CASEY: His copay for a generic medicine rose from $21 in May to $600 in August

It's hard to blame Bruce Brown for feeling frustrated these days. Especially when you hear the Christiansburg resident's saga of trying to refill a recent prescription for a generic medication Brown's been taking for decades.

The medicine is ciclopirox. According to the National Institutes of Health, it's an anti-fungal drug that's been around since the early 1980s. The topical solution comes in 60-milliliter bottles and is available as a generic.

Brown, 73, a retired college professor and former two-term Radford mayor, said he's been using it for 40 years, to treat a stubborn and recurring yeast infection in his skin.

One 60-ml bottle lasts Brown nine days; thus, he needs 10 bottles for a 90-day supply, he told me. He last filled the prescription in May at Christiansburg Pharmacy.

At that time Brown paid a $21 copay, under a state-retiree Medicare Part D supplemental plan administered by Express Scripts.

But now, Express Scripts is telling Brown the copay for his ciclopirox should instead be $600 every 90 days, a nearly 30-fold increase. And in trying to explain why, Express Scripts has served up an ever-changing series of justifications to Brown and/or his doctor or pharmacist.

Brown believes he's being gouged. He noted that Express Scripts was among three pharmacy benefit managers recently accused by the U.S. Federal Trade Commission of anticompetitive and unfair rebating practices that artificially inflated drug prices to diabetic patients.

(Express Scripts subsequently sued the FTC, alleging its report related to the agency's lawsuit was "seventy-four pages of unsupported innuendo" that defamed the company.)

Brown first realized he had a problem in mid-August, when he returned to Christiansburg Pharmacy for another 90-day refill of ciclopirox. At that time, the pharmacist told Brown he needed a fresh prescription, because the prior one was more than a year old.

Brown said he got a new prescription from Dr. Daniel Hurd, his longtime dermatologist — the same doctor who's been prescribing him ciclopirox for decades. By then it was late August.

That's when Express Scripts informed Brown his cost for a 90-day prescription would be $600. In justifying that out-of-pocket cost, the company claimed Hurd's office had filled out a questionnaire with Express Scripts indicating ciclopirox was a "compound" medicine.

(Brown said he hasn't seen that questionnaire; but that's what Express Scripts told him.)

Compound medicines are custom-prepared by a pharmacist, and Medicare Part D doesn't cover them, Brown said. But ciclopirox is not a compound medicine. It never has been.

"So Hurd's office sent a letter to Express Scripts saying it's not a compound, it's a formulary, and I've been prescribed it for 40 f—ing years," Brown told me.

Roughly 10 days later, Express Scripts denied Brown coverage for a different reason, Brown said.

On that occasion, Express Scripts said the dosage indicated on Hurd's prescription — 10 60-ml bottles over a 30-day period — was far above the normal recommended dosage for that drug.

That was a mistake by the dermatologist's office, Brown said.

The prescription should have read 10 bottles over a 90-day period, rather than over 30 days. Hurd's office later notified Express Scripts of the correction, Brown said.

"Ten days later, I get denied again, not because of the quantity (of ciclopirox)," Brown said. "This time, a doctor at Express Scripts who has never seen or treated me decided that Dr. Hurd's been wrongly prescribing (ciclopirox) all these years."

Brown is currently appealing that decision.

He called me and described this saga last week. I got involved on his behalf beginning Tuesday morning, when I sent an email to a public relations company for Express Scripts.

Late Tuesday, I got a reply from Justine Sessions, who works for a different company called Evernorth. Like Express Scripts, it's a subsidiary of Cigna, the giant health insurer.

"We'll look into Mr. Brown's case but since we only received your inquiry a few minutes ago, I don't know if we'll be able to get back to you by noon (Wednesday)," Sessions wrote Tuesday night. "Will do our best!"

I responded and extended the deadline by three hours, to 3 p.m. Wednesday.

"It should be simple to learn why Bruce Brown's Express Script copay for a generic medicine rose from $21 to $600 suddenly," I added. But she had no more relevant information by then.

I also sent a similar inquiry Tuesday to Allison Evans, director of customer service at Express Scripts. Her reply email appeared automated.

"It would be my pleasure to help," the reply said. "I have forwarded your issue to my supervisor for review. Please allow time to review and research your concerns. You can expect to hear from Express Scripts within the next 3-5 days."

Then Tuesday afternoon, Brown got a call from a woman at Express Scripts whose first name was "Hilda."

He didn't get her last name, but said Hilda identified yet another issue with Brown's decades-old diagnosis and prescription of ciclopirox. This time, the excuse was something Brown hadn't heard before.

Hilda told Brown his dermatologist needed to write a detailed letter to Express Scripts that specifies the Latin name of the yeast strain for which Hurd is treating Brown.

"Hilda said if the doctor just writes that letter, I'll be covered," Brown told me.

He remains skeptical because Hurd has already written two letters, Brown said. The only things that resulted from those were two additional Express Scripts' justifications for denying coverage of his ciclopirox.

Also, the doctor's assistant spent hours on the phone with Express Scripts, trying to straighten out the prescription boondoggle, without success.

But Brown says he will give it a try. Hilda also informed him what would happen if the latest appeal gets rejected by Express Scripts — like the other ones have been.

In that case, Brown can pay $189 to appeal to an administrative law judge who works for a third-party, Hilda told him.

Seems like a heck of a thing to have to go through, to persuade your health insurer to cover a medicine that it's already been covering for years.

"This is what health care's like in the United States in 2024," Brown said. "It's not getting better."

Hard to disagree, eh?

Dan Casey (540) 981-3423