A Cure for the January Blues

1 10 20 Blog Pharmacy Blues

Yes, the January blues are a thing. They set in as soon as the holidays end, when reality hits that spring is a long way off, and as the wait drags on for new seasons of Ozark and Better Call Saul.

For many people, pharmacy frustration compounds these January blues. It’s a stressful month for people who rely on medications, as well as those who dispense them.

Of course, peak season for colds, flu and other winter illnesses doesn’t help. Lots of prescriptions are written and filled for the first time in the new year. But the symptoms of January pharmacy blues—confusion, sticker shock, despair—usually occur for people at the first fill of their regular medications.

What are the causes?

  • Price increases: The pharmaceutical industry has made raising prices on prescription drugs a New Year’s ritual. List prices have gone up on more than 400 products already. The impact at retail varies by drug and is subject to some crazy calculus, but many consumers see higher prices at the counter for the same prescription they picked up a month ago.
  • Deductibles: Most plan years start anew on Jan. 1. That means deductibles reset, so high-deductible health plan (HDHP) members can be on the hook for the full retail price for a while. That’s painful even for consumers who are used to it. We’ve seen and talked with countless members who moved to HDHPs without realizing their deductible applies to pharmacy. Reactions can range from utter shock and anger to sheer hopelessness. Many prescriptions go unfilled or rationed, which is never a good thing.
  • Insurance Changes: It’s rare when someone’s health insurance and/or pharmacy benefit doesn’t change in some way on Jan. 1. Could be a new carrier, a different pharmacy benefit manager (PBM), a changed formulary, a tweaked plan design… Maybe there are bigger copays, a drug is no longer covered or prior authorization or step therapy is now in place, there’s a new pharmacy network, or the negotiated price is suddenly higher.

Any and all of the above can lead to varying degrees of stress, confusion and frustration. Retail pharmacists and pharmacy techs often bear the brunt of customer reaction, but unfortunately can’t offer much help.

“We would scramble to try and assist patients, but we’d have no clue and no answers due to all the changes and disruption,” said Nikki Stone, PharmD, Clinical Pharmacist Manager for Rx Savings Solutions, who spent 15 years in retail pharmacy. “More often than not, we just pointed to the 800 number on the back of their insurance card, knowing they were probably in for a frustrating experience.”

Rx Savings Solutions to the Rescue

Here are five ways members can use Rx Savings Solutions to avoid or eliminate the January pharmacy blues:

  1. Determine whether a medication is covered on a new formulary, whether prior authorization or step therapy applies, and if there’s a new pharmacy network
  2. Determine the price of the member’s drug(s) for 2020, or the price they can expect to pay (if sufficient claims/pricing data don’t exist yet for certain plans)
  3. Search for Savings Suggestions and alternatives
  4. Let Rx Savings Solutions remove the hassles of switching to a different prescription or pharmacy
  5. Talk with real people, experts who know the struggle and will go out of the way to help, and who can be reached quickly and directly on the first attempt

January is a tumultuous time for pharmacy consumers. It can be downright depressing. We can’t make spring arrive any sooner, but we can shed light on their plan year changes and offer a ray of sunshine to members who need it.