My daughter has asthma. We've tried over the years to determine a control medication (the stuff you take every day) program that keeps her asthma in check without giving her more medication than is needed. When we get it wrong, she's likely to end up in the hospital.
We've been on Flovent, Qvar, Advair that I can recall offhand of various strengths. We seem to be doing well now with a Singulair tablet with Dulera inhaler.
Our health insurance is pretty good. Most of the medicines on the list above are free under our plan. Dulera isn't. We're on a HSA and trying to keep to the spirit of the idea behind HSAs and work to control our healthcare costs. It's an experiment this year.
Part of this is going through the extra work of checking if there are coupon program for some of the more expensive medications. Dulera runs us between $227 and $287 a month–I don't know why it varies for the same drug. Merck, the maker of the drug, contracts with McKesson to run a co-pay coupon program that will reduce your out-of-pocket costs down to no less than $15 or up to $90 off your out-of-pocket price.
$90 off a ~$250 drug is great! Still on the pricey side, but it seems to work well-enough.
When filing the prescription, the coupon is denied because she is under 12. While the doctor is free to prescribe the drug to anyone, Merck indicates it is for 12 and over, and thus McKesson won't honor it for children under 12. Which isn't mentioned on the card.
I call them and, after condescendingly telling me to talk to my doctor, told me to consider Asmanex Twisthaler, another drug they make for children 4 and up. The problem is the dosage she needs is the higher dose (for children 12 and up per the drug information, so I assume it wouldn't be covered by the card anyhow) and people with milk allergies shouldn't take. Which she has.
I appreciate the drug makers having these programs. Whether or not the original price is fair isn't my point or concern. That's for a different day, but it is very frustrating when these programs don't apply to children who are medically determined to benefit from a particular drug.
There are far, far worse horror stories out there about drug costs, but a small reminder that it impacts a lot of people–not just those whose stories are bad enough to get viral attention.