My 96 hour ordeal in getting a prescription for my 85 year old mom........ [View all]

[mrmpa]

This past Friday I took my mom for an appointment at the wound care center. She has a large open wound on her leg caused by vascular disease, she is not diabetic.

The Doctor prescribed "Santyl" and faxed it to a pharmacy they say gets it for their patients at usually about $40. It's not a pharmacy that I would go to, it is locally owned and has a good reputation, but it is a bit out of the way. I checked the price on goodrx.com and found the lowest price about $212 @ the local Walmart Pharmacy. So I figured the $40 cost was of course utilizing a person's insurance.

Now my mom has Pacenet (A Pennsylvania program for seniors with a certain income). Now this insurance is $40 a month, with $8 copays for generic medications and $15 for name brand. I do not allow my mother to utilize the Pacenet as most of her medications are never more than $25 for a 3 month supply and Pacenet does not allow for a 3 month supply to be dispensed. Mom understands this and knows that Pacenet is only to be used when she needs a name brand and the cost is very high. Which in this case we will use it. The cost to mom should be $80 ($40 for insurance premium for January & February) and $15 for the medicine.

I go to the pharmacy on Saturday, give them mom's Pacenet card and learn that Pennsylvania does not cover medications from this manufacturer. Now understand there is only one manufacturer of this drug, world wide. As the Doctor wrote the prescription for a volume of 60, mom will need 2 tubes of this ointment, so now the cost at this drug store is $500 (though it will match the Wallmart price). However $424 is still something my mom can't afford.

I go home do my research & find that there is another drug "xenaderm" which is similar to "Santyl" but at 25% of the cost, $62. I called the Doctor's office on Monday and was told that "xenaderm" is an excellent substitute and they called the prescription into the Walmart Pharmacy. Closer to me and $62 is the goodrx.com price at Walmart.

I called Pacenet offices and learned that the manufacturer of "Santyl" refuses to participate in the Pacenet Program. They gave me the name of the company that makes "Santyl" and I called that company, it was recently bought by another company. I told the company service representative, Martha, that I was not happy that they would not work with the PA program and that they were forcing many seniors to pay for medication that was too costly for those on a very fixed income. I was very nice and informed her that I would be letting my State Senator know about the unwillingness of this manufacturer to work with Pennsylvania.

After I get off the phone with Martha, the Doctor's office calls us & tells us that Walmart is having difficulty finding "xenaderm". I call the local pharmacy and ask if they can locate it, they check their distributor and they can't find it. I then do my research and learn that the manufacturer of "xenaderm" is the same manufacturer of "santyl".

I called Martha back, left a voice mail and told her I need to have "xenaderm" available in Pennsylvania, so my mom can get it. Martha promptly called me back and informed me that they discontinued manufacturing "xenaderm". The light bulb went off in my head. I incredulously asked "so you discontinued the less expensive medication (the medication that gets better consumer ratings) in order to sell only the more expensive drug? I continued with comparing her company to the NYC exec who upped the price on the $1.50 pill to $750. I continued with and you have the audactity not to work with insurance programs run by States." I also informed her that not only will my State Senator get an email about this, but also my US Senator will.

I called Walmart and told them that I learned that "xenaderm" is discontinued by the manufacturer. The Tech was great, she said to give her a few minutes to look something up. She directed me to the Santyl.com web page, where there is a coupon worth $50 toward the purchase of "Santyl" and the company will pick up the next $150. I called the local pharmacy and told them what I had learned. The pharmacist told me they could take the coupon but it would be about $200, since mom needed 2 tubes. I said no, I'll take one tube today, $50, I'll pick up the 2nd tube next week, $50. And that's what I did.

Doctor's office called this morning & said she ordered something with the Home Health Care Agency. I told her to rescind that order, as I had taken care of the matter and "Santyl" was in the house.

This was an ordeal that no one should have to go through. I'm 59 and it was a headache for me, I just wonder how many people my mother's age, don't have an advocate and paid full price for this drug. Also I don't see the $150 the company pays for this drug as "corporate care, or corporate giving back". I think that the drug's real cost is far from $500, it's just a price they wanted to charge for it. They don't have to research it, as it was developed by the company they bought out. I think this company just sees an uptake in the need for this ointment and is trying to make a quick buck.

If I sound cynical, I'll admit that I am.