Her doctor has her on Zyrtec-D, a prescription allergy medication that includes a decongestant to help with nasal congestion caused by allergies. She's been taking it since mid-2006, at least - possibly longer, but that's as far back as our prescription records are available online. We've been with the same prescription insurance company (Caremark) the entire time she's been taking Zyrtec-D. Our prescription coverage copay for a month's supply of Zyrtec-D was $21.46 at a retail pharmacy. If you choose to utilize our insurance company's mail-order pharmacy then you can get a 3-month supply of your prescription for the cost of a 2-month supply at a retail pharmacy. So we were looking at paying roughly $172 for her Zyrtec-D for the entire year. Calculating the estimated costs for the year is fairly significant when it directly factors into how much you contribute to your Flexible Spending Account for the year, since you have to set your FSA election before the year starts and cannot change it once it is set.
We had been getting all of our prescriptions locally at a retail pharmacy. This year we decided to switch most of them to the mail-order pharmacy to save money. My wife's Zyrtec-D was one of the prescriptions that I tried to switch to mail-order in January. A little more than a week after I mailed in the prescriptions, we received an envelope in the mail from the mail-order pharmacy. I opened it to - surprise! - a letter informing me that Zyrtec was now an OTC drug and no longer available by prescription. There was also a coupon of some sort that I saved somewhere, not really expecting it to ever be useful.
My wife still had one or two refills left on her Zyrtec-D prescription at our local pharmacy, so at that point I just requested a refill from them, curious to see if it would go through. Somewhat surprisingly to me, the pharmacy did fill it and the insurance covered it at the usual rate. When I queried the pharmacist about Zyrtec switching to OTC, she informed that Zyrtec-D was indeed available OTC now, but said to continue trying to fill it via prescription in the future since our insurance wasn't fighting paying for it (yet). I didn't think much more about it until today.
I did a little bit of research today and discovered two key facts:
1) The manufacturer of the prescription version of Zyrtec-D has stopped producing it. Thus, the supply of prescription Zyrtec-D is limited and will likely be exhausted before too long.
2) The cost for the OTC version of Zyrtec-D is $19.99 for 24 pills. Each pill is a 12-hour pill, so 24 pills will last for just 12 days.
So we've suddenly gone from paying $21.46 for a 1-month supply to paying $19.99 for a 12-day supply. Factor in the mail-order pharmacy price that we had planned on getting, and it's a $14.31/30 days to $19.99/12 days difference. In other words, our yearly costs for Zyrtec-D just skyrocketed from the $172 that we had planned on up to $608. That's a significant jump, and it threw a huge monkey wrench into our FSA plans that were already in massive disarray from some other unexpected medical expenses early in the year.
This bothers me on two different levels. The first is all of the advertisements and news stories that talk about how consumers will save money because Zyrtec is switching to OTC. Just about every ad and news story that I have read about the switch likes to trumpet the fact that this is a big win for consumers because 1) they will save money on Zyrtec, and 2) Zyrtec will be easier to buy. Lost in all the hubbub is the fact that people with insurance that covered Zyrtec with a modest copay are probably not saving much money, and in many cases are actually losing money on the deal - sometimes substantial amounts. Ads/stories that tell me I'm going to save money really rub me the wrong way when in reality my costs more than tripled.
The other aspect that bothers me is that our insurance company did not notify us of this change until late January when we tried to order Zyrtec-D from their mail-order pharmacy. Were they obligated to inform us earlier? No, certainly not. But they knew about this change months in advance, and their records clearly reflect that my wife has been taking Zyrtec-D very consistently for more than a year and they've been paying for most of the cost. Couldn't they have informed us of this back in October or November? "Hey, we know you've been taking Zyrtec-D consistently for more than a year, and we thought you'd want to know that in a couple of months you'll only be able to get it OTC and we won't be covering the costs any more. We don't know what the OTC costs will be exactly, but it's safe to assume they will be higher than your current prescription copay. You might want to plan accordingly for the coming year." I still would have been very unhappy with the switch, but at least I would have been able to plan accordingly when figuring out our medical expenses for this year.
You could make the argument that as consumers we should have been more aware of the news about our prescriptions, and on some level you'd be right. As I said previously, I don't feel that our insurance company was obligated to warn us about this. I don't think it was necessarily their responsibility to give us advance warning, but as a company that likes to pride itself on customer satisfaction I would have thought they would have given advance warning to their customers that would be seeing a price increase once they stopped covering the prescription version.
I'm happy for all of the people that now have easier and supposedly cheaper access to regular Zyrtec. Really, I am. But no matter how hard I try I can't shake the feeling that we got royally screwed in this process.
