Saturday, October 24, 2009

Why do doctors prescribe the most expensive medication first?

I recently went to my doctor for suggestions on how to treat a sinus condition I’ve struggled with for some time. I explained that I had tried several over-the-counter remedies with little improvement. She checked me out and then pulled out some sample packs of pills and nasal spray and said I should try those for a couple of weeks and if they seemed to be working she would write a prescription. Well, I tried the drugs and they did seem to improve things. I was about to ask for a prescription but decided to check out the cost of the pills and spray first. They were over $90 each for a month’s supply. All I had to do was pocket out $200 a month and I could get relief. I called the doctor and told her I thought $200 a month was a little steep to treat a minor but annoying sinus condition. I asked her if there was an alternative treatment. She said there was no generic version of the drugs she had given me since they were new but there were different drugs which she called in to my phramacy. The cost of these drugs turned out to be about $12 each for a month’s supply. Around $25 per month vs. $200. Now, these drugs may not perform as well as the first ones. I’m just starting on them so I’ll find out. But, my question is why she didn’t suggest the cheaper alternative first. Couldn’t we save some money by starting with the cheapest treatment option first and then working our way up to more expensive treatments if the cheaper ones don’t work particularly when we are dealing with a non-life threatening condition?

I’ve come to the conclusion that doctors always prescribe the latest designer drug assuming that the patient has seen an ad on TV and won’t agree to accept anything less than the newest drug available. A doctor told me once that he had given up prescribing generic drugs since few of his patients would agree to take them. I also don’t really think doctors think about the cost of the drugs or maybe even know what they cost and patients usually never bother to check since many of them have a low drug co-pay. Relatedly, I recall calling around to various pharmacies asking what they charged for a particular drug since I was looking for the lowest cost. Most of the pharmacists told me they couldn’t tell me what the drug would cost until they went to fill the prescription and called it in to my insurance company and even that quote might change from day to day. It is all crazy. I don’t know how anyone can truly comparison shop for drugs or medical care. Take lab work. I had some routine lab work not long ago. When I got the invoice from the lab, it had billed my insurance company $209 for my lab work. The insurance company allowed $25. Now I can understand an insurance company being able to negotiate lower rates but that is an 88% reduction. Don’t get me wrong, I would rather pay $25 than $209. However, my question is what is the service really worth, $200 or $25? Who knows.

Our health insurance/care system in this country is broken. The Democratic Party is trying to do something to fix it. The No/Nothing Party is trying to block any meaningful reform not because they think reform isn’t needed but because the leaders of the No/Nothings believe they can gain a political advantage from causing the Democrats and particularly Obama to fail. Well, if the Democrats fail to achieve meaningful reform, then the whole country loses. Healthcare costs will just keep going up and up and up and up………. If they do, blame the No/Nothings.

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