Allergy sufferers, insurers shuffle drug costs
Linda Coover’s allergies give her a hard time.
“When the pollen and mold counts go up, my nose shuts down,” she said. “I live on nasal spray.”
She used to take Claritin, the best-selling prescription allergy medication — but not anymore.
“It got way too expensive,” said Coover, a filing clerk at Douglas County District Court.
Coover’s health insurance, Blue Cross and Blue Shield of Kansas, used to pay for Claritin. For a month’s supply of pills, her co-pay was $5.
But in December, when the Food and Drug Administration approved Claritin for over-the-counter sales, the nation’s insurance companies announced they would no longer cover the popular antihistamine. Instead, customers were encouraged to pay for it themselves — like they already pay for aspirin or cough syrup.
Claritin’s move to over-the-counter status was expected to cut insurers’ costs by more than $1 billion a year.
What it really did, many now say, is shift allergy sufferers like Coover from one prescription to another. And it may be just the first round in a shell game that will send prescription users looking for alternatives as other medications’ status are changed and insurers respond by dropping coverage.
As an over-the-counter medication, Claritin now costs about a dollar a pill when purchased in quantities of 20 or more. For Coover, who takes a pill a day, that was a 600 percent increase. Her solution was to get a prescription for Allegra, a similar allergy medicine.
Rick Awbrey, a pharmacist at Hy-Vee food & Drug Store, 4000 W. Sixth St., shows the recently designated over-the-counter antihistamine, Claritin, next to Allegra and Zyrtec, its prescription counterparts.
Blue Cross still covers Allegra, so Coover is back to paying $5 a month.
Not as popular
She’s not alone. Mike Fink, pharmacist at Medical Arts Pharmacy, 346 Maine, said that since Claritin went over-the-counter, its sales had plummeted.
“Most people on Claritin have switched to medications that are still covered by their insurance,” he said. “Without that co-pay, Claritin is definitely not as popular as it used to be.”
At the Asthma, Allergy & Rheumatology Associates clinic, 346 Maine, Dr. Warren Frick said a steady stream of patients had asked him to switch their Claritin prescriptions to Allegra, Zyrtec or Clarinex.
“I don’t refuse them because, for the most part, the benefits and potential risks are very comparable — and it’s their pocketbooks they’re looking out for,” Frick said.
Insurance companies have a different view. Switching to Allegra, Zyrtec or Clarinex, they argue, only adds to the industry’s costs, forcing rate increases.
“I tell people that if we’re going to keep health insurance affordable, it’s going to have to be more like car insurance,” said Graham Bailey, a spokesman for Blue Cross.
“By that I mean your car insurance doesn’t cover the cost of new tires, wiper blades or tune-ups. It can’t — that would make it way too expensive,” Bailey said. “Health insurance is the same way. It shouldn’t be expected to cover what’s available over the counter because if it does, it’ll be too expensive.”
In the coming months, Bailey said he expects:
- The FDA will move Allegra, Zyrtec and Clarinex to over-the-counter status.
- A generic form of Claritin will be made available.
- Some insurers will drop their coverage of antihistamines altogether.
| Last year, Blue Cross and Blue Shield of Kansas paid $210 million in prescription drug claims, including $8.8 million for antihistamines. Here’s a look at the insurer’s top five drug categories, and how much it paid for each:1. Heartburn, ulcers — $18.7 million2. High cholesterol — $17.4 million3. Depression — $16 million4. Antihistamines — $8.8 million5. Asthma — $8 million |
Currently, Blue Cross is not planning to drop its coverage of antihistamines. But, Bailey said, that could change.
“If all kinds of people who were taking Claritin switch to prescription-type antihistamines, I think you’re going to see a lot of (insurance) companies making different decisions.”
‘A shorter list’
Some already have.
“Oh, yeah, we’ve had companies tell us they’re no longer covering Zyrtec now that Claritin’s over the counter,” said Jeff Sigler, pharmacist at Hy-Vee Food Store, 3504 Clinton Parkway.
“Now, there’s still a list of prescription antihistamines they can choose from,” he said. “But it’s a shorter list, and I suspect it’ll be getting shorter.”
Last year, Blue Cross of Kansas, the state’s largest health insurer, paid $210 million in prescription-drug claims, including $8.8 million for antihistamines.
Antihistamines constitute the insurer’s fourth-largest drug category, trailing medicines for treating heartburn and ulcers, high cholesterol and depression. Asthma medications are the fifth largest.
See latest pollen report for LawrenceThis summer, Kansas Insurance Commissioner Sandy Praeger will launch an educational campaign aimed at showing consumers how their health-care decisions affect their health insurance premiums.
Part of the campaign will encourage consumers to at least try over-the-counter drugs — Claritin, for example — before opting for a prescription drug covered by their insurance.
“I can certainly understand why someone who’s on a co-pay would want to stay on co-pay,” said Praeger, who lives in Lawrence. “But at some point we’ve got to get people to realize that, really, that’s forcing up the overall cost of health care, and insurance companies are just going to turn around and either raise rates or eliminate certain prescriptions.”
Just the beginning
At the Hy-Vee pharmacy, Sigler said the fight over Claritin was only the opening skirmish in a much bigger war.
“When we took the cost of drugs out of the patients’ hands and made them part of their insurance plans, the drug companies were free to raise prices indiscriminately — and they did,” Sigler said. “So, in a way, all of us brought this mess on ourselves.”
As more prescription drugs switch to over-the-counter status, Sigler said consumers should consult with their pharmacist.
“There are many, many ways to reduce costs — they may not be as convenient as that Cadillac we’ve all come to expect and want, but when you’re looking at something that’s a fraction of the cost, it ought to be considered.”
Amber Parks, a 25-year-old records clerk at Lawrence Memorial Hospital, takes Zyrtec for her allergies. She’s not buying all the big-picture talk about helping insurance companies reduce costs.
“If Zyrtec goes over-the-counter, I know what I’m doing — I’m getting a prescription for whatever else is covered,” she said. “If they don’t want people doing that, then they need to figure out a way to make it cheaper, not more expensive.”
Coover agreed. “All I know is that when Claritin went over-the-counter, it became cost-prohibitive for me,” she said.