THCB

Hidden Medication Costs

Always covered by an employer health plan, I had never given a thought to prescription costs – my medications had been covered by moderate copays. This changed when I retired and enrolled in Medicare (and a Medicare Part D plan).

Just prior to retirement, my eyes suddenly began tear and swell so much that it impacted my vision. The eye doctor diagnosed an allergic reaction and prescribed prednisone drops to reduce the swelling and antihistamine drops to combat the reaction. The antihistamine drops required pre-approval by my employer’s PBM, which was granted. Per my employer plan I paid a relatively small copay for each prescription.

Three weeks later, on a follow-up visit, the doctor recommended that I continue the antihistamine drops for the duration of the allergy season. But I was running out and had to refill the prescription. Now I was on Medicare so I checked the cost of the drops on the website of my Part D provider. It was $279. Could this be?? Oh indeed it could — and I had a high deductible and would have to pay all of it!! Of course, if I continued to need the drops, the plan would eventually assume more of the expense – but even then the cost would be high – to the plan, even though not as much would come from my own pocket.I was somewhat puzzled. I did not have an exotic illness requiring a specialized drug and it seemed that there should be a less expensive alternative. After a conversation with my doctor, it turned out that there were, in fact, two reasonable options: one a prescription which was ½ the price of the current prescription; the other a medication that had previously been script-only, but was now available OTC – the cost for this was $14.79. He suggested that I experiment with the alternatives to see if they were as effective as the current drops. Fortunately, the $14.79 version was just fine. Of course, it might not have been, but it was. But had I not asked, it would not have been offered. And had I not had a plan that exposed the cost of the expensive prescription, I would not have asked.

A few weeks later, I had a similar experience while visiting my 92 year old mother. In response to a complaint about stomach pain, her doctor had prescribed an extremely costly medication. She was required to pay $80 for the first prescription and then $184 when she tried to renew it. She decided that it hadn’t really helped much anyway and decided not to renew. But I realized that had the cost not been so high, she would have ordered it.

These two experiences led me to wonder about the impact of “hiding” medication costs from patients (as my employer plan had essentially done), and of doctors not being sensitive to cost issues until prodded by patients. Of course, sometimes the more expensive drug might well be necessary – but surely there must be many instances in which money could be saved by balancing therapeutic need and cost.

Costs of Care (Twitter: @CostsOfCare), where this post was originally published, is a Boston-based nonprofit organization that collects anecdotes from doctors and patients. We feel these stories are poignant because they put a face on some of the known shortcomings of our system, and also because they unveil how commonplace and pervasive these types of stories happen.

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Local Gabehow much does a prescription costyvonne BehrensSchumacher GroupMary Pat Whaley, FACMPE Recent comment authors
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yvonne behrens
Guest

In response to Christopher Stines’s comment “Anthistamines are really necessary if you have perenial rhinitis and urticaria.” According to http://www.wisegeek.com/what-is-perennial-rhinitis.htm, “instead of only prescribing antihistamine or steroid treatment, some doctors recommend people undergo allergy testing to determine what substances are resulting in perennial rhinitis. It is true that the most common allergies that cause this condition are to things like pets or dust mites, but there could be other causes. Exposure to certain identified allergens might be partially or totally eliminated rendering use of daily medication unnecessary. This possibility suggests it may make good sense to try to determine cause… Read more »

Local Gabe
Guest

Not only the hidden medication cost for the what about the hidden charges on the insurance planes. We recently had to hay about $3,100 in deductibles and extras for our child appendicitis.

how much does a prescription cost
Guest

Hello,

Thank you four nice writing. It will help me for my research on prescription medications.

yvonne Behrens
Guest

The original writer has hit a bullseye. Whatever the reason, the pharmaceuticals, the insurance companies, and the doctors seem to all be in this together. There is no need for this kind of expense and most people do not know about the expenses because we are only paying out of pocket so much (while paying premiums to the insurance company). Following is a very interesting article on how Vermont tried to change this Triage and how they were fought: Posted by Thomas Sullivan on June 27, 2011 at 05:05 AM in Medical Legal When filling prescriptions, pharmacies collect information including… Read more »

Schumacher Group
Guest

Great post. It’s become increasingly important for physicians to remain aware of the cost of medications with relation to the patients they are prescribing them to.

Mary Pat Whaley, FACMPE
Guest

It is a routine carried out many times a day, every day, in most practices across the country. The patient arrives at the pharmacy to find that their new prescription is not affordable. The pharmacy calls the practice and it involves a message, possibly a chart pull, and a physician’s time to change the prescription. Most EMRs can tell what is or isn’t on a payer’s formulary, but few if any can offer a physician options based on the cost to the patient. It’s a major disconnect that costs every practice time and money. Walgreens has partnered with Epocrates to… Read more »

John D
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John D

Medication can be very expensive, but there are often alternatives that can be cheaper. I decided to invest in some suppliments, and they have been brilliant. Free places online like questionmyhealth .com can give you a free profile of what items your body needs, and can help prevent serious deseases and illnesses. Definately worth a try before you end up spending loads on medication!

DeterminedMD
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DeterminedMD

I have no problem calling a pharmacist when the patient raises concerns with expenses and they are literally counting dollars to save. My issue is with those who have fairly decent insurance coverage that is turning down meds that are medically necessary and causing pts to lose time in beginning or maintaining use just because we are dealing with for profit entities that do not give a damn about the patient, just the CEO and the stock holders who need to maximize their dividend checks. And that is what this is about, insurers turning a profit. There are those who… Read more »

Joe
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Joe

I’m a pharmacist who works in a clinic setting. Makes it nice because the doctors can talk to us and we can speak with them about these therapeutic alternatives. While I would prefer it be done all electronically, we can discuss a patient’s situation and often recommend the most cost effective medication for a particular situation. While I sympathize with DeterminedMD, a discussion with the patient’s pharmacist can save a lot of problems down the road with cost issues or drug interactions. Maybe bump a few minutes from the drug reps and use this extra time to consult with us… Read more »

DeterminedMD
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DeterminedMD

how about the ongoing scam of albuterol, you had to buy ProAir at $40 an inhaler, so you can save the Ozone layer, because hey, all those inhalers out there are irradiating the planet, and now that we found out that is no big deal in the end, guess what Ventolin inhalers now cost after previously being 1/5 the cost? Yep, they are now just 4 dollars cheaper. And you wonder why pharma supported the bastard in the White House. Their money was well spent, and that is yet another reason to flip the bird at these bold faced liars… Read more »

Margaret Lawhead
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Margaret Lawhead

I had to buy 1.5 ml of Trazadone eyedrops when out of town at a CVS Pharmacy in Big Bear Lake, CA. They wanted $210.00 for the little bottle. Then, when I got home, my opthamologist looked up the real cost of the drops and it was a mere $50.00 per bottle.

I contacted CVS Pharmacy about it and the representative “sounded” very concerned, but never called back as she had promised…!!!

Dr. Mike
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Dr. Mike

Are you telling me that if you knew the price, you would object even though your co-pay was minimal? Really? The problem is not that costs are hidden (they are not, actually) but that you don’t personally feel the pain of the more expensive choice, for as soon as you did, your awareness of the cost changed the doctor’s behavior. There are those who argue that the physician must be responsible for choosing the lower cost options, but can you honestly say that patients will respect a physician who chooses for them based on cost when the cost is of… Read more »

DeterminedMD
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DeterminedMD

Amen!!! It is so true, how it is so easy to spend other peoples’ money, but when it comes to pulling out your own wallet, grab onto something as those brakes get hit hard!!! And besides, why should I answer to unknown faces and places in accepting their opinion I should write for something else first?! Maybe I know the patient has failed other meds first, that this lame-o insurance company didn’t have the chart in front of them to confirm it. If you agree to this kind of blatant interference, good luck defending that in a court of law.… Read more »

susan
Guest

Excellent example of taking the bull by the horns and asking questions to get a med you could afford that was as effective as the expensive one. Hopefully people reading this will better understand how crucial it is that we as patients do our part to tamp down the costs. I found this helpful in shaping my questions: http://tinyurl.com/4odprtz

Best whey Protein Powder
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Many thanks for revealing the important facts about Hidden Medication Costs.

MD as HELL
Guest
MD as HELL

The only reason those drops were so much is because there was insurance and not a price-consious consumer paying for it. You were fine with your co-pay. Now you are allpay.

If there was no insurance there would be no 279 dollar eyedrops. Same for everythin that is healthcare.

Get rid of third party payors and watch the prices melt for lack of demand (at present prices).

Med School Odyssey
Guest

Ah…but that is precisely the kind of protection that pharmaceutical and insurance companies pay for.

Dial Doctors
Guest

Unfortunately prices for medications are too high and doctors don’t always have a list readily available. I know many doctors prescribe a medication without knowing its actual cost. That’s perfectly ok because their brains need to be focused on medicine and not on prices.

It would be interesting to learn how much money goes into fixing ailments because patients choose to put aside prescriptions because of prices.