What Patients Need to Know at the Pharmacy Counter — Daily Rise: Wednesday, February 17

What Patients Need to Know at the Pharmacy Counter

Are you being gouged at the pharmacy counter? That’s the question Jay Olstad and Steven Eckert are asking in their KARE 11 investigation after a Minnesota man was hit with an exorbitant bill for kidney medication.

“When Curt originally went to the CVS pharmacy in Maple Grove last Spring, the initial 30-day supply cost about $.87 per pill. But when he followed his insurance company’s advice and ordered a 90-day supply through the mail, CVS Caremark increased the price to more than $6 a pill.”

The piece is worth watching. It offers a great reminder that patients must protect ourselves at the pharmacy and that there are many factors and entities that affect the retail price of a drug. The price is not the price.

One question all patients should ask: How much will this drug cost if I pay cash?

#FailFirstFeb: Beware Double Speak

This month, we’re joining the millions of patients fighting the devastating policies of insurance companies that enforce “fail first” policies.

ManagedCareMag has yet another “drug prices are too high” piece that endorses the “fail first” mentality. The piece suggests three solutions to high drug prices proposed by the Hutchinson Institute for Cancer Outcomes Research, “Insurers need the ability to withhold products from formularies if drug prices do not represent good value.”

“Withhold products from formularies”… That’s code for patients won’t get life-saving treatments. Doublespeak, euphemisms and intentionally unclear language, such as “step therapy,” exclude patients from the health care debate.

Here’s an idea:  How about three solutions each for payers, providers, regulators and innovators?

The New Black: Transparency

State Rep. Joann Ginal, D-Fort Collins, writes in the Denver Post on her new legislation for drug pricing transparency.

Colorado House Bill 1102 would require “each pharmaceutical manufacturer of a drug that is priced at or above $50,000 per course of treatment or per year to provide a one-time report to the Colorado Commission on Affordable Health Care on the cost of producing that drug.”

To her credit, Rep. Ginal doesn’t vilify the drug industry. “Prescription drugs play an essential role in preventing, managing and curing diseases,” she writes. However, the measure takes a narrow view of transparency.

The Players

Your Pharmacy:  Our opening story tells you all you need to know. We know it sounds like a line from a Dr. Seuss book, but really —  “The price is not the price.”

Your Hospital:  Hospital costs represent the largest segment of healthcare spending, they too have some ‘splainin’ to do. Should every state have their hospital Chargemasters online like they do in California?  From what we can gather in this New York Times piece written by Elisabeth Rosenthal just over two years ago, it does not appear to matter much for the bottom line.

Your Insurance: Are insurers actually, as Michael Hiltzik writes in today’s Los Angeles Times, “Making a mint from Obamacare?’

Are you dizzy yet?  We are. And we stopped before we got to regulatory reform.

Bottom Line: “It’s your money or your life” can quickly become a true statement for a patient holding inadequate coverage and faced with a life-threatening illness. If you find yourself unable to access the care you need because of insurance issues or other cost related problems our first recommendation is the Patient Advocate Foundation.

…Your Ever-Growing Premium Increase

Speaking of rising prices, the Congressional Budget Office released a new report that projects employer health care premiums will increase by 5 percent every year for the next decade.

Morning Consult’s Mary Ellen McIntire has the scoop:

“Between 2005 and 2014, employer-based insurance premiums rose 48 percent for single coverage and 55 percent for family coverage, they say. ‘CBO and JCT expect them to grow at similar rates over the next decade—by about 5 percent per year, on average, or about 2 percentage points faster than income per capita,’ CBO says.”

On Our Bookshelf

We’re enjoying virologist and philanthropist Jan Vilcek’s newly-released book, “Love and Science: A Memoir.”

Born in Czechoslovakia, the New York University research professor was “instrumental in the development of the anti-inflammatory drug Remicade®, the first member of a new class of therapeutics called TNF blockers that are now widely used for the treatment of Crohn’s disease.”

For those who don’t have time to enjoy the entire book, Marian Turner has a great review over at Nature. Among the great ancedotes and lessons from Vilcek’s life is his ongoing investment in charitable endeavors and research from his royalty payments — “projected to eventually reach more than US$105 million.”

“At first, Jan and Marica ate at restaurants and caught taxis more often; they helped family and friends, and replaced their second-hand furniture with European art-deco pieces. But they had no interest in luxury living, so as the royalties grew, they established what would become the Vilcek Foundation in 2000.” 

Vilcek’s ongoing philanthropy is a great reminder that “profits” are often reinvested in our community.

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