Published August 4, 2020
THE VIEW FROM MY SEAT
Researching drug costs can save you money
Drug pricing information to be more transparent next year
By Ernie Williamson / The Bulletin
I am no expert on drug pricing. I am not a doctor, a pharmacist or a drug company executive.
I am simply a senior citizen with a chronic illness who thinks drug prices in this country make little sense.
Last October, I wrote about a prescription medicine that had an out-of-pocket cost of $273 when it was prescribed in liquid form.
Before buying that drug, I did some research and found that the same medicine would cost me only $19 in pill form. I assumed the drug must not be as effective as a pill, but I asked the doctor. He said it was fine and would redo the prescription: This time for pills.
I recently had a similar experience that raises questions about the system.
Just like between 18 percent and 28 percent of North Americans, I have battled gastroesophageal reflex disease (GERD) most of my adult life and, through the years, I have been prescribed various proton-pump inhibitors to reduce stomach acid.
Most recently, because of a new complication, a doctor prescribed 180 pills of esomeprazole magnesium 40mg (Nexium) to be taken twice a day.
It turns out my insurance company considers esomeprazole a non-preferred drug and would not pay for it unless other drugs were tried first. The esomeprazole prescription would cost me $302.
Like a fool, I paid it. But just once.
When refill time came, I asked the doctor about pantoprazole, a proton-pump inhibitor my insurance covered and I had used before. He said he thought esomeprazole was slightly better, but that he had no objection to prescribing pantoprazole instead.
I suspected the pantoprazole would be cheaper, but I didn’t anticipate the out-of-pocket cost would be only $3 for the same number of pills. I am not a math wizard, but I calculate that’s a savings of $299 every three months.
Almost 44 percent of respondents in an online poll admit that within the last year they had not purchased at least one medically necessary prescription because of cost.
My most recent experience suggests a partial solution may be found in the doctor’s office. And I am not the only one who thinks so.
The pricing tool, which is embedded in each participating physician’s electronic records and pricing system, shows how much patients can expect to pay out of pocket, based on their insurance and pharmacy they choose.
It also allows the doctor to find a cheaper alternative when possible.
As good as this sounds, the pricing tools have limitations. Some doctors have been hesitant to embrace the technology out of fear of getting bogged down in long discussions about drug costs.
And because price negotiations among insurers, drug makers and middlemen are often highly competitive and secretive, the tools don’t have useful data for every patient.
Humana, for instance, has had the technology since 2015, but fewer than 10 percent of its doctors use it. The technology got a boost last year when the Centers for Medicare and Medicaid Services mandated that all drug plans embed such a tool in their doctors’ electronic prescribing systems starting next year.
At a hearing last year, Sen. Martha McSally R-Ariz., pressed officials about why many patients lack access to drug prices in their doctor’s office.
“This is America. Why can’t we have this tool available now,” she asked.
(Ernie Williamson welcomes reader input. Please contact Ernie at email@example.com. Or, send letters in care of The Bulletin, PO Box 2426, Angleton, TX. 77516)