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When A Health Journalist Walks into a Pharmacy….

Why have the most basic prescriptions become so expensive?

It sounds like the start of a great joke, but my trivial tale of woe speaks volumes about the absurd price of healthcare in the U.S. compared to the rest of the world. It is also about how the businesses that deliver our healthcare can get away with extortion. And nothing in the current Congressional debate — on either side of the aisle — deals with this fundamental pricing problem.

Earlier this month I innocently offered to pick up a basic prescription for a family member and fell into that Kafkaesque rabbit hole of American medicine. I was spurned, threatened — twice — with robbery, and had my blood pressure rise as I wasted nearly an hour of my time. Even my knowledge of healthcare and pharmaceutical costs could not fully protect me.

“That’s impossible,” I said, “I’m a physician…It’s a very old medicine.”

The prescription was for hydrocortisone suppositories, a basic, decades old medication to treat hemorrhoids that comes in generic form. (As a trained physician, I can say it wouldn’t be a bad idea for every family to have them in the medicine chest, just in case.) Used for a few days they have no downside, other than to make downsides more comfortable. Nonetheless — and we’ll explore why this might be so later — this medicine requires a prescription in the U.S.

When I requested the medicine at the counter, a pharmacist told me her computer indicated a copayment of $50 for twelve of the little torpedo shaped items. “That’s impossible,” I said, “I’m a physician…It’s a very old medicine.”

After she double-checked she informed me that she was wrong — the insurance wasn’t processing properly. Could I wait for her to phone the carrier?

Impatient to get to work, I said I’d just pay the cash price and not use insurance. She checked. It was $277.00. That’s right, $277.00.

As many of you may know, I recently published a book on America’s pricey healthcare system, with tips on how patients could bring down their costs at the hospital, the doctor’s office and their medical bills.

The price of this old medicine reflected rule #4 of what I called “the dysfunctional medical market”: As technologies age, prices can rise rather than fall.

After my initial outrage at the price tag wore off, I did as I suggest to readers: looked on the website called goodrx.com to see if there were any coupons to download to get a discount.

I discovered that most pharmacies in the zip code were selling a box of a dozen hydrocortisone suppositories for about $150 to $190 to cash paying customers. And with an instant coupon I could get it for about $90. No real bargains here, even though a number of companies make the medicine. (Rule 6: More competitors vying for business doesn’t mean better prices…)

So I waited for the pharmacist to make the call.

In the meantime, another customer stepped up the counter to fill some prescriptions for her college-aged son, who had visited a local walk-in clinic for a bad sore throat. “What are they for?” she wisely asked.

Why would any doctor at a walk-in clinic prescribe two medicines that are available over the counter at far lower prices?

One was for an acid reducer.

“But he doesn’t have a stomach problem,” the mom responded.

“Sometimes reflux can cause a sore throat,” the pharmacist offered helpfully, but noted too that the acid reducer, Zantac, was also sold over-the-counter, for a fraction of the price. “Zantac, why is that prescription?” she asked.

“The pills are over the counter but the capsule is prescription,” she answered with a shrug and an eye roll. The woman decided to skip that.

The next prescription was for a painkiller, ibuprofen 600 mg. I pointed out that this medicine, too is old, cheap and over the counter. But only in 200 mg form. Taking 3 generic 200 mg ibuprofen pills costs pennies. She declined that one too and was furious — she’d paid $140 for a “useless” urgent care visit.

It may be good for patients, but it’s not generally in the industry’s financial interest…

Why would any doctor at a walk-in clinic prescribe two medicines that are available over the counter at far lower prices? It is a symptom of the perverse financial incentives that underlie American medicine. Perhaps:

  1. The doctor didn’t want to send a patient out empty-handed?
  2. The doctor had no idea how much the medicines cost and assumed insurance will cover.
  3. The urgent care center has pharma investors who stand to profit from the inflated prices of prescription drugs. (I’m being only slightly paranoid.)

After about 20 minutes of waiting, my family member’s insurance snafu with the insurer had been corrected. Processed properly, I paid $10 copay for the scrip.

Fast forward: A week later I was in London for work and, still irritated by the thought of anyone charging $277 for such a basic prescription, I stopped at Boots, the chemists. I bought some hydrocortisone suppositories (though a somewhat lower dose) over-the-counter, because — as I said — it’s something useful to have in every family medicine chest.

The price: 5.79 pounds, or about $7.50, and that likely with a nice profit. I thus avoided Rule #5: “Patients are stuck and they’re stuck buying American.”

In the UK, as in much of the world, you can buy this medicine off the shelf. That’s not possible in America. Why? It may be good for patients, but it’s not generally in the industry’s financial interest to change the status of medicines from “prescription” to over-the-counter.

If it was available over-the-counter, you wouldn’t need to go to the doctor, or the walk in clinic, to get a prescription. You couldn’t sell such an old medicine — or any medicine — for $277 or even $90 (with a coupon).

So next time you’re passing through Heathrow I’d suggest skipping the shortbread and tea — you can buy that in the United States. Stop at Boots and buy some suppositories instead.

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