Tuesday, March 15, 2011

Miscellaneous: One Reason America's Health System Stinks

Last time I had to get a prescription for antibiotics, I had an infected cut on the middle finger of my left hand, the result of a mishap with an oyster and an oyster knife. I bought the prescription at a Kaiser Permanente pharmacy for around $31 only to find later that the same drug in generic form would have cost only $4.99 at Target.

Today a family member got a prescription for a different antibiotic, to treat an oral infection. The Kaiser pharmacy quoted a price of $28.70. Going on my previous experience, I tucked away that bit of information and smugly called Target, congratulating myself on what I expected to be a significantly lower price--but I was surprised to get a quote nearly four times higher than the Kaiser Permanente price, even asking for a generic equivalent.

I got curious. I called three other local pharmacies. The high price (at Dollar Drug) was $161.98 (nearly six times the Kaiser price), but Dollar Drug helpfully pointed out that it would be only $58 if I got the prescription in the form of 80 150mg capsules instead of 40 300mg capsules. (Oddly, Kaiser charges a few dollars more for the 150mg capsules.) Costco, however, was able to fill the prescription in generic form using 80 150mg capsules for only $21.76. The results of my inquiries are in the table below, which shows prices quoted for the prescription using 300mg and 150mg capsules where both were available.

Clindamycin HCL 

                      300mg x 40      150mg x 80

Dollar Drug     $161.98     or     $58.00
Walmart           $116.00     or     $83.00
Target              $100.99     or     $51.99
Kaiser              $28.70       or     $31.10
Costco                                          $21.76

Does this make sense? First, I wonder why Kaiser Permanente isn't offering me a lower price than Costco, considering that I send Kaiser hundreds of dollars every month in premium payments--far, far more than the annual dues I pay to get the benefits of a Costco membership (although it's worth noting that anyone can use a Costco pharmacy--Costco is required by law to fill prescriptions for members and non-membern alike). Second, I wonder why there should be a difference of greater than 300% between the least and most expensive ways to fill this prescription that don't involve being a member of Costco or paying premiums to Kaiser (the difference between $51.99 and $161.98). Most importantly, it seems to me, if Costco can fill this prescription at 13% of the highest price quoted, something is seriously wrong--but I don't suppose that's news to anyone. I don't mean to single out Dollar Drug here. I assume their prices are in line with prices at other private pharmacies--and it wouldn't surprise me if a few more phone calls turned up still-higher prices for this particular prescription. I just wonder how often insurance companies get paid for prescriptions at prices much higher than are necessary? Why can't we do something about this kind of wasted money? 

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