is the onfi, it costs about $1,200 a month. This one right here is really, really expensive – Diazepam. This is just in case he has a seizure that lasts longer than five minutes,” said Rodriguez.
Their total cost -- $2,600 a month. Without them, “he'd be very sick, uncontrollable seizures. He'd be in the hospital almost every day,” said Rodriguez.
They are the kinds of stories heard at pharmacies every day.
“Drug inflation over the last 10 to 15 years is double digits,” said Mark Newberry, pharmacist and owner of Tarrytown Pharmacy. “Some drugs we see go up 200 to 300 percent over night."
Newberry's family has owned Tarrytown pharmacy 75 years. He has run it the last 13.
Family owned pharmacies have one big advantage over big box stores. Suggested Retail prices at big chains are set by the corporate office and not negotiable.
At local pharmacies “our pricing is set by a guy 15 feet away from the customer who is getting that prescription so if there’s an issue with it. It’s a little easier for us to take up,” said Newberry.
The KVUE Defenders looked at prescription costs and found the top 100 name brand drugs jumped on average of 164 percent in the last four years.
One of the drugs Daniel takes -- Onfi -- rose 127 percent.
“Exact reasons for that are shortages in the market, fewer manufacturers, lack of price control from insurers,” said Newberry.
Pharmaceutical companies aren’t shying away from pouring money in to try to influence Congress. $37 million in 2013, $35 million in 2014 – and $36 million in 2015. That’s a $107 million lobbying effort in just three years.
“A lot of people don’t know there are vehicles to getting some assistance with their prescription costs if they don’t have insurance or if they aren’t in a public health program,” said Daniel Borel, executive director of the Coalition of Texans with Disabilities.
“They can get assistance from the manufacturers of these drugs all of them have good programs, robust programs that give away a significant percentage of their drugs for free,” said Borel.
Places to find savings
There are several search engines, some set up by the manufacturers, others third party sites which can tell you if you qualify for a discount. This website puts several in one place.
And try Good RX. It will tell you if you can buy your medicine someplace cheaper.
GoodShepHealth.com works with people who have no insurance or those who still can't afford their prescriptions even with insurance. It's another great place to look for savings.
And print out a Texas Drug Card. This is a free prescription savings program for anyone living in Texas. This pharmacy coupon card provides you with savings up to 75% at more than 68,000 pharmacies across the country including CVS, Randall's Target, Walmart, Walgreens and more. It can be used on name brand and generic drugs. You can print the card from your home.
Then search for locally owned drug stores.
Tarrytown pharmacy actually helps patients find coupons and savings.
“We have people who come in all the time who can’t afford to pay for it so we’ll try to cut people a break,” said Borel.
Dell Children's Medical Center, part of Ascension, the nation's largest non-profit health system and the world's largest Catholic health system, was able to provide the life-saving drugs for Daniel at no cost to his family, thanks in large part to the Federal 340B drug pricing program, which seeks to aid the most vulnerable patients.
Still their struggles are real.
“He’s had a busy day today. He’s already had Occupational Therapy, school.”
As a dad, Daniel’s hopes for his son are simple.
“To be healthy, live a normal life, a good quality of life.”
That's a prescription to live by.