Barbara Cisek: Congress must take action on drug prices | TribLIVE.com
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Barbara Cisek: Congress must take action on drug prices

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Barbara Cisek testifies about drug prices before the State Senate in March.

When Sen. Bob Casey asked me to testify at a March 6 Senate hearing on big pharma and rising drug prices, I immediately thought about every senior citizen who has stood alongside me in line at the pharmacy, only to be forced to leave behind a needed medication because the price is too high. For many of us, our fixed incomes are just high enough to disqualify us for financial help from the state but still too low to absorb the mounting costs of prescription drugs.

I pay nearly $300 for a comprehensive Medicare Advantage plan through Highmark (Freedom Blue) and a Medicare Part B premium of $134, yet I still can’t count on affordable access to the life-saving medications I need to treat my slow-bleed stomach ulcers, diabetes and migraines. In fact, my plan has covered less and less each year.

My plan no longer covers either of the medications that were effective in reducing the severity of my migraines. I’ve paid $85 out of pocket for a 20-day supply; now $43 out of pocket for 27 pills of a generic brand. I spend $100 on a skin cream to treat rashes that insurance won’t cover. The inhaler I need for my chronic obstructive pulmonary disease (COPD) costs $150 per month.

My most crucial medication, Nexium, also happens to be my most expensive. Nexium keeps me alive, treating my slow-bleeding stomach ulcers, and costs $800 for a 90-day supply. Under my current plan, I pay $300 every three months. Other versions of the drug have made me sick, which means I also go through the step therapy process each year where my doctor is required to send a letter to my insurer confirming that I do in fact need the brand name drug because substitutes won’t work.

If you’re following along at home, the math racks up to over $1,000 per month for four medications and two Medicare plans. Of course, this price tag doesn’t account for other supplies I pay for like diabetic test strips and lancets, my oxygen tanks, my CPAP, an eye vitamin to prevent cataracts. … Nor does it account for the medications my doctor recommended that I couldn’t afford. Phenergan, recommended to help with my nausea, costs a whopping $1,032 and isn’t covered by my insurance.

Frankly, I’m starting to wonder what they do cover. I’m about to be priced out of seeing a trusted doctor soon as well.

Last November, I suffered a stroke and am preparing for a total shoulder replacement surgery in the coming months. But more insurance changes mean my orthopedic surgeon, a UPMC doctor who helped me recover from a fall and fractured foot, will be out of network beginning July 1 as the agreement between UPMC and Highmark is set to expire.

So, on top of the $1,000/month I’m spending on medications and insurance plans, I soon won’t be able to afford to stay with the doctor I already know and trust, which means I’ll have to begin the painstaking process of finding someone new right as I prepare for surgery.

I worked hard to be able to build a good life and future for myself and my family. My husband worked as an engineering aide in nuclear fuels for nearly 40 years. We’re retired now and want to be able to afford the home we’ve lived in for 45 years, but with my prescriptions costing more and more and my insurance covering less every year, I don’t know what we’ll have to do.

It’s time for Congress to take action and lower prices on prescriptions, especially for senior citizens living on fixed incomes who, like me, should be able to rely on affordable prescription drug coverage after paying so much for insurance.

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