At Aetna, another example of screwy medical pricing

A patient discovers that the mail-order cost of Lipitor is nearly four times the retail drugstore price. Aetna vows to rectify.

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Consumers have been told by insurers again and again that if they want cheaper prices for prescription drugs, they need to order them in bulk from mail-order pharmacies. And typically, it works out that way.

Sometimes, however, the prices reveal how screwy our healthcare system is — and what a challenge it can be to get a straight answer about medical costs.

Jeff Zoldos, 61, had such an experience after his employer switched his coverage to Aetna at the beginning of the year.

The Tustin resident went to Aetna's website to check his options for filling a prescription for the generic version of the cholesterol drug Lipitor. It said he could go to a retail drugstore such as CVS and buy a 30-day supply for $37.62.

Or he could order a 90-day supply from Aetna's own mail-order pharmacy for $400.86.

Huh? The mail-order option was nearly four times as expensive as the retail alternative.

Making things even stranger, Aetna outsources its drug transactions to CVS Caremark, which means CVS is the one negotiating prices with pharmacies on Aetna's behalf.

CVS couldn't get a better deal for Aetna's customers than it could for its own?

"It makes no sense," Zoldos told me. "So I thought I was entitled to an explanation."

Good luck with that. Zoldos said he tried calling Aetna but couldn't reach anyone at the company's call center who could address his question.

So he sent in multiple written queries via the insurer's website. This also got him nowhere.

"It was ridiculous," Zoldos said. "I just couldn't get a straight answer."

Ridiculous, perhaps, but also business as usual. When it comes to healthcare pricing, the standard response from insurers, hospitals and drug makers is typically no response. Consumers are routinely kept in the dark about the prices they pay compared with actual medical costs.

Anjie Coplin, an Aetna spokeswoman, blamed Zoldos' experience on "an error that occurred when implementing a pricing change that was not properly updated for a very limited set of products."

She said the insurer will review all claims involving the erroneous prices "and reimburse any members who were inadvertently overcharged."

Coplin declined to elaborate on the nature of the error or which drugs were given incorrect prices. She said the problem affected "only a small number of members" but declined to be more specific.

A CVS spokeswoman, Christine Cramer, said only that "we have identified a technical issue and are working closely with Aetna to fix it."

The episode highlights how difficult it can be for consumers to know whether they're being charged a fair or even reasonable price for prescription drugs. It also shows that if you take the initiative, as Zoldos did, in trying to get answers, you can quickly find yourself being stonewalled.

Clearly, though, other Aetna policyholders using the company's mail-order pharmacy owe Zoldos a debt of gratitude. If he hadn't spotted the strange prices and tried to do something about them, the insurer might never have stepped up with a pledge of reimbursements.

Chances are, it would have continued overcharging people.

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