Just thought I’d bellyache about our current approach to health care. For any policy makers advocating a market based solution to our health care problems, I suggest that job one is transparent pricing. Without that, any signals from the market place are going to be about useless.
The reason I bring that up is that today Amy went about getting a prescription filled on some heavy duty skin cream for Harper. Our normal pharmacy quoted us a price that was wildly inflated from the price that had been quoted two weeks ago at the same pharmacy. At a second pharmacy, the price was somewhere between the two. She asked a few different people for an explanation on the pricing. All they could do was mumble about “the computer” and “insurance.”
So, if I find myself suffering from a sucking chest wound, I’m going to have to do my comparison shopping in a hurry. I’m going to want apples-to-apples comparisons.
Or, you know, we could go about planning health care policy with a recognition that “the market” is a difficult fit for delivering health care services in some respects.
Can transparent pricing happen while insurance does have such a heavy hand in the proceedings? Insurance decides what it will pay for, and what it won’t. Insurance decides how much it will pay, and providers and pharmacies run that cost straight up to that line. This isn’t true in the market for other goods or services.
Maybe the market might be exactly what, er, the doctor ordered. *cough* With consumers paying the freight, and therefore examining costs and making decisions with cost in mind, prices might actually go down as people decide to look into other options, such as there might be.
Sure, the market is difficult in some respects- such as the need to comparison shop in a hurry, as you point out. But as we see, a general absence of comparison shopping in health care leads to an absence of restraint on costs- a problem if there ever was one.
Seems like a huge opportunity for a web based application.
I mean, if a web site can keep track of E85 prices…
Here is another idea for helping the market: make more medications over-the-counter. I LOVE that Claritin and Prilosec are OTC. More medications need to be OTC. Pretty much any medication that is relatively safe should be OTC.
It was actually three pharmacies, because the first time I was in Indy. I almost felt like trying a fourth to see if I could get it better.
What kind of insurance do you have?
Our Board of Pensions plan uses Express Scripts for the pharmaceutical coverage.
I have a few different options:
If it is a medicine a family member is on for chronic illness, I can get a 90 day supply through mail-order paying the price I would for a 60 day supply at a store pharmacy. Unfortunately I can’t do this with my son’s ritalin b/c it is a controlled substance and the doctor won’t give us any more than a two month prescription at a time. And we have to drive quite a distance to pick up the script in person-she’s not allowed/or won’t fax it into the pharmacy.
With a pharmacy, prices are broken down into three different tiers: generics are an $8 co-pay, next tier is a $31 co-pay, and the final tier is a $62 co-pay for a month’s supply (or less-if it’s an antibiotic, etc.)
My co-pay is always the same regardless of if I go to Walgreens, Meijer, Walmart, CVS, or Target (although Target does save us $4 on my son’s 5 mg generic ritalin.)
Now here’s the part that kills me: Walgreen’s always prints on their receipt that insurance saved you $xxx. So I know what the “going price” is for the medicine (although it could be “going price” after an insurance adjustment-the receipt doesn’t tell me that!) Okay, I’ve had times where I’ve bought a generic for my $8 co-pay and seen the insurance has saved me $250. Then I’ve bought medicine at the next level and had insurance save me $53. Then I’ve bought at the highest co-pay and had insurance save me $7.56. I just don’t understand that part of the pricing!
I mean here’s one price thing I never understood-when my wife was pregnant with our twins, she had horrible morning sickness. So her doc put her on Zofran, which is an anti-nausea med they give to chemo patients. It was soooo expensive, the insurance company would only give us a ten day supply at a time. Our out of pocket every ten days-in the $25 range (this was four years ago and all our co-pays were less.) The insurance company’s tab? Well over $1,000 each ten days. Why weren’t we paying the highest co-pay?
Oh yeah, and the final insurance complaint-I’ve been on a med for two years now. Went to fill it at Walgreen’s a couple of weeks ago. Came back a few hours later and they said the insurance company needed “preauthorization” from the doctor. Mind you I’ve been at the same dose for well over a year and at the same doc for over two years. I asked if I could get an emergency dose b/c I was out of medicine. They told me if I wanted to pay the full $171 and get reimbursed by my insurance company, then yes. I ended up without medicine for a week. Should have been smart and did like my wife just did. The insurance company is pulling the same trick on her-so she called her doctor and he gave her two weeks worth of samples. Guess the person who does insurance reviews is on vacation-and her file won’t be reviewed until next Thursday.
Rev–
Do that ten times/day, sometimes a lot more, and you’ll have a good idea of what my days are like.
Zofran is frickin’ expensive. I remember we would chip in twenty out of our own pockets to buy a tablet to try to avoid admitting uninsured pregnant women with nausea.
It’s not all bad news. Some meds are relatively expensive, but it varies by plan because those plans negotiate for lower prices. The problem is that you are unlikely to find a plan that negotiated for all of the particular versions of the meds you are accustomed to being on. Sometimes a cheaper substitution will work. A big problem with Medicare Part D is that the negotiations to reduce drug prices aren’t allowed. That’s ok, though, because we’re once again in an emergency 10 day stay of the decision to cut my medicare pay by 10.6%. Every few months they announce a 10% pay cut to providers. But reduced pay to the drug companies is off the table.
I also hear how an Obama administration will cut my pay. But the bill to cancel the 10.6% reduction in medicare reimbursement had 59 votes in the Senate, and was blocked by nine Republicans at the urging of the President.
Yeah, we called the stuff “white gold.” And she was on it for a good three months-and it only worked 1/2 to 3/4 of the time. But without it she would have been non-functional all the time.
Don’t envy you that part of your job. You’ll notice my complaint was against the insurance company and not my doctor.