One of the things we have been told repeatedly since the rollout of the HSA/high-deductible health plan as a savior of the utterly broken U.S. healthcare system is that "giving" consumers control of "their own" money will lead to greater fiscal responsibility. It sounds good, doesn't it?
Unfortunately, it is absolutely unworkable in practice, and I can give a concrete example the size of a pylon to demonstrate it.
Recently we changed insurers. While we are still on an HSA/high-deductible plan, it is now administered by a much larger company with a supposedly better network. One of the results of the change was that we can no longer have our prescriptions filled through the mail-order company we were required to use before. That meant going through the irritation of having all our prescriptions transferred, which we tried to alleviate by having the new member pharmacy accomplish for us. When I called to find out about the prices for the drugs, I was told that those prices would be a mystery until the prescription was actually filled. When they filled them, I returned to find huge increases over what we had been paying for the mail-order drugs. Huge. Like a hundred bucks a month more.
So I asked my insurer about it, and one of the things that was suggested was to call around to various pharmacies--including a mail-order that they work with--to find the best price. The only problem is that all the pharmacies say exactly the same thing: We cannot price out this medication without actually filling the prescription. When the mail-order pharmacy told me that the insurer determines the price and told me to call them, I did that. The person I spoke to was very, very nice and wanted to be helpful, but she could only tell me an average price throughout their national coverage area--not what our necessary, doctor-prescribed medications are going to cost when we show up at the pharmacy or have our credit card billed from the mail-order service.
How is this possible? And how exactly am I, lowly healthcare consumer, supposed to comparison shop when the Health Care Expert at my insurance company can't even figure it out? Believe me, I would go through the extra effort of calling around, of driving to Bozeman, of ordering through the mail--basically whatever it would take to make these drugs affordable. I'm doing my part.
Health care costs--whether for a pap smear or a prescription--are not exactly tacked up to a menu board above reception. When even motivated people cannot get a straight answer, it begs the question of how exactly I'm going to be controlling health care costs with my HSA. In the end, I guess I'll just choose whatever pharmacy is closest and hope for the best. If I get burned I guess I'll go with another pharmacy next time. Meanwhile, I'll just have to keep trying to make hard decisions about how to afford luxury items like milk and eggs given the new out-of-pocket drug costs we're likely to be facing. It shouldn't be this way. It just shouldn't.