When my sister Ella first started having liver problems in December 2007, I went out to visit her. When I got to her hospital room, she was trying to be brave, but was deeply worried. In addition to her fears about treatment, Ella was terrified about her finances. As a graduate teaching assistant, she didn't have very much money, and she wasn't insured; frankly, she had no idea how she was going to pay for the drugs and medical care that she needed to save her life.
A few days later, when the hospital released Ella, they gave her prescriptions for Ciprofloxacin, an antibiotic, and Percocet, a painkiller. While we were in Wal-Mart picking up a huge pile of assorted health-care paraphernalia, she dropped off her order at the pharmacy counter. When we picked it up a half-hour later, we had a huge surprise: Ella's medications came to less than $15.
Later on, discussing this with Ella's doctors, we realized that the low cost of her meds wasn't an accident. Understanding her financial situation, her health-care team had carefully chosen Ella's drugs. Taking into account both efficacy and cost, they had determined that Cipro and Percocet would not only do the job medically, but would also minimize the strain on my sister's wallet. Apparently, the Geisinger clinic had consulted with Wal-Mart, determined which medications were less expensive, and was careful to prescribe them whenever possible.
Geisinger isn't the only hospital in Pennsylvania that is striving to reduce the cost of drugs. In fact, Pennsylvania has one of the oldest and most effective "unsales" programs in the country. Basically, the state pays 11 consultants to speak with doctors and discuss ways to lower the cost of pharmaceuticals. This program, which costs approximately $1 million a year, is primarily aimed at reducing healthcare costs for senior citizens, but its physician education program has had an extensive effect on both medical care and state-funded healthcare expenditures. For example, according to some estimates, this program has cut state expenditures on heartburn drugs by up to $572,000.
It seems odd that doctors can be talked into prescribing certain drugs. However, it's nothing new; in fact, pharmaceutical companies spend over $7 billion a year to convince physicians to prescribe the latest, most expensive drugs. A friend of mine, Michael, was a pharmaceutical rep for years. He used to regale me with tales of taking doctors on deep-sea fishing trips and treating them to expensive dinners. In return for this, many of Michael's clients religiously prescribed the drugs that he represented.
If this seems outrageous, you might consider the case of OxyContin. Perdue Pharma, the company that owns OxyContin, paid out a $19.5 million settlement in 2007. The company was accused of excessively promoting the drug, as well as encouraging doctors to mis-prescribe it.
Although Pennsylvania doesn't spend billions of dollars on its unsale program, the state has already felt the effect of this policy; in addition to saving the state hundreds of thousands of dollars, it has also made life a lot easier for thousands of lower-income patients. Other states, including Vermont, South Carolina, and West Virginia, have pursued similar programs, but have found that the cost is somewhat prohibitive. Vermont is currently considering partnering with Maine and New Hampshire to develop a regional initiative. Regardless of the form it takes, I hope that these sorts of patient-advocacy programs continue to gain ground; frankly, I need the money more than Purdue Pharma!
Bruce Watson is a freelance writer, blogger, and all-around cheapskate. He thinks doctors should still use leeches.