Insurance and Pharmacy

Last updated: 2021-Feb-09

History

My eczema (atopic dermatitis) has been really bad lately. I've had to take time off of hydrocortisone, which is a steroid cream that normally calms down the immune response leading to the rash.

My current functional medicine doctor, Dr. Amy Nett, recommended looking into Epiceram, a topical medicine meant to assist restoring the skin as a protective layer.

I have a high deductible health plan with Kaiser Permanente ($326/month), so I had Dr. Nett fax over the information to my local Kaiser Permanente pharmacy, figured I would probably pay for it all, but at least it would count toward my deductible.

Call with Kaiser Permanente

I called the pharmacy, waiting on hold for about 20 minutes. When they answered, they found the info faxed over, looked up the medicine, and told me it was "non formulary", basically it's not in their list of medicines. They said one 90g tube would cost a little over six thousand dollars.

Call with Avrio Pharmacy

Dr. Nett found another pharmacy near where I will be moving in a month: Avrio Pharmacy in Scottsdale, Arizona. She faxed the prescription over to them. I called to see how much it would cost and they told me $20. A literal $20. I placed the order and they're mailing it to me.

Who is getting healthcare?

I realize that our new healthcare insurance system is designed to make me overpay for my insurance so that the extra money goes to people with less income and greater healthcare demands. But this is really tough. Obviously something is wrong here.

Validated decision making

I am glad I signed up for the High Deductible Health Plan as it comes with a Health Savings Account. Every treatment I find helpful has always been out of network, so this way I can at least used pre-tax dollars to purchase.

My only other option is to just not have health insurance and hope for good luck. It would probably be much cheaper since I don't have any major, life-threatening health issues and am unlikely to experiene something catastrophic.