New Tool, Approach for Consumers to Find Lower-priced Healthcare

There are a lot of people concerned about their healthcare costs in the U.S.  I’m certainly one of them.  My family gets hit unexpectedly like any other, and we have our own recurring medical bills to deal with.  Since I realized a few years ago that I could save upwards of one to two thousand dollars a year in medical expenses, I’ve made a habit of reviewing my medical bills much more closely.  This can take hours upon hours on the phone and researching of medical codes and jargon—far from a simple process.

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But what can you end up saving by comparing costs?   Multiple case studies have shown that the difference between the low and high price is often a factor of 5 to 15 times.   For San Francisco (the first metro area we have significant data for) you can pay as little as $149 or up to $833 (cash rate) for an ultrasound during pregnancy.  For those who don’t ask, or for whatever reason don’t get the uninsured or cash discount, the amount could go as high as $1,733.  Several imaging and lab work procedures have a much greater disparity.

 

The problem is finding prices to compare. In California, hospitals are required to publish some of their pricing data annually.  And though there’s a lot more where that came from, it’s just a drop in the bucket.  That source cannot currently give us insurance-negotiated rates at these hospitals.  And then there are the tens of thousands of non-hospital facilities.  Crowd-sourcing on a large scale is currently the only way to provide the full set of data we’ve all been waiting for.

 

Pricing Healthcare   Together We Can Make a Difference

That is where Pricing Healthcare comes in.  Our model is designed around crowd-sourcing healthcare pricing information.  All that’s needed now are individuals willing to share a little of their data.  We make it quite easy, anonymous and secure.   A few individuals in the same area going to the same facility can submit data and begin to pull back the curtain on that facility’s prices.  Providers have long been a roadblock to price transparency and we are removing provider dependency from the equation.  Furthermore, providers and facilities feeling a little competitive pressure on price will be forced to compete more on service and quality.

 

 

Bio

Randy CoxRandy Cox is the founder and CEO of Pricing Healthcare.  He grew up in Idaho and studied computer science at Brigham Young University in Provo, Utah.  In 2002 he moved into Medical IT and worked as software architect, analyst, and senior developer for Allscripts and Misys Healthcare. In 2011 he discovered a huge jump in some regular family medical expenses, and in the process of getting to the bottom of it, realized that healthcare services could be compared at any facility using standard medical codes, which usually show up on itemized statements.  When he realized that it was virtually impossible to get pricing from various companies online or over the phone, the idea of Pricing Healthcare was born.

Double Check, Don’t Double Up on Medicines Containing Acetaminophen

Acetaminophen is the most common drug ingredient in the U.S. and is found in more than 600 different prescriptions and over-the-counter medicines, including pain relievers, fever reducers, and sleep aids as well as cough, cold, and allergy medicines. It is safe and effective when used as directed, but taking more than directed is an overdose and can lead to liver damage.

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Research recently conducted by the National Alliance for Hispanic Health (the Alliance) found that more than half of Hispanic consumers are not aware of any health risks associated with taking too much acetaminophen, and do not check their medicine labels to see if their medicine contains acetaminophen.

 

That’s why NeedyMeds is partnering with the Acetaminophen Awareness Coalition’s Know Your Dose Campaign to get the word out.

 

Here are four important steps to follow when taking any over-the-counter or prescription medicines:

1)     Always read and follow the labels on your medicines;

2)     Know if your medicine contains acetaminophen;

3)     Never take two medicines that contain acetaminophen at the same time; and

4)     Always ask your healthcare provider or pharmacist if you have any questions about your medicines.

 

Know Your Dose

 

Visit KnowYourDose.org for more acetaminophen safe use tips in English and Spanish, a list of common medicines that contain acetaminophen and an interactive guide on how to read a medicine label. You can also call the Alliance’s toll-free Su Familia Helpline at 1-866-783-2645 if you have questions or need referrals to health resources in your community.

Volunteers in Medicine: Caring for the Uninsured

Access to Health Care

Today, many working individuals in America do not have health insurance and as a result do not have access to quality health care services.  Their employers may not provide coverage, or they may earn too little to buy affordable health insurance or earn too much to receive other types of public assistance.  These are the “working uninsured” who, in many communities, turn to Volunteers in Medicine (VIM) clinics and other safety-net clinics for access to health care services.

 

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Services provided in VIM Clinics

VIM clinics provide health care services free of charge.  Retired and practicing medical professionals volunteer their time and expertise to give back to their neighbors, treating diseases like hypertension, diabetes, mental health issues, and obesity.  Specialized services offered in many VIM clinics range from pediatrics and dentistry to ophthalmology and counseling. VIM clinics are supported by the local community and the services offered are based on the needs and resources in each community.

 

VIM Clinics and a Culture of Caring

VIM clinics promote a “Culture of Caring” wherein each patient and volunteer is treated with dignity and respect.  It is based on an ethical standard in medicine that acknowledges that how people are treated during a clinic visit is as important as the actual medical care they receive.  This approach promotes delivering quality health care in a coordinated manner within a nurturing environment.

 

How to Find a VIM Clinic

There are currently 95 VIM clinics is 29 states across the country.  To find a VIM clinic in your area, visit the VIM Clinic Directory on the Volunteers in Medicine website.  If you live in a community without a VIM clinic, the NeedyMeds clinic list can provide information on free or low cost clinics for your area.

 

Start a Free Clinic

Interested in developing a VIM clinic in your community?  The Volunteers in Medicine national office is dedicated to assisting individuals, groups and local communities in starting a free clinic. Experienced staff at VIM are available to work with local groups throughout the development process.  Visit Start a Clinic to find out what is involved.

Drug Discount Cards – Lifting the Veil of Secrecy

by Richard J. Sagall, MD, President of NeedyMeds

 

Everywhere you look you see claims of savings from drug discount cards. You may be skeptical when cards promise huge savings. And you should be because not all the claims are real.

 

Too Good to Be True

The old saying “If it seems too good to be true then it probably is” applies to drug discount cards. Drug discount cards have the potential of saving you a lot of money, but you have to understand how they work.

It’s important to remember that they all work basically the same way. Here’s the scoop.

First, a company called a “pharmacy benefits manager” (PBM) or an adjudicator sets up a network of participating pharmacies that agree to accept the cards. Then the PBM negotiates with each pharmacy chain and all the participating local pharmacies offer a discount on the drugs they dispense. The discount is usually a percentage of the cash price of the drug. The percentage may vary from drug to drug.

Next, the PBM finds companies or organizations to market their card. These groups, called marketers, may be for-profit companies or non-profit organizations. They may be multilevel marketing organizations. Some marketers work with other groups.

 

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The amount you pay when using a drug discount card is the sum of four components. This is true for all drug discount card.

1. The Negotiated Discounted Price – The PBM does its best to negotiate the best discount from the pharmacies. Some PBMs do a better job of this than others. The size of the PBM, its market share and how much business it will direct to the pharmacy are all important factors in the final discount.

2. Pharmacy Transaction Fee – Each time a card is used the pharmacy earns a small amount to help cover their costs.

3. PBM Transaction Fee – The amount the PBM earns to cover their costs of setting and running the pharmacy network, processing claims, etc.

4. Marketer Fee – This is how much the marketer earns for promoting and distributing the card.

Who pays all these fees? You do!

 

Why Pharmacies Accept Drug Discount Cards

You may wonder why pharmacies accept drug discount cards. After all, wouldn’t they make more by not accepting the cards and charging customers the non-discount price? There are five reasons pharmacies accept the cards:

1. Earning a profit even at the discounted price – They wouldn’t offer such a large discount that they lose money on the transaction.

2. Selling prescriptions they wouldn’t sell otherwise – For example, a customer may not be able to afford a prescription with a non-discounted price of $100 but may be able to afford it at the discounted price. The pharmacy gets the sale, but earns a lower profit.

3. Building customer loyalty – The drugstore business is very competitive. If a pharmacy gives you a good discount with a drug discount card you are more likely to continue to patronize that store than others.

4. Increased non-pharmaceutical purchases – There’s a reason most pharmacies are at the back of the drugstore. This arrangement forces you to walk down aisles, increasing the chances you will make additional purchases.

5. Peer pressure – If all the pharmacies in town but one accept drug discount cards, that one will lose business.

 

How Marketers Make Money

There are two main ways card marketers make money from drug discount cards:

1. Transaction Fees – Each time a marketer’s card is used the marketer earns a transaction fee designed to cover expenses and make a profit. The size of the fee varies quite a bit. Generally speaking, non-profit companies and marketers that don’t have expensive marketing programs have lower transaction fees. Lower fees mean more savings for card users. Remember, card users pay the fees.

2. Selling of Information – Some card marketers gather personal information on people who use their card. They can do this if you have to register to obtain a card. They can also receive personal information each time you use the card. For example, a company selling diabetic supplies would pay for a list of names and addresses of people who buy insulin.

 

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Here are some tips when selecting a drug discount card:

1. Never pay for a card – There are many good cards that are free. There is no reason to pay for a card since it’s unlikely it would offer a discount any better than a free one.

2. Never register for a card – This is one way marketers get info that they sell. The only reason to give your name and address is if the card is being mailed to you.

3. Read the privacy policy – Make sure the marketer has a privacy policy that you agree with. Even then, there’ no guarantee they will follow it.

4. Helpline – All reputable marketers have a toll-free helpline. Give the line a call and see how responsive they are. Do they have real people answering your questions or just a recording? If you leave a message do they call you back?

5. Shop around – Try different cards to see which offers you the best discount. Ask your pharmacist which has the best prices.

6. Consider who is making money – All things being equal, using a card offered by a non-profit is best. Any money they make is going to further their cause while the money earned by a for-profit is just going into someone’s pocket.

 

Richard J. Sagall, MD, is the president and co-founder of NeedyMeds. He spent 25 years practicing family and occupational medicine. He now devotes his time to NeedyMeds and Pediatrics for Parents (www.pedsforparents.com), a children’s health newsletter.

Price Shopping Pharmacies To Save On Meds

Sumanah was a 26 year old event planner in New York City when suddenly diagnosed with congestive heart failure.  Sumanah was like many typical 26 year olds, without health insurance and no savings capable of paying for her medical bills. Taking 10 medications for her condition, Sumanah was paying full price at what she “thought” was the cheapest pharmacy. After she discovered that not only were some pharmacies cheaper for the same exact medication, she learned that some pharmacies can be upwards of 16 times more expensive than another pharmacy right across the street. Using this information, Sumanah was able to price shop for the right pharmacy and save a lot on her prescription costs. This story, although not uncommon, shows how important shopping around for medications can be.

In their May issue, Consumer Reports published an article confirming the experience Sumanah and many others have each time they go to fill a prescription. The study focuses on five of the most prescribed medications in the U.S. and reviews more than 200 pharmacies for price comparisons. The findings show the details of each pharmacy and drug researched as well as the overall discrepancy between the lowest cost pharmacy and the highest cost pharmacy. For the same prescriptions, the difference was a whopping $749 per month or 447% between the highest and lowest cost options.

Price shopping prescriptions from one pharmacy to another can dramatically cut out of pocket costs for patients without changing medications. The cost savings for patients using these medications are large and can help patients who were unable to afford medication in the past, be able to consider options at a low cost pharmacy. The current lack of pharmaceutical price transparency currently causes many patients to simply stop medication because it is too expensive for them to afford. When patients perceive medication as being too expensive, many times they will simply stop taking their prescription to avoid the cost, which is a truly dangerous option for patients to consider.

Currently, non-adherence (not taking your medication) is cited by The IMS Institute of Healthcare Informatics as the largest contributor to healthcare costs in their June, 2013 study, “Avoidable Costs in U.S. Healthcare.” The study shows that a patient’s inability to stay on a prescribed medication is estimated to cause over $100 Billion in avoidable healthcare costs due to the resulting health complications, hospital visits, and additional advanced treatment.

As a practicing doctor, it really amazes me how a simple understanding of pharmacy pricing can change a patient’s ability to afford their medications, take them as directed, and avoid the complications that can result from not taking them correctly. I make it a point to share this message with all of my patients and colleagues and I look forward to the day when everyone knows that by simply walking to the pharmacy across the street, they could save a lot of money.

Ali Khoshnevis

Ali Khoshnevis is a practicing Optometrist and the CEO of WeRx.org, a pharmacy price comparison site and app with the goal of helping patients find the lowest cost medications in their neighborhood.

 

This article originally appeared on CostofCare.org