Debora T. had a blood pressure of 180/110 during her routine visit in my internal medicine clinic. She was already on every blood pressure medication I could think of, save one — amlodipine. I prescribed the medicine and asked her to follow up in a week. I feared her blood pressure was going to cause a stroke if it went up any higher.
At our next visit, her blood pressure was unchanged. She had not bought the medication. Unfortunately, the pharmacy she happened to shop at was charging $100 for this generic prescription — and “my family just can’t afford that right now”.
Kmart charges $5 a month for amlodipine, if you buy it in a 90-day supply.
Joan K. found a lump on her chest wall. I sent her for an X-ray. The radiologist reported, “a shadow that might be lymphoma.” He recommended an MRI to better evaluate. Joan had insurance — but with a very high deductible. She called the MRI center I had referred her to (a major academic institution in Chicago) and discovered it would cost her over $3000, out of pocket, for this test. Joan spent many sleepless nights worrying about whether or not she had a potentially terminal illness — and whether or not she could afford to find out.
A local, free-standing American College of Radiology-accredited MRI center charges as little as $350 for a non-contrast MRI.
Carmen R. lost her job in real estate. She was in her early 60’s — still too young to get Medicare insurance coverage. Her prospects of getting another job, at her age, in a down-spiraling real estate market, were grim. She knew it was time for a mammogram but she decided that perhaps this year, she would skip it, since she was not sure when or if she would be getting another paycheck. The place she normally went for her exam charged about $400. She told her daughter about her decision not to get a mammogram.
A local hospital offers screening mammograms for $67.
All three of the above cases illustrate how the lack of pricing transparency in healthcare is dangerous and can cause serious morbidity. The first two cases are actual patients from my practice in Chicago. The last case, Carmen R, is my mother.
Inspired by all of them, I developed a free community service website called LesliesList.org that spotlights and compares medicine and diagnostic testing prices. These cases also illustrate that, as docs, we MUST ask our patients if they can afford the medicines and testing that we are prescribing. And we must help them find a way to afford them, or find an alternative, if at all possible.
The good news is, our LesliesList data show that many drugs and tests that seem unaffordable at first glance can often be found for dramatically cheaper prices. And with more price transparency in the healthcare market, as in any market, this should eventually lead to lower prices overall.
Maybe then more of our patients will actually fill their prescriptions and get the testing we recommend for them — because they’ll know they can afford it.
Leslie Ramirez is an internal medicine physician and founder of Leslie’s List, which provides information that enables all patients, but especially the uninsured and underinsured, to find more affordable medications and health care services.
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