Medication

Cheaper Medications

So, incredibly cheap medications are a known benefit of being a part of Sequoia MD. Everyone knows that. So, what could be better than the medications you need, at a completely affordable price?

How about even an even cheaper price? I recently added another medication supplier, that has some even better deals than what I have been able to offer. It will not be for every medication, but for several medications, the cost will come down even more. I love it.

This will slowly filter through my stock. As I order new medications at (hopefully) lower prices, those cost savings will be passed along. Depending on the medication, this may take a little while to work through the inventory, and will not, unfortunately, apply to everything. I also ask for your patience in advance, as I anticipate having multiple suppliers may cause some small challenges with keeping things in stock.

Still, pretty cool though, right?

Its the individual...

This article hits the nail on the head around a lot of the current issues around chronic pain and addiction. It also is another example of another huge challenge in healthcare.

 One of the biggest challenges I see in medicine is the idea that "someone else" knows better. For any individual patient, that patient, and the doctor taking care of him or her, are going to make the best decision. It won't always be right, but it will certainly be a better decision than one make for 2.000 miles away.  Politicians, insurance company administrators, bureaucrats, "policy makers." and a long list of other people are going to know less about any given situation than the patient and the doctor. And yet, they often have as much (if not MORE) influence, in how an individual patient gets treated. 

This is true with managing pain. For a long time, doctors were very concerned about the dangers of prescribing opiates. Then a whole host of other people got involved, and basically told doctors they were not doing a good job, because we weren't controlling patients pain, not prescribing enough. Now, those very same people, are coming back and telling us we are not doing a good job because they are being prescribed too much. 

How about we let doctors work with patients to come up with the best treatment for that individual person? Complicated? No. Revolutionary? Maybe...

Eight Seventeen

I recently saw a patient in the office who sees a specialist. His specialist had started him on a new medication (that I also prescribe sometimes), but the patient hadn’t picked it up from the pharmacy. He said it cost too much. This man is not particularly well off, but does ok. So I asked him how much it cost. I was thinking maybe I could convince him to pay for it for a month, see if it worked, and then make a decision. 

“Eight seventeen” he replied. “Can you believe that?”

That didn’t seem too expensive to me, I  though he probably could afford it, but maybe it just wasn’t worth it to him. Still, I could try and find him a lower price, I like solving problems for my patients. I asked him to wait for a moment. Maybe I could shave a a few dollars off, and that would be the difference.  After a bit of looking, I found the medication and the price, and felt disappointment. 

“Sorry, I can’t beat that price. I can order it, but it would cost you about $12 or $13 to get it from me.” I was a bit bummed. I like to help if I can. Still, maybe I could convince him to try it for a month or two, see if it would help. 

“That’s fine,” he said, “could you order it?”

I looked at him. Why would he want to pay be an additional 5 bucks for the the same medication he could get more cheaply from the pharmacy? He told me cost was the problem, but was willing to pay more to buy it from me? 

“Sure, but why don’t you get it from the pharmacy?”

He looked at me. “Doc. I  told you, they wanted eight seventeen for it. I can’t afford that.”

I frowned. $8.17 is cheaper than $12, $8.17 is cheaper than $13, this doesn’t make any sense. I mean, I can order it, but why pay more? You just told me, cost is the issue. Then, slowly, it sunk through my skull. 

“DO YOU MEAN TO TELL ME THEY WERE TRYING TO CHARGE YOU MORE THAN $800 FOR THIS?” I felt like my head was exploding. I couldn’t believe it. The pharmacy was trying to charge him with insurance, $817. Eight seventeen. Eight hundred and seventeen dollars. 

He looked at me and shook his head, “Yeah doc, that’s what I told you. They said it was eight seventeen. There’s no way I can pay for it. Go ahead and get it for me, maybe this one will work.”

I want to be clear: I don’t stock every medication. I can’t get every medication for less. But boy is it fun when I can save my patient $805 on a single prescription.

Adventures in Healthcare Land (Part II)

Have you ever gone to to pick up a medication at the pharmacy, and been told, “its not covered by your insurance.” Its annoying, right? Its also annoying as doctor when this happens: I pick what I think is the best medication for a patient, and then am told by an insurance company if this is ok, or not. You know what is especially annoying? When we are arguing over pennies. 

I recently got a fax from a pharmacy. I had prescribed a medication to a patient, and before the insurance company would agree to pay for it, they needed additional justification as to why this was the right medication. Keep in mind, this was a medication to decrease stomach acid in a patient who was having heartburn. But before I spent 20 minutes filling out paperwork and faxing it back, I decided to check my inventory, and see how much it would cost the patient to get the medication from me. The answer?

$1.71. 

You read that right— about half the cost of your morning coffee. Oh, and that cost includes my mark-up. 

This is not an isolated incident, and is not the first time something like this has happened. I once had a patient wait 10 days to start a medication because the pharmacy had to get authorization for a medication for which I charge $1.53 per month (that is 5.1 pennies per day).

Now, I don’t think I can change the enormous healthcare system. I don’t think I will be able to change it even in California. But I do think I can change it for myself, and for my patients. Its a wonderful feeling; instead of getting angry about the absurdity of it, instead of trying to convince an insurance company to spend 5.1 pennies per day, instead of getting indignant because of the difficulties my patients are exposed to, build a solution that actually works.