Medication Sticker Shock

Last week my office received a call from a distressed patient who went to the pharmacy to fill prescriptions following a hospitalization. The cost for a month’s worth of three medications she was expected to stay on indefinitely was over $800. With mortgage rates being what they are, most people don’t have mortgage payments that big. She called our office in a panic. As she related her story, I wondered how this fiasco could have been avoided. When I prescribe medications, either my EHR or my Epocrates program gives me an idea of what the patient’s price will be based on her insurance. Is that too difficult for hospitalists to do? That sounds sarcastic, but I’m serious. Are the logistics for a hospitalist such that running medication through software to determine the likelihood a patient can afford them not realistic? What about the pharmacists in the hospital? Could this become part of the discharge process?  Patients should not have to deal with “sticker shock” after a difficult hospitalization.

I changed two of her meds to inexpensive generics and called a cardiologist to ask what to do with the anti-arrhythmic. He told me that the new medication was only slightly better than placebo in studies. And for that she was paying over $300/month!

One of the Affordable Care Act provisions is that hospitals will be penalized for readmissions within a month of discharge.  It will become incumbent on the hospital team to have a better understanding of medication costs, one of many reasons why patients are non-adherent[1] with their therapy. As the family physician getting panicked phone calls I view this as a good thing. My patients will be discharged on medications they can afford and will take. Then we can spend our time in the office taking care of health problems instead of fixing something that shouldn’t have been broken to begin with. 


1. Medication Adherence: WHO Cares? Brown MD, Marie T. et al. Mayo Clin Proc. 2011 April; 86(4): 304–314. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/


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Followup on the Healthy Uninsurable Patient

As a quick follow up to The Healthy Uninsurable Patient, a few weeks after the blog was posted my daughter received her COBRA (Consolidated Omnibus Budget Reconciliation Act) papers. By this time she had obtained individual health insurance with a high deductible, but a reasonable cost. The COBRA quote came in at $569.04 per month. This is, by the way, more than I pay for my family plan that covered four people. This is also more than she makes in a month. How many 26 year olds can afford $569.04 monthly for health insurance? Of course I have a cadillac plan as an employed physician at a hospital but there are no other options offered. There is not even any information on how she might obtain other coverage included with the papers.

As a side note, it turns out that she was covered by my insurance when she had the CT scan done. Despite the fact that the letter received from Humana stated that her insurance would terminate when she turned 26, she actually was covered until the end of her birth month. She is a post-graduate student and I’m a doctor who deals with insurance issues every day and we still got it wrong. No one at the hospital where she had the tests, including the financial aid people, realized she was still covered. And this is where I work!!! Nor did the upper management in my office or the office staff at the surgeon’s office understand that she had continued coverage until June 30 (and the surgeon is employed by the same hospital I am).

Of course payment for the scans will be denied because pre-authorization was not obtained for them and we will have to appeal and cross our fingers. What a mess.

When she saw the premium amount on the COBRA papers my daughter asked, “How can they send this stuff out with a straight face?” Of course we don’t know that they do, since we don’t know the people at Ceridian in Florida who mailed the papers. More surprising to me is the number of patients in my office who keep a straight face when they say “But there is nothing wrong with our healthcare system. It’s the best in the world!” No. It’s not.

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The Healthy Uninsurable Patient

On the heels of the Supreme Court ruling regarding the Healthcare bill my oldest daughter turned 26. (If you aren’t aware, this is the age after which your child can no longer be listed on their parent’s health insurance plan). After this, a saga began. She applied for a high deductible personal insurance with Anthem right before her birthday. At that time the extent of her medical problems included a twisted ankle about a week before she applied, for which she took a couple of days of naprosyn. Other than that she’s been perfectly healthy. They declined her. Unbelievable! Exactly who do these people give insurance to?

She contacted an independent insurance agent, who was equally mystified, to try to help her. Anthem has yet to provide her with the promised explanation of their denial.

So here is the amazing thing–immediately after her denial, she developed epigastric and chest pain. She had recently been on an airplane and her chest pain was worrisome for a pulmonary embolis. So of course she got a CT scan which she will have to pay for out of the money she has saved for medical school. My question is–are the insurance companies now omnipotent, able to see into the future? If so, how do I, as a Family Physician, obtain the same powers. It would really come in handy in my line of work!

(Of course now she’ll NEVER be able to get personal health insurance.)

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