It hasn’t happened yet, but recently there were proposals from the president to require pharmaceutical companies to include the prices of their products in all direct-to-consumer ads on television.
A federal judge blocked a new rule, declaring the Department of Health and Human Services exceeded its regulatory authority by the mandate.
But it did inspire me to survey some of my patients about how they would feel if they knew how much their medications actually cost — not just what they have to fork over at the pharmacy counter.
Although the overall goal of the Trump administration was to force down drug prices, the responses I received from the 10 patients I surveyed were quite surprising, and had little to do with finding cheaper medicine.
Do you care about the true cost of your prescriptions, as opposed the out-of-pocket copay?
One patient, a 73-year-old-grandmother, was creative enough to suggest an entrepreneurial underground business on the side selling unused pills, something I did not expect to hear, and do not condone.
Seven patients mentioned that if they knew how much each pill cost, they would be more likely to take it as directed, and be careful to keep all of their medications in a safe place. Naively, I had assumed they did that anyway, but statistics show 50% of patients do not follow instructions with their medications.
Four of my patients said they would be happy they got a good deal and less likely to grumble if their insurance premiums went up a few dollars. I didn’t expect this peripheral benefit for insurance companies — a greater willingness to pay more because of the knowledge that they were essentially paying less in the long run.
Five patients said they don’t pay for their medication so they didn’t care how much it costs, although they still believed drugs are too expensive.
Three said they if they found out their medication was more expensive than they realized, they would delay retirement to keep their insurance coverage so that they didn’t have to pay cash for the prescriptions.
Two suggested that they would wonder if their own medication was cheaper because it wasn’t as good, thinking that all of the newer, more expensive drugs had to be better than the older ones.
Only one, a 64-year-old man, said he would change medication if I told him to, because he trusted that I would know if it would work well enough. He assumed I knew the price of the drugs and only picked the ones that were best for him.
Doctors don’t know how much medications cost, and patients don’t know how little information that providers have when they prescribe a certain pill.
Which brought up another point worth investigating. What if I didn’t know how much medications cost? Did my colleagues know? Were we all in the dark here?
So I asked 10 of my colleagues as well.
All said they had no idea what drugs cost for their patients other than a vague idea of their copay. We all figured that if patients couldn’t afford their medication, they would call our office and tell us. So, if we didn’t hear from them, they didn’t have a problem.
Four colleagues said that they knew how much their patients paid, but had no idea of the cost to the insurance company.
None of us knew how much the newer blood thinners cost, just that they were a lot more expensive than older ones like warfarin. We didn’t know if there were more than one generic medication available, and if one might be cheaper.
We were all confused about the “rebates” offered by drug companies, pharmacy benefit managers and insurance companies.
If drug prices were revealed on TV ads, my colleagues said they might consider this when prescribing new medications, but that it would not be the only factor. They also worried the prices wouldn’t be accurate.
We all agreed that if the prices were correct, having them on the electronic medical record would help them lower the overall cost of care for patients. But it would have to be easy to find, and apply to all of the different insurance plans that we accept.
Overall, my survey results are loud and clear: Doctors don’t know how much medications cost, and patients don’t know how little information that providers have when they prescribe a certain pill. We all rely on someone else to pay for it, and if we found out that we were getting a great deal on our medications, we might grumble a little less if the premiums for our drug coverage go a bit higher over time.
These were the results I expected, but they highlight how far we are from making a real difference in controlling the cost of medical care in the United States. That needs to start with everyone learning more about how medications are paid for, no matter who ends up with the bill.
Because in the end, we all pay.
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Kathleen Kozak, M.D., is an internal medicine physician at Straub Clinic and Hospital. She is also a part-time medical director for UHA Health Insurance and is the host of “The Body Show” on Hawaii Public Radio.