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Why Are Workers Comp Pharmacy Benefits So Expensive – In One Picture

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Workers Comp Pharmacy High Costs – One Pic Explains It All

A Workers Comp Pharmacy comparison can be shown in the picture below.    My comparison is not for a Workers Comp claim that I have presently.  Instead, a simple picture shows the source of the high costs of name-brand medications regardless if the benefits are health or workers compensation.

picture of inhalers from Workers Comp Pharmacy
Taken by article author

The one on the left is brand  name.   The inhaler on the right is a generic version.   Each one of them provides 200 doses.

Every year, I have to use an inhaler when I catch the usual upper respiratory infection at an airport or in an airplane.  I use air travel just enough to have the usual travel maladies.

I was explaining to a friend of mine in another country that an inhaler here retails for approximately $175. I will not mention the drug company or the drug in the inhaler.  He said let me check on that as I think they sell here over the counter without a prescription for $4.   I thought he was out of his mind.

Then, one day I received a package from his present home country.  I will keep the country anonymous as well.  I had remarked to my good friend that the inhaler was running low and I would have to pay for a Doctor’s visit and an extremely high price, even with health insurance, for the inhaler.

I opened up the package and there was an inhaler from his home country from the same pharmaceutical company.   With postage, it cost him less than $10 including the cost of the inhaler.

I had thought that it could not be  the same medicine.  I was wrong.  IT WAS THE EXACT SAME MEDICINE manufactured by the same company overseas.  So the inhaler can be obtained without a physician visit in his country – amazing, and it was the dollar equivalent of $4.

Let us look at the comparison:

  • US – $25 for office visit, $175 (let’s not count in the insurance copay) = $200
  • Foreign country – $4 + 6 postage = $10
Cash workers comp pharmacy on table
by StockUnlimited

Why does it cost 2,000% more for the same drug manufactured by the same company?  I then honed in on Workers Comp Pharmacy expenditures.   The light bulb went on quickly.   Why are name brand pharmaceuticals so expensive for Workers Comp?  I think it may be that the generics are produced in the same factories as was the inhaler.

By the way, there is no generic version of the inhaler, unless you live in another country.   Why?   The domestic patent has not expired yet.

Workers Comp pharmacy costs for the inhaler would be full bore at $175, right?

I am not a Pharmacy Benefit Manager (PBM) expert.  However, the numbers are the numbers – PBM or not.   If you wish to comment, below, please explain the $173 difference and if the inhaler would be cheaper with a Workers Comp Pharmacy network.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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