What if We Treated our Prescription Drugs…Like Prescription Glasses in the US?

Photo taken by author

Let’s take an exploratory journey today on…how we get…prescription glasses here in the US. As I did that myself this week, (my prescription changed), I couldn’t stop thinking about how the process is similar, and yet distinct from how we obtain prescription drugs in the US. Parts of it are frankly…better to get Rx glasses than Rx drugs.

Could we learn something in pharmacy from the prescription glasses industry and process?

Let’s explore!

I’ll Be Seeing You: Prescription Glasses

So, I have a regular optometrist that I go to every year to get my eyes checked. I stare at a lot of screens, have some screen strain and dry eyes after about hour 10 of staring at them…and now have a hobby of trying to read astronomically small font on costume jewelry these days (even with the jeweler’s loop). SO….off to the eye doc I went this past week and shocker…my prescription changed.

I paid around $70 for the eye checkup and prescription using my HSA card. No prior authorization needed. No battling it out if my provider was in or out of network — none of those shenanigans.

Second, I never buy glasses where I get my eyes checked. Well, I tried once or twice, but every time it turned out to be a disaster, so I’ve vowed to shop elsewhere for my glasses. With my eye doctor, no problem! She hands me a PAPER PRESCRIPTION (hint: no funky electronic jazz or e-prescribing to deal with here), and off I go to explore the multitude of glasses options within the universe.

This time, I took it to a couple of places where I’ve bought glasses in the past — SEE and Warby Parker. Although SEE had some amazing frames as always (neon is back, BTW!) Warby Parker won the day and I bought 3 pairs of glasses for around $900. I used my HSA card(s) (drained one in the process and started in on a second HSA card) and they’ll be in around 2 weeks from now.

Best of all, there’s NO PBM or intermeddler here telling me that I need a prior authorization prior to buying my glasses from Warby Parker or I have to try another glasses company before I go to Warby Parker. I don’t have to deal with any red tape. There’s no battling it out with the insurance company, and if I WANT to buy the bougie high-end SEE neon glasses, that’s my choice, and my money.

Last — the optician helping me took a photo of my glasses and used my HSA card and measured my eyes — and then HANDED ME BACK MY PAPER PRESCRIPTION. I can take it anywhere else I like if I want for the year.

What if Prescription Drug Benefits Were Like This?

Here’s the part I pondered on the way home from my 15-minute experience at Warby Parker picking out my glasses: What if we treated prescription drugs like prescription glasses in the US? Like:

1. You get paper prescriptions from your doc for your maintenance medications when you go for your annual physical. (No e-prescribing toll booth fees driving up the cost of healthcare.)
2. You can take them to any pharmacy of your choosing.
3. You shop around and if you want bougie service, you can get it if you can pay for it with your HSA. If you don’t want bougie, you can go low cost style if you like and go to a discount pharmacy.
4. You can shop for the lowest price if you like.
5. You don’t have to worry about the pharmacy being in-network, or out-of-network, and you don’t have to worry about prior authorizations, step therapies, whether or not the drug is on formulary*, and/or trying and failing on other therapies before heading straight to the best medication your doctor wants you to use.
6. Your prescription is portable and on you to keep and use as and where you like.

But wait — What About Specialty Drugs?

First, I know I’m extremely lucky. I have an HSA account to actually PAY for these items. Second, I also know you smarter folks out there are already thinking ahead — what about specialty medications?

First off, I don’t really know what a ‘specialty medication’ is — no one can seem to define it for me — other than EXPENSIVE. If we use that definition, I’m not completely sure what that means to the average American either. Does expensive = $25 a month? $100 a month? $200? $300? $500? If we use the glasses analogy, and if the average American spends $300 on a pair of prescription glasses, that’s about $25 a month spread over a year.

Poll I’m running over at LinkedIn the week of 6/21/23 — let’s see what happens here.

Let’s say the cut-off is $100 a month on a prescription drug.

Hypothetically, if that’s the threshold, maybe employers could contract with specialty pharmacies directly to cover mail-order specialty drugs for their employees for anything above $100, and skip the PBM altogether. If smarter stop-loss insurers were out there, they’d offer self-funded employers the option of a policy rider for high-cost specialty drugs as well in addition to the stop loss on medical.

However, everything under $100 a month would be on you and your HSA card. That forces all of us to get really savvy really quick and shop around for the best price on our prescription drugs.

I’m sure there are employers out there that offer amazing $0 cost to the employee 100% covered vision insurance. But I haven’t worked for one of those companies for my entire career. I’m guessing I’m not alone either.

The bottom line:

• Maybe consumerism under a certain $ threshold for prescription drugs in the US with employer-based healthcare insurance isn’t a terrible idea. We all need to start pinching pennies. Otherwise, we’re heading into a brick wall while driving at night — without our prescription glasses on….
• I think smart stop-loss insurers out there might team up with medical plans and start cutting out the PBMs on lower-cost drugs where spread can happen and PBMs can make $ and shaft the employers and employees. (Although most medical plans have vertically-integrated PBMs too. Insert analogy here as to why I don’t buy my glasses at my optometrist’s office…)
• Maybe let’s try more consumerism at lower-cost drugs and create a threshold where some type of prescription benefits kick in after a certain threshold (yes, I get that this could be an HDHP, but do a carve-out exception for prescription drugs above a certain amount regardless of whether or not the employee has met their deductible or not.
• We all have to start paying attention to saving $$$ when it comes to our Rx drugs — if we just keep on handing over our prescription benefit cards at the pharmacy counter, we play right into the system of making the big vertically integrated healthcare insurers more profitable. Not really helpful for anyone, except the big vertically integrated healthcare insurers.

This was an interesting comparison. And one worth writing about.

We need to look at options for our future in the US, because frankly, the current system is broken.

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Erin L. Albert is a pharmacist, attorney, and VP of Pharmacy Relations at Mark Cuban Cost Plus Drug Company, PBC. However, the opinions above are hers alone. An option for Americans without insurance or tired of insurance games is two-fold with MCCPDC: 1. www.costplusdrugs.com and 2. www.teamcubancard.com.

*Note: Neither costplusdrugs.com nor teamcubancard.com has a “drug formulary.” Drug formularies are a menu of drugs put together through clinical pharmacy and therapeutics committee members after review of clinical data and economic data as well. Some drugs may be included and excluded from a drug formulary after clinical reviews. We at Cost Plus Drugs will sell any FDA-approved A-rated drug that would be sold to us. We only have a drug list…no drug formulary, and no drug tiers.