Question the price of drugs and medical procedures

Hypertension was the trigger that forced medical cost awareness to the forefront. My doctor decided that with my rise in blood pressure it would be prudent to prescribe a blood pressure medication and order a nuclear stress test. With only a catastrophic insurance policy and a $5000 deductible it was imperative for my financial health to know the cost of both the drugs and the procedure up front.

The prescription was the first thing we faced. The script for Lotrel was written and a trip to the pharmacy revealed an out of pocket cost of $200 for a thirty day supply. This was way beyond my means especially factoring in that this drug would most likely be required indefinitely. Relating this information to the doctor resulted in a prescription for the generic Norvasc and the pharmacy cost was to be $138 for 30 days. Still beyond household finances. I then began to research Lotrel and Norvasc and discovered that they are two old blood pressure medicines, amlodipine besylate and benazepril hydrochloride. I requested that my doctor write the script for these two separate drugs and I now take them daily at a cost of $7 for a thirty day supply of both drugs.

Having successfully challenged the cost of prescriptions my eyes were wide open as I began the quest for a nuclear stress test. My doctor, fully aware that I would be a self-pay referred me to a colleague in our area. A phone call began with introductions, but then I quickly explained I would be a self-pay patient and needed to know the cost of the procedure beforehand. The doctor was unable to immediately provide a cost and after checking with staff requested $2500. I reminded him that I was paying out of pocket. He replied that it could be done for $1900.

I told the doctor that I wanted to be sure I understood. I asked, “if I walked in with a check for that amount I would walk out with the test results?” The physician responded that I would need to come in for a consultation first. Cost $250. I asked again, “if I walked in with $2150 would I walk out with the test results?” Again the reply was that there would have to be a follow up visit to review the results. Cost $250. Hesitation must have been detected in my voice or the doctor detected a possible mark, because the doctor then said that perhaps I didn’t need a nuclear stress test and a regular stress test would suffice. Cost $800.

Consultation and follow up not included. I then asked what would occur if the regular stress test revealed nothing. His response was that we would do the nuclear stress test to be sure. The inverse was also true; if the regular stress test revealed any anomaly then a nuclear stress test would be ordered to provide further information. Total cost out of pocket would be $3450.

Feeling much like a cow on a milking machine I began to test the theory that medical procedures should be available as a commodity. Using the Internet to begin my search, the only specific criteria required was that the location of the facility performing the test be within a short drive from home. It took very little time to find and confirm a company that would provide a nuclear stress test sans consultation, and would willingly and promptly forward the results to my primary care physician. To verify that all was understood I informed them that I would have a check for the exact amount they quoted and no further remuneration would be forthcoming. All was as stated and the procedure was done. Total cost was $938.11.

While these two episodes have been the only challenges faced so far, having related these stories to friends and family, they also have begun to challenge costs and procedures with very similar savings.

It will be several years before Medicare is available to me and until that time I intend to challenge every prescription or procedure as to necessity and cost.

Court Nederveld is a patient.

This story was one of the winners of the Costs of Care 2011 healthcare essay contest, with the goal of expanding the national discourse on the role of doctors, nurses, and other care providers in controlling healthcare costs. These stories from care providers and patients across the nation illustrate everyday opportunities to curb unnecessary and even harmful health care spending on a grassroots level.

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Comments

bruce fryer
You can get a 30%-50% discount by paying cash. However it is important to get it in writing. I paid in cash with a written receipt and the billing department sent me a dunning notice. Because I had it in writing I was able to prevail.
James Purdy
I’ve gotten a much better system — I’ve almost entirely quit going to doctors. Most conditions seem to caused by lifestyle, and they usually can be corrected by lifestyle changes. No consultations, tests, surgeries or drugs required.
http://www.facebook.com/habeansha Jacob Blair
part of this story doesn’t make sense. Generic norvasc doesn’t cost that much.
Anonymous
Where else does a consumer go where the price of a drug or a procedure is not discussed? Do you buy a home or a car and never ask, “How much?” Do you take your car to a mechanic and not ask, “How much?” Every time I ask my primary care doctor (PCP), “How much?”, he always responds with, “Why do you care? You have insurance, don’t you?” That’s the mentality we must change. Doctors always bill insurance for the highest amount. Always! It will not change this practice until consumers begin shopping around for the best value. If insurance companies have any value whatsoever, it would be to weed out the shyster doctors that are always bilking the system. My PCP will always opt to prescribe a brand name drug over the available generic. When I ask him, “Why?” He always says, “I’m the doctor. I know better than you! Just shut up and go along.” Meanwhile, when I’m leaving, I see three pharma sales reps sitting in the waiting room for their turn to see the doctor. Something stinks really bad!
Anonymous
Court, we need you on a gov’t steering committe!! Keep going with it!!!
Brian
Even more important than the question of “how much does it cost” is the question of “Do I need this?” Hypertension isn’t an indication for a stress test or an echo. The next time, you should ask “what condition is this test for?”, “what is my pre-test probability of having the condition you are testing for?”, and “how will a positive or negative result affect my treatment?”
Anonymous
Find a new doctor. The one you’ve got is a loser.

http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem
^^ – what southerndoc said – ^^
Recall the argument against HSA’s was that individuals are not smart enough to make these decisions.
People have a tendency to get real smart when it’s their own money.
Unfortunately, the changes contemplated in “obamacare” will go a long way toward killing off HSA’s. The one healthcare payment reform with six-plus years of proven success.

http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V
Not smart enough to ask if a test is necessary. I agree with southernoc1 — this doctor not only ordered a test which is likely not necessary, but did it even knowing that the lady cannot afford it.

Chris OhMD
This is a great article – the main problem with healthcare is the complete lack of price transparency. Doctors who order test do not know how much they cost and patients have no idea how much they are will be billed until months later when they receive a bill. In all other industry price is transparent – I can sit in front of a PC and look for the best deal to Miami – same should apply to healthcare – it’s just another commodity. As a PCP I find myself more and more involved in trying to find the best “deals” for test and drugs because I see my patients paying uncessarily – in the past week I’ve converted several pts from diovan to cozaar which is 10 X cheaper.
http://www.bryantsstatisticalconsulting.com Donald Tex Bryant
I believe that more docs will go to cash only service. Seems to be an emerging trend. Perhaps you can find one in your area that you like and trust. Until Medicare, you will probably find such a physician service easier to navigate.
Anonymous
I feel I can speak from both sides here. I am the director of a medical practice but also the daughter of a non-citizen (albeit a legal resident) 85 year old who pays cash every time we visit a physician. I think the one thing patients tend to forget is that physicians are NOT business men. They went to school for 12 years to save lives not to work out the cheapest drug on the market for the 20+ patients they see each day. That is for each individual to determine with their insurance company or, if paying cash, to look up on the internet as did the author.
In general, despite current beliefs, doctors do NOT prescribe drugs because they like the drug representative or they get something for it. In the past that was the case and, as with every else in life, the minority abused it and everyone suffered. In our practice, the drug representatives come in to “detail” the physicians on their drug, complete with recent studies showing efficacy, side effects and comparisons to other drugs on the market. There have been too many instances to count where a patient has been stablized on a brand name drug, changed to generic because of the cost and their numbers become out of whack again. However, many of the drug companies now have cards where you can get the drug for the same cost or less than generic drugs and that is something you should ask your doctor about.
Please also remember that many of the pharmacies have agreements with the generic manufacturers whereby THEY are paid a certain amount for dispensing a generic rather than a name brand drug and that some of the pharmacies have some kind of ownership or partnership with the generic manufacturer. That’s why they immediately fill with a generic unless the doctor ticks the box that says no generic and never mention that with the card, the name brand drug can cost the same or less with the coupons and/or cards.
That said, as someone who pays for her mother’s doctor visits and procedures, I quite agree with the author, and others who have commented, that you need to do your research and ask for a cash price. If you are told by the person at the reception desk there is no such thing, then ask to speak to the office manager or the physician. The same applies for imaging and other tests. Brian is correct in that when push comes to shove, people become amazingly smart when it comes to their own money.
http://twitter.com/ddwebster Dana Webster
My husband calls me his million dollar baby. I very likely am at this point having battled cancer twice in the past 3 years (including an 18 day hospital stay for a stem cell transplant 6 months ago). We’re fortunate to have had excellent insurance to cover the majority of our costs.
In addition to being a seasoned patient, I’m also work in the pharmaceutical industry and have been privy to more information about drug costs than the average consumer.
One thing that needs to be added here is that pharmacies, like any retailer, can price a medication at whatever price they wish. The average consumer usually doesn’t think to shop around for different costs to prescription medications, but there can be a big variance from one pharmacy to another. Much depends on their distributors, your location, etc. If you have the means to call around or stop into different pharmacies (don’t forget local mom/pop pharmacies as well as local/national chains), you may find it benefits you tremendously.
http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V
Actually, my question would’ve been the one Brian mentioned – is the stress test necessary? May have saved me these $938 that you paid as well as all the stress worrying about money and the result. Surely this extra stress wasn’t good for your blood pressure. Not to mention that stress test has false positives, so this $938 may have lead to more expensive as well tests that also have risks.
Zachary Westbrook
I think the one thought that’s missing here is why the prices are so high for patients with insurance: If a physician accepts Medicare, he is more or less LEGALLY (I stress this, because private insurers don’t have that leverage) bound to give Medicare his best price (which Medicare sets). He could definitely afford to give a cash patient a better deal 99% of the time, but legally is prevented from doing so. Insurance related prices have to be inflated of actual procedural costs to cover all the additional time, effort, and expense that the physician or his staff has to put into doing the required paperwork (Medicare being the worst of all and requiring mountains of paperwork and ongoing documentation); whereas, cash patients do not require much additional paperwork beyond the order form for a test or a pad Rx. The only really good way to find a good deal as a cash patient is to find either a cash only physician/testing facility or at least find one that doesn’t accept Medicare.

Question the price of drugs and medical procedures

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