Sarah Stultz: How did out-of-pocket costs get so high?

Published 8:45 pm Tuesday, February 2, 2021

Nose for News by Sarah Stultz

It’s that time of year again.

We’re in the second month of the year, and for those of us with family members with high-cost medical needs, that means it’s time for some sticker shock again until we reach our deductible and out-of-pocket maximum.

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My son, Landon, who has had epilepsy since he was 1 week old, has been on anti-seizure medication his whole life.

About two years ago, we changed to his current medication lineup, and we have gotten to a point where his seizures are under better control — though not perfect. We went from him having multiple seizures a week, to where he is now having one or two a month — sometimes less. It’s much better for this over-worried mom’s stress level, that’s for sure.

Because of this, when it comes time to get his medicine each month, we don’t dare suggest that it’s time for a new medication because it is so expensive. It is working relatively well, and we don’t want to go through the worry of switching medications unless absolutely necessary. Anyone with delicate medical needs can surely understand that concern because how someone reacts to a medication sometimes depends on the person.

Last week I went to pick up one of Landon’s medications from our local pharmacy, and the person in the pharmacy asked us if we knew how much that prescription was going to cost us. Before running it through the insurance, the cost was over $900, and we were being asked to pay about $300.

That was for one month’s worth of medicine and for one medication. He has four different prescriptions, though that is by far his most expensive.

I cringed and told the man in the pharmacy that, yes, unfortunately, I knew the cost and handed over the credit card from my flexible spending account.

Thankfully, my workplace offers us to have an FSA account, which allows employees to set aside money out of our paychecks pre-tax to pay for qualified medical and dental expenses. I  take advantage of the maximum allowable, and it typically allows our family to get through probably the first half of the year of expected medical expenses without having to upfront any money.

Eventually, Landon reaches his deductible — typically halfway through the year if he has one or two same-day doctor visits or if he needs any dental work done. Heaven forbid he needs to go into the emergency room or stay overnight in the hospital because of a seizure episode.

It’s no wonder with the cost of medical and prescription costs these days that you hear stories of people who don’t take their medication as prescribed to reduce their prescription drug costs, or people who turn to alternative therapies or who put off doctor’s visits.

According to a Consumer Reports survey from September 2019, 30% of Americans say their out-of-pocket cost for a drug they regularly take has increased in the past year. Of those, 12% said their costs went up by $100 or more.

It’s sad that even with the cost of health insurance premiums, families have to be strapped to pay for medical costs and medications.

I encourage our representatives at the state and federal level to do what they can to address this issue.

Medication can be a matter of life and death.

Sarah Stultz is the managing editor of the Tribune. Her column appears every Wednesday in the Tribune.