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Monday, December 09, 2019 {{ new Date().getDay() }}

By Steve Twedt, Pittsburgh Post-Gazette (TNS)

PITTSBURGH — Charles Conn stopped in to see his pharmacist to fill a prescription for a cough that had persisted for a month. Once he saw how much the medication cost, he could have used a side order of blood pressure pills.

The price, under his insurance plan, was $91 for 30 nonnarcotic Benzonatate gel caps.

“I told him, ‘I’m not paying it,'” the Baldwin resident said.

Ninety-one dollars isn’t the most expensive prescription medication sold in a pharmacy, but for a retiree on a fixed income, it’s not a payout to be taken lightly.

Luckily, the pharmacist had flagged the prescription and was able to sell the medication for $26.10 in cash.

Conn, 66, happily paid the lower price but the episode left him wondering: Why would a prescription cost nearly four times more through his insurance plan than paying cash?

The answer may lie in the vagaries of pharmaceutical pricing, which include the wholesale prices that hardly anyone pays and the largely unseen influence of third-party pharmacy benefit managers.

In Conn’s case, there was an immediate hurdle he didn’t recognize at first: Medicare Part D, the prescription drug coverage for seniors, does not cover cough suppressants and Benzonatate was not in his plan’s formulary of covered medicines. That meant he could not take advantage of any discount negotiated by his insurer, UPMC for Life.

That still didn’t explain why the gel caps cost much more through his insurance.

Tom Tritinger, a pharmacist at Conn’s pharmacy, said it probably has to do with a price set by the wholesaler that is rarely charged to the patient.

“I can’t even tell you what goes into setting that price,” he said, adding that usually, the pharmacist “would have managed that down” to a lower price or, absent that, charged a lower price anyway.

“With most pharmacists, the price is a courtesy. There is some compassion,” he said.

His advice: Check ahead to see if a new medication is covered under your insurance; ask to speak to a pharmacist if the price seems high; and, if practical, shop around if you’re unhappy with a pharmacy’s price.

UPMC for Life literature also suggests checking with its staff to see if a similar drug is covered under its plan when the prescribed drug is not in its formulary.

The insurer’s members can request the plan to cover a drug not in its formulary “at a pre-determined cost-sharing level,” although such exceptions generally are not granted unless alternative medications would not be as effective or could cause adverse side effects.

Pat Eppel, executive director of the Pennsylvania Pharmacists Association in Harrisburg, said a pharmacy benefit manager — typically a third party that manages prescription benefits for an insurer — also may be telling a pharmacy what to charge for a medication.

“No one sees exactly how much the (Medicare) Part D plan is billing the government,” she said.”A lot of pharmacists believe that the government is paying far more than they need to.”

Looking back, Conn’s wife, Christine, said they are is still “flabbergasted” by the price difference and now wonder if they should ask for the cash price every time.

Tritinger said that’s probably not necessary. “Ninety-nine percent of the time they’re going to get a better price through the insurance company.”

Photo: Charles Conn, of Baldwin, Pa., was told a prescription for his cough medicine would cost $91 under his insurance plan, but paying out of pocket would only be $26. (Robin Rombach/Pittsburgh Post-Gazette/TNS)

Sen. David Perdue

Sen. David Perdue (R-GA) pulled out of his final debate against Democrat Jon Ossoff on Thursday —because he'd rather attend a Donald Trump campaign rally.

The Nov. 1 Senate debate was planned months ago, but Perdue's campaign said he could not participate as promised because he has been too busy doing his job.

"Senator Perdue will not be participating in the WSB-TV debate but will instead join the 45th president, Donald J. Trump, for a huge Get-Out-The-Vote rally in Northwest Georgia. For 8 of the last 14 days of this campaign, Senator Perdue went back to Washington to work for much needed COVID relief," his spokesperson John Burke said in a statement, referencing a failed attempt by Senate Republicans to pass Senate Majority Leader Mitch McConnell's (R-KY) "skinny" $500 billion proposal.

"To make up for the lost time, Senator Perdue has over 20 campaign stops planned for the closing days of this race, and he is excited to welcome and join President Trump in Georgia before November 3rd to campaign for both of their re-election efforts," Burke added.

WSB-TV noted on Thursday that it offered Perdue's campaign other time slots to accommodate the Trump rally, but the overture was rebuffed.

Ossoff's campaign blasted Perdue's "cowardly withdrawal," saying in a statement that the move "says it all: David Perdue feels entitled to his office, and he'll do anything to avoid accountability for his blatant corruption and his total failure during this unprecedented health crisis."

The incumbent's decision to break his promise to debate came one day after a video of Jon Ossoff criticizing Perdue's anti-Obamacare record at a Wednesday debate went viral. As of Friday morning, a 72-second clip of Ossoff has been viewed more than 12 million times.

Perdue responded to that attack by making the odd claim that he repeatedly voted to repeal the Affordable Care Act — which would take insurance away from hundreds of thousands of his constituents — because he believed doing so would cover more people.

"I voted against the Affordable Care Act, better known as Obamacare, because it was taking insurance away from millions of Georgians. Today almost 18 percent of Georgians don't have any health insurance because of the Affordable Care Act," he falsely claimed.

This is not the first time Perdue has put Trump ahead of the interests of Georgians. According to FiveThirtyEight, he has voted with Trump about 95 percent of the time, including backing his right-wing Supreme Court nominees, his tax cuts for large corporations and the very wealthy, and his repeated attempts to take money from military families to pay for a massive Southern border wall.

Medical experts and data analyses have suggested Trump's rallies have been super-spreader events for the coronavirus. Trump has refused to adhere to social distancing rules or to require mask usage at the events and the mass gatherings have frequently been immediately followed by case spikes in the communities where he holds them.

One poll this week found that voters across the country said they are less likely to vote for Trump because of his "large, in-person campaign rallies where wearing a mask is not required of attendees."

The race between Ossoff and Perdue is considered a "toss-up" by election experts, and polls show it as virtual tied.

If no candidate gets a majority on Tuesday, the top two finishers will face off in a January runoff.

Published with permission of The American Independent Foundation.