Pharmacy Rip-Offs

Generic Prozac is Fluoxetine.  It used to be $100 for 30 pills. Since it became generic, you can get 100 pills from Walmart for about $10.  You can get 30 pills for $4.

CVS sent me a fax this past week:  “Your patient wants a drug which is less expensive.  30 pills of Fluoxetine 20mg is $48. Consider Citalopram or Paroxetine which is less.”I was stunned.  FORTY-EIGHT DOLLARS?!?!?!?  This is WITH INSURANCE!!!

Plus, these drugs are not equivalent.  All are SSRI’s but they have very different issues of half-life, sedation, EKG changes and weight gain.  No!  This is not acceptable.  I called the patient and told her she could get the drug cheaper at Walmart.  I sent in a new prescription to Walmart. She was thrilled.

Then I returned the fax to CVS with big bold magic marker written accusations of fraud and theft.  I avoided four-letter words….but it wasn’t easy….

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Steven Mussey MD

Steven Mussey, M.D. is a physician in Internal Medicine, practicing in the Fredericksburg area for more than twenty years. He grew up in Springfield, Virginia and earned a degree in Physics from The University of Virginia, Phi Beta Kappa. He earned his medical degree at The George Washington University and was inducted into the medical honor society AOA. He is Board Certified in Internal Medicine. He served in the Air Force for four years before entering into private practice. He particularly enjoys geriatric medical care and working with complex patients. For almost a quarter century, he has been practicing with one other Internist. Both doctors enjoy practice in a small, but busy office, and plan on working into their 70s, as long as they can still find their way to the office. Dr. Mussey is also an avid cartoonist and has a weekly cartoon in the local newspaper. He also enjoys cartoon animation and has had several public service cartoons playing regularly on the television cable systems.

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9 Responses

  1. Benjamin J says:

    To be fair to CVS, if you wrote for fluoxetine TABLETS, those really do cost somewhere on the order of $48/30 tabs.

    Fluoxetine CAPSULES are the ones that are on the Walmart $4 list.

  2. Sir Hakum of Hugo says:

    Just today I had a patient with Diabetes in the office. His mega-insurance company sent him a notice that Metformin ER was no longer being covered, it ‘teas non-formulary.! 90 days at a local pharmacy with GoodRX was $24 cash.

    A1c under 6.5. Happy patient. Less than a co-pay.

    99% of my insurance pharmaceutical faxes are recycled. Patient’s save green by me going green.

  3. Edmund Hayes says:

    This is what happens when pharmacists make a recommendation on something they (at least in this case) know little about. It paints a bad picture of all pharmacists and I will tell you that there are many great, knowledgeable pharmacists out there that would never have made this recommendation.
    There are big differences between SSRI’s and he/she should have known that. The crazy thing about this is, even if everything else was the same the T1/2 surely varies enough to not just say, stop SSRI #1 and start SSRI #2.
    Hospitals and their restrictive formularies do this kind of thing all the time. They do it with SSRI’s, statins and a host of other drugs. There are pharmacists that are experts in their domain and then there are pharmacists that know a little about a lot.
    There are so many cracks in the cement of the healthcare system that we all have to walk on. It’s amazing that the system doesn’t kill us all.
    BTW – I am a Pharmacist and a former Dean of a School of Pharmacy.

    • Steve O' says:

      Thank you, Edmund. I have had patients return to the clinic, angry because their pharmacist said that the prescription was “wrong.” It is within the pharmacist’s purview to send a prescription back for error. But to send back a hydroxyzine prescription, given as an adjuvant for chronic pain, a credible use – and tell the patient that this medicine is “for itch” and “the doctor made a mistake” serves only the vanity of the pharmacist, not professional skills.
      This problem with vanity and arrogance in the health professions is not limited to pharmacists – it is seen in all fields where a professional neglects their insight into their own skills, and feels as if they can do anything; and they can, badly in most instances. In turn vanity and arrogance in the health professions only mirrors that across the culture. People refuse statins and flu shots, but beg for antivirals to get immune to the Coronavirus Epidemic. Google tells them so.

      • Edmund Hayes says:

        I find it amazing that this pharmacist did this. To send the patient away and comment that you made a mistake is so just far out of bounds. Why wouldn’t he/she call you and ask for clarification? I would call who ever is his/her boss and them removed for being unprofessional and grossly ignorant.
        Once again, this kind of unprofessional behavior paints a bad picture of all pharmacists and I will tell you that there are many great, knowledgeable pharmacists out there that would never have done this. (I hope and pray)

        • Mamadoc says:

          Hate to rain on your parade, but this sort of thing is not at all unusual.

        • Beth K says:

          In all fairness, a pharmacist questioning a prescription probably kept me out of the hospital a few years ago. I’d been to the dentist. I’d written on the paperwork what medications I was on and at what dose. The dentist prescribed an antibiotic for an infection. I took it to the same pharmacy I had all of my other prescriptions filled at – a local pharmacy owned by the pharmacist who’d been practicing for decades. He told me that there was a severe interaction with that antibiotic and a SSRI I was taking. He called the dentist, explained the problem, and got a substitute antibiotic. Problem solved. Yes, the dentist made a mistake. A second set of eyes with knowledge of drug interactions was invaluable.

          Yes, doctors (and dentists) make mistakes sometimes. The pharmacist can check them. However, if a patient is using several pharmacies, that second check goes away. Same as if the pharmacist is too rushed.

          • Edmund Hayes says:

            Pharmacists are part of the health care team and can act as gate keepers, making sure the medications you take are not going to cause side effects and potential harm. Pharmacists do what you describe every day and don’t get much credit for doing so.
            You are smart in the fact that you go to only one pharmacy. If you would have gone to a different pharmacy for this antibiotic you would have been in trouble since pharmacies do not share information with other pharmacies unless they are part of a chain.

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