There was a long pause. The technician pronounced each word carefully and with some force, “Doctor…I told you.. I DO NOT KNOW. That is not our job. We do not set prices.”
Another pause, then… “I AM DONE TALKING WITH YOU. HERE IS THE PHARMACIST.” She handed me the phone.
I got to the doctor first, before she could get to me. “Doctor, what is the problem? I was listening to the technician and she is right. We do not set copay prices.”
“Three hundred and sixty-five dollars? Isn’t that ridiculous?”
“If that is the copay it IS ridiculous. The patient’s mom needs to get different insurance, complain to her employer or…..”
“I want the generic, but that WOMAN told me that she can’t give the generic. Why is that?”
I took a second to ask, then back to the fray. “There is no generic available for Pulmicort Respules.”
“That’s ridicuolous. It is budesonide. You are a pharmacist. You should know that.”
“Everything has a generic name. That does not mean that there is a generic equivalent to the brand name product available.”
“But, $365.00 is ridiculous.”
“I agree, but I can’t influence the copay.”
“You pharmacists make too much money.”
Oh oh! You will be proud of Jay Pee. I took a swig of my Diet Coke and drew a long breath.
“Doctor, I will assure you that there are very few pharmacies in the United States rolling in profits.”
“Oh, that’s rich,” she laughed. I did some checking of pricing. She is a pediatrician. “I prescribe Questran in Eucerin all the time and my patient’s moms complain about the price. I checked and the prices around here (South Houston) go from $50.00 to $150.00. That’s ridiculous.”
“That’s a compound,” I said.
“It has to be mixed.”
“So? One packet of Questran and a few ounces of Eucerin. Those can’t be expensive.”
“It isn’t the ingredients. It is the compounding that costs.”
“Of course. The only people who are trained to compound are pharmacists. We learned it in school and we perfected our techniques as we gained experience.”
I paused, but she was silent. So, I continued. “Doctor, I have been a pharmacist for a long time. I learned compounding when one of every ten prescriptions had to be mixed. I have compounded papers, capsules, suppositories as well as creams and ointments. I am good at it, even though my talents are rarely called upon in the 21st Century.”
“But, $150.00?” Oh, she was smug.
“Doctor, you charge for YOUR education, knowledge and experience. Why shouldn’t pharmacists? I have compounded the Cholestyramine/Eucerin prescription. If you were the mom, you would like my product. It is creamy and non-gritty. It is as elegant as the best cosmetic products. It turns out that way because I WAS trained in the 1960s. I have a learned talent, doctor and I AM NOT GIVING IT AWAY.”
I was getting loud. The technician to my left was smiling and nodding. She gave me a thumbs up sign. I lowered my voice. “You are a physician. There is never a second thought that you should charge for your knowledge and experience. Why shouldn’t a pharmacist charge for her knowledge and experience?”
Later, I called the prescriber back and told the receptionist that I needed to speak with the doctor. The message I conveyed about the $365.00 “copay” was that this mom had a $500.00 deductible on her prescription insurance.