By Michael “Mike-the-Pharmacist” Ilardo RPh
Fraud, waste, and abuse is a big problem in health care. Someone ends up footing the bill. Sometimes patients won’t see it, sometimes they will. One example is the drug above –
A bottle of #100 costs our Pharmacy $2700.
$2700!!! We ordered it because a Doctor wrote for a brand name of that medication. Generics have to prove they work the same and most patients routinely take generic meds and never notice a difference.
A #1000 count bottle of Generic is around $30. That person is taking this three times a day, so $29,000 of brand or $30 of generic takes care of the patient for the year. And that is just one of the meds this person is on. Imagine the drain on the system if this person takes 5 BRAND name meds like this one.
Most insurances will rightly balk at paying for brand but often a Workman’s Comp will cover brand names. If the patient had to pay cash, he would refuse and would accept the generic, maybe reluctantly at first, but he would take it. And it would end up working just fine. Funny how the generics work just fine when you are the one paying it.
I am passionate about cutting costs when possible.
Not taking brand meds is one way. Avoiding wasteful combos can be another. Some combos are worth it – one that isn’t for example is Vimovo. Vimovo is the combo of Naproxen (think Alleve OTC) and Omeprazole (Prilosec). You can purchase these meds separately for $10 or so. Guess how much a month supply of Vimovo is? My cost would be $2407.
Another way to cut costs is to use discount programs. You may want to pay for prescription drug coverage, but if you only take a few meds you may be able to reasonably guess if the premium to add drug coverage is the same or more than what you would spend all year on your meds. Factor in what you would pay vs. the cost of your meds with a discount program and it may be better to just go with a discount program. FREE Prescription savings programs (like RxSpark which I promote) greatly help the patient. I stand behind RxSpark because they don’t sell your info like GoodRx does. And they have loyalty rewards built in. See my referral link for more info or to sign up – https://www.rxspark.com/p/536
Some new and impressive cost savings programs help the system and help reduce costs to insurance companies and practices. I also know of a program that greatly lowers costs of one of the most effective classes of diabetes medications- the SGLT2 inhibitors. These work by getting your body to excrete blood sugar and patients lose about 9/10 lb a week. This program has NO up front costs and will save about $4,000 per pt per year!! Learn more at http://3cutpro.com
A Canadian Pharmacist told me about that bottle of Ativan above- “Our cost for brand name Ativan here in Canada is about $22 per bottle of 500 – $2700 that’s insane!”
So unless you plan on moving – plan on looking for smart ways to cut costs.
Mike-the-Pharmacist
Nice article Mike. Clearly shows the challenge the Pharmacist faces with these price disparities. As A. Einstein said “In the middle of difficulty lies opportunity.” I think that’s where you are with your effort.