Benzoyl peroxide is a chemical that’s been used to treat acne for over 40 years. It can be purchased over the counter in brands such as Clearasil®, Oxy 5®, and Stridex®.
Below are two benzoyl peroxid products. Both are reimbursable by SC Medicaid (ie your tax dollars). The product on the left is Triaz® cleansing cloths. The product on the right is a generic over-the-counter benzoyl peroxide 10% cream.
South Carolina reimbursement medicaid for Triaz® is $254.11. Benzoyl peroxide reimbusement is $9.67. Now pretend you’re a cash customer without insurance. You bring in a prescription for Triaz® and ask for a price quote. After we picked you up off the floor, you would probably question the cost. You’d ask “doc, isn’t there something else we could at least try?” I’d point you to the over-the-counter acne product shelf. I’d tell you to “wash your face real good with soap and water 2-3 times per day and apply a little dab of the acne cream on your face when its still wet. Since the cheaper cream is 4% stronger, you may want to apply it only once a day if it irritates your skin. This may be a little more trouble, but hey, it’s your $ 244.44, not mine.”
Unfortunately, the taxpayer doesn’t get this option.
The problem with insurance coverage is that the consumer doesn’t have the incentive to question these costs. The physician doesn’t have the incentive either. The drug companies control the Pharmacy Benefit Managers, so they like this stuff. (A PBM is the go between the pharmacy and the insurer).
I could give you dozens of examples of this kind because I see it everyday in the drug store. This is why our health care system is such a mess. There’s a lack of consumerism, lack of accountability, and very little free market.
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