Drug costs at pharmacies lack transparency

AS A PRACTICING PHYSICIAN, nearly every time I write a prescription, I have to ask myself: “Will this patient be able to afford this at the beginning of the calendar year when they have not yet met their deductible? Will they be able to afford this medicine in the middle of the calendar year when they fall into the ‘doughnut hole’? And will they tell me if they stop taking it because it is no longer affordable?”

Despite having health insurance, many of my patients frequently cannot afford their medications either at some point in the calendar year or they simply cannot afford the “preferred” medication at any time. When my patients are unable to take their medications, their health suffers and this has cascading adverse ramifications on their family, friends, employers and the cost to our healthcare system in general.

In today’s health care system, it is crucially important that the physician know their patient’s out-of-pocket medication costs during the office visit because that is when one has the conversation discussing the risks (including cost) and benefits of a proposed medicine. Unfortunately, there currently is no way for a physician to obtain this information during the office visit as there exist neither free-standing apps nor features integrated into the electronic health records which will provide this information to the physician.

In 2017, in preparation for the MIT Grand Medical Hackathon, I contacted Blue Cross Blue Shield, Tufts, and Harvard Pilgrim health plans and told them I intended to write an app to deal with this problem. Their response could most charitably be summarized as “yes that is a problem we are aware of but we are not willing to deal with it at this time.”

Recently I sent a prescription to my local pharmacy for my generic cholesterol medication. I then received a call from a pharmacy technician who informed me the cost would be $200 for a 90-day supply. As this seemed a rather high price, I logged on to GoodRx.com, Walmart, and blinkhealth.com and determined that their cash price for exactly the same medicine was about $10-$70.

I called the pharmacy and asked to speak to a pharmacist. After I told them about the price discrepancy, I was informed that “you have a deductible which you will eventually have to meet.” I said you should have informed me, and all your clients, of the least expensive purchasing option. There was no response. Clearly, the pharmacist could have – and should have – told me that if I paid cash, and choose not to use my health insurance plan, the cost would have been $60 instead of $200.

While pharmacists might argue that they will divulge the cash price of a prescription to any client who asks “what is the cash price for this medicine,” the act of asking the question requires a level of health care literacy which many patients do not possess. Asking that question also engenders a degree of confrontation that many people would prefer to avoid, especially with their pharmacist, who is a person they trust.

It is unconscionable that Massachusetts law does not mandate that the pharmacist disclose the lowest possible price of a prescription to the patient at the time of every financial transaction. Allowing this situation to continue also promulgates the fallacy that every health care decision is driven by financial ramifications and thus does a disservice to all those who strive to provide high quality/low cost healthcare.

It is morally imperative for our governor to champion a “Truth in Pharmaceutical Pricing” bill that would require all pharmacies to inform their clients of the least expensive purchasing option during every financial transaction.

Failure to enact this legislation STAT is manifestly irrational and will have a pernicious impact on my patients’ health, finances, and on our society in general. 

Hayward K. Zwerling, MD, is an endocrinologist at the Circle Health Diabetes and Endocrine Center in Dracut, an affiliate of Lowell General Hospital, and serves on the Massachusetts Medical Society’s Committee for Information Technology. A graduate of State University of New York Upstate Medical University, he has been a practicing physician for nearly 30 years.