medications-257370_640When I would get in the way of something going on at home, when I’d stand between my parents and interrupt their line of view when talking they would say, ” You make a better door than you do a window….even though you are a pane (play on words…..old-fashioned fun…!)

I thought of this funny little ditty when I was thinking about that lack of transparency in the costs of medical care.  The OPACITY of medical costs is meant to keep us from understanding what we are paying for and how much it truly costs, and this opacity works in favor of Big Pharma, the hospitals, and drugstore chains like Walgreens.

Here is an example:  I have a patient whose husband has early stages of Alzheimer’s and we are starting him on new memory medication.  So…I write a prescription for him for Aricept, the most common of the memory medication for this condition.  I write a script for the generic form at a low dose, 5mg.  Standard dose is 10mg but we are going to start lower, so that we can make sure he tolerates it.

She takes the prescription for generic Aricept to Walgreens and is told that the medication is not covered without pre-approval, and if she wants to pick it up today, 30 pills will cost her $500!  She is a bit flustered, and in her 80’s.  She does not question this and knows that she wants to begin the medication immediately for her husband so she pays the $500 and then calls me later to explain how expensive this medication was for him.   Now…I’m aghast because I know this medication is $30 for 30 pills at Costco, and cannot understand the discrepency, but that is where the opacity of the system and the lack of information causes such issues.

First….because we started on 5mg to make sure he could tolerate the medication, his pharmacy benefit would not cover the medication.  They only cover 10mg dosages as this is the ‘proven dose’ to be effective and they don’t want to cover ineffective dosing regimens.   That I understand, that their insurer wants to make sure it’s patients receive effective treatment, but rather than telling the patient we can change to 10mg pills and cut them in half, so that we have the proper dose, the pharmacist explains that the pill is not covered.  To add insult to injury, since it is not a covered medication they can charge virtually any price they choose….and they choose to make it $500!!!!!   Even though they know quite well that this pill is $30 cash for someone without insurance!!!  How galling…that this is not explained to the patient.

Now…I’m not blaming the pharmacist.  He is not Santa from Miracle on 34th Street who has to shop around town and inform everyone where the cheapest ‘toy’ can be purchased.  In fact, I’m sure he’d get fired if he told people how warped the entire system is.  He just tells them what he is supposed to and let’s the customer/patient decide what to do.

I can imagine such medical rip-offs are occurring day after day at chain pharmacies and in a myriad of other ways.  It proves the maxim CAVEAT EMPTOR…that we all heard in grade-school.  Sadly, this is the state of affairs in medicine these days, that patients need to become savvy consumers and hunt & peck for the best prices in all ways, to get the best value they can.  Yet…the opacity of the system and the charges involved is ‘baked’ into the system so that such comparison shopping is extremely hard and near impossible.

As Obama-care affects everyone’s insurances, it will become more important than ever to be a savvy shopper and get the best deal that is out there for you.  You can’t be too careful.