Amid an already devastating flu season, the story of a Texas teacher who, sick with the flu, skipped her prescription for Tamiflu (oseltamivir) because of a $116 copay, and subsequently died of the illness, has struck many as a tragedy that could have been avoided. It’s especially mystifying because of the high price of such an essential drug. How is it that such a life-saving medicine can be out of reach for so many people?
Heather Holland, a second-grade teacher in Fort Worth, Texas, decided not to fill her prescription for Tamiflu when she saw it would be $116. Her husband says they could have afforded the medication, but she refused to pay out of principle. Three days later, she died from flu-related complications.
It’s impossible to say whether Tamiflu would have saved her life – but the story has provoked alarm and outrage across the country.
It is indeed an outrage – and it only gets worse when you start digging into the pricing behind the story. In fact, prices for Tamiflu – and its equally effective generic form, oseltamivir, are all over the place, depending on where you pay and how you pay. People across the U.S. are reporting paying $90, $25, $106, $10, $200, or $9 – and that is with insurance. Without insurance, paying cash prices people are paying as much as $250 for a prescription for Tamiflu, or $135 for the generic version.
“I just paid $220 for my children’s flu medication (Tamiflu) – they are 6 and 4, not taking them isn’t optional, my daughter got Strain A, more serious one. And this is AFTER insurance coverage AND their state supp. insurance wouldn’t pay because it copay exceeded $100.”
— Johanna (@JohannaMarcia01) January 14, 2018
“The copay for my 7 year old to get tamiflu was $370 dollars. I’m fortunate to have the resources. Others don’t.”
— ♀♀ (@abirdabeeaplane) February 10, 2018
What is going on? Here are some facts that can help explain the chaos behind the tragedy.
Tamiflu comes in a generic version
Tamiflu is the brand-name for the drug oseltamivir and is manufactured by Roche pharmaceutical company. Roche sells its version of the drug for a premium price – typically for around $175 cash. But most people who are prescribed the drug will actually get a bottle of generic oseltamivir, which is made by several generic manufacturers. This version of the drug is much cheaper, about $135 for a 10 dose prescription. Whether you are paying with cash or your insurance, be sure you are getting this cheaper generic form of Tamiflu – it is exactly the same medicine and works just as well as the brand version.
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Tamiflu comes in 2 forms
Oseltamivir is typically prescribed to adults and most people 13 years or older in 75 mg capsules. But the drug also comes in a liquid form: Children under 13 can be prescribed the oral suspension, which is usually much more expensive than the capsule form – up to $350 for the brand version and around $250 for the generic version. The medicine also comes in a 30 mg and 40 mg capsule, which is sometimes prescribed to children instead of the liquid. Even though the dose is smaller for these smaller capsules, the prices are about the same as the 75 mg form.
Insurance often doesn’t give the lowest price
Even though oseltamivir is the medicine most people take when they are diagnosed with the flu, it is not always covered by health insurance plans. Often, it is put on a “low tier” formulary, meaning that the insurer will cover some – but not all – of the cost. Since there are hundreds of health plans and formularies in the U.S., this means that prices are all over the place. Often times people with insurance find that they are being asked to pay the full cash price of the drug (or even more baffling, sometimes even a higher price).
This is especially true when you factor in available discounts on the drug, such as those featured at GoodRx. Using a discount, prices drop to around $50 in many locations, with average discount prices nationwide at around $60. For many people, this is a lot less than what they would pay with insurance. There’s no catch, but to get the price you must 1) have the coupon and 2) tell your pharmacist you are not using your insurance.
GoodRx also has discounted prices for the brand version of Tamiflu – instead of $175, we have a price of around $140.
As to why prices vary so much from location to location? That’s because pharmacies and PBMs (the companies that actually supply the drug from the manufacturer) are constantly shifting prices around based on supply and demand. It can be terribly confusing but suffice to say that by using GoodRx you can be confident you are getting the lowest prices we can find.
Tamiflu is not the vaccine – and not a cure
Once somebody is diagnosed with the flu, there are very few medicines that actually work to fight the virus. Tamiflu is the most used of these – but even Tamiflu isn’t perfect. In fact, the research has been rather spotty in just how effective the drug is in reducing symptoms and speeding up recovery. Research does show, however, that the drug is most effective when it’s taken as early as possible (it also has some preventive properties, which is why it’s often prescribed to siblings when one child gets the flu).
And no, oseltamivir is not the flu vaccine and not a replacement for getting vaccinated. Even though there’s been doubt about how effective this year’s flu vaccine is, experts agree that it is the best available defense against illness, and reduces your chance of getting the flu by about ⅓. That should be reason alone to get vaccinated.