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Wednesday, May 29, 2019

Cost vs. Cost

ME: What is today's lesson? 
MYSELF: Hippopotomonstrosesquippedaliophobia is the fear of long words. 
ME: No. I mean, yes, that's correct, but I was asking CP. 
CP: Cost differences. 
MYSELF: <zzzzzzzzz>
CP: As in expectations versus reality. Or actuality versus perception, more like.
ME: Okay. I'll bite. Do we need to follow "MYSELF's" lead and define words for everyone?
CP: No. I trust they'll follow.
MYSELF: On with the show.

CP: Thanks for calling CP, head Pill Pauper, how may I help you?
Pt: I would like to know how much my medication will cost.
CP: Got it. For today's entree, we have prepared for you a 90 days supply of the finest 5mg Eliquis available. For such an exquisite pheast, you will only be charged $135.00.
Pt: Apparently my insurance didn't cover any of it, then? That's a shame. And I pay them so much money.
CP: They actually are covering a large part of the cost.
Pt: Obviously they're not if it's that expensive.
CP: You have to be careful. Perhaps you don't understand.
Pt: Oh, I totally understand. My insurance is worthless.
CP: Not exactly. You mustn't confuse "expensive" with "not covered". To you, $135.00 for 90 days seems expensive. If we compare that with the actual, cash paying, or coupon-aided, price, I would have quoted you around $1500.00 for the same 90 days. I can take this down to a 30 days supply, which will be a third the price, or $45.00. The cost is the same, just paid more frequently. In this case, it's spread over 12 months as opposed to 4 quarterly payments.
Pt: Wow. So they didn't cover much. I guess I'll take the monthly installments as opposed to the lump sum.
CP: Again, they covered ~90% of the cost.

ME: What was the lesson you were trying to teach?
CP: With our pricing system in America, no one understands cost. People have expectations of a number. If the reality of the actual number is outside of their expectation, then something is wrong and they blame either their insurance or the pharmacy.
MYSELF: I'm guessing you're not even going to attempt to add value to this equation.
CP: No. It would be a farce for me to explain it. It's fairly simple for us to compare related products and place value on them. What differentiates the gaming consoles on the market? Blu-Ray players? Pasta? Deli Meats? Within their respective groups, you are able to compare and contrast the similarities and differences. Prices are similar or wildly different but you are able to understand and explain why and how.
ME: I'll take Capocollo and Prosciutto and Soppressata for my charcuterie, please.
MYSELF: And you'll pay for it.
CP: Many will say it's expensive. Others, a luxury.
ME: But Eliquis is not a luxury.
CP: No. But you cannot compare the price to any other, similar product. You can't compare the Prosciutto to a Playstation anymore than you can compare Eliquis to Hydrochlorothiazide.
MYSELF: Unless you compare within the class itself, provided more than once product is available.
CP: Unfortunately, that comparison has already been made, by the insurance company as part of their formulary.
ME: Which means they can either pay their formulary copay or, if the drug requires and receives prior authorisation, the higher, non-formulary copay.
CP: Right. Simply put, you cannot put a price on your health and, again, "expensive" is not the same as "not covered". It often has more to do with the plan you selected. (Think of choosing the high deductible plan for your auto protection. The more or less liability, collision, or property coverage you choose, the higher or lower your copays. Same principle.)
ME: What is your wish for all patients out there?
CP: People seem to understand their auto insurance premiums and deductibles and spend a lot of time  researching the best deals. They should read and understand the health benefits they select.
MYSELF: Especially since they will be using their health insurance much more than they will their auto or home policies.


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