Patients have a very hard time navigating the world of medical supplies and medications. Frankly, physicians do as well. We went to school to be doctors and help people, not navigate insurance contracts. Nothing frustrates us more than to prescribe a regimen we know will help someone and then get a phone call saying that isn't possible for financial/insurance purposes. Happens all the time.
To combat this, I've started doing some of my own research to find ways to keep things affordable for patients. My love for generic medications and the $4 list is well documented. Today, I'm going to lay out an extremely affordable strategy for someone that has just been diagnosed with diabetes. There are a few assumptions I make, but the strategy is fairly generalizable to most new diabetics and involves only two different stores that most folks have within driving distance of their homes, Wal-Mart and Publix, as well as Amazon. I've broken this down into three parts.
Medications
The mainstay of therapy for new diabetics is a medication called metformin. The vast majority of folks will be started on this and will be controlled well for some time. Publix has this medication for FREE. Yes, that's right. $0. Make sure your prescription gets sent to Publix, or you just get the paper prescription to take it yourself.
Total Cost: $0
Diabetic Supplies
The main supplies required for a new diabetic are the items needed to test your blood sugar. If you are just taking oral medications, then your doctor will typically tell you to test your sugar daily in the morning and as needed. To do this, you must have a glucose meter, test strips, lancets, and alcohol wipes. The key to understanding how to price these items lies in the test strips. There are tons of different brands of glucose meters. All have corresponding test strips that ONLY work with that particular brand of glucose meter. Many companies will heavily discount the meter itself to lure you in and then charge crazy prices for the test strips. Never buy a glucose meter without knowing the test strip cost because that is what you will be continually buying every few months.
The cheapest, most convenient option here is the basic Wal-Mart brand. Here are the links and relevant prices:
ReliOn Prime Blood Glucose Monitoring System: $16.24
ReliOn Prime Blood Glucose Test Strips(100 count): $17.88
ReliOn Lancing Device: $5.84
ReliOn 33G Micro Thin Lancets(100 count): $3.74
Curad Alcohol Swabs Antiseptic Wipes(200 count): $4.66
One Time Cost (Meter + Lancing Device): $22.08
Ongoing Yearly Cost: $87.42
Labs
Besides your regular blood sugar tests, your physician will likely see you about once per quarter to check your Hemoglobin A1c (A1c for short). Current American Diabetes Association guidelines suggest to have the A1c checked every six months if under good control or quarterly if not controlled. Your A1c is a measure of what your average blood sugar has been over the prior quarter and is used to help determine if your diabetes is under control. I don't know about you, but labs can be downright expensive, even with insurance. Wal-Mart has come through here again with an at home test that you do yourself and send off. There are tests that give you instant results as well for a bit more money.
Reli-On A1c Test: $8.98
Yearly Cost (assuming 4 checks per year): $35.92
If you're keeping track, here are the totals for initial investment and ongoing yearly costs:
Initial Investment: $22.08
Ongoing Yearly Costs (averaged over 365 days): $123.34
There you have it. Diabetic supplies, medication, and necessary labs for an up front cost of about $20 and ongoing yearly cost around $125. No insurance involved. When you think about how this doesn't even touch the average deductible, its pretty amazing to me that more people don't do something like this. You wouldn't drop $50,000 on a car when your neighbor got it for $5,000. Don't treat health care any differently.
*All figures are as displayed online and do not include applicable taxes or shipping and handling fees.
Wednesday, February 25, 2015
Tuesday, February 17, 2015
Sensible Medication Refills
Medications will drive you up the wall as a physician. You would think that the simple act of evaluating a patient and prescribing a medication would be rather easy, but it's not. 90 or 30 day supply? How many refills? Generic or brand name? Are we going to e-scribe or print it out? Is that medicine on the patient’s particular insurance formulary? Do I need to fill out a prior authorization for it? All these things take up time throughout the day that clinics could use to see patients.
Many insurance companies don't make this very easy. As physicians, we see patients with a myriad of different insurance plans all day. It's impossible for us to accurately keep track of what each insurance formulary says. It's also exceptionally difficult for us to always keep track of which mail order service or pharmacy your insurance company prefers.
As much as I can, I try to steer folks towards the $4 list. Wal-Mart started this and now most pharmacies have a similar list. You can manage the vast majority of conditions effectively with meds from this list. The trick is reminding patients to not run their insurance when they buy the medication. Ironically, these $4 medications can often cost you more than $4 if you use your insurance.
From a physician efficiency perspective, I’ve often wondered about the way we prescribe medications. We must write both how many days’ supply to dispense as well as number of refills. As I consider this, I wonder why we do this? As a physician, do I really care if the insurance company prefers you have 90 days’ supply? What if they preferred 47 days or 102.6 days? The number doesn’t matter to me.
When a person with high blood pressure comes for their appointment and I give them 30 days’ supply with 5 refills, the punchline is that I want them to have 6 months’ worth of that drug. Why don’t we just say that? The insurance companies and pharmacy can then work out exactly how that is dispensed. Let me move on to the next patient and not have to take the phone call back from the patient asking for a new prescription because their insurance company prefers 90 day supplies. If their insurance company has that preference, then their insurance company can take that phone call.
Sunday, February 8, 2015
Warren Buffett and Colon Cancer
I love listening to Warren Buffet talk. The Oracle of Omaha is a repository of wonderful business and investing tips. I especially love his focus on value. He is widely regarded as one of the greatest value investors who has ever lived. If you listen closely, you'll note a peculiar thing that he repeatedly says. The key to investing has nothing to do with brains.
Buffet constantly harps on the ability to think clearly, not get too high or too low, and never follow the crowd. He uses his catchphrase, "circle of competence," to describe how investors should spend a lot of time determining what they know well and never venturing outside of it. He maintains that any one can invest well if they simply stick to what they understand, no matter how large or small that "circle of competence" is.
Many people are simply incapable of doing this. The attraction of following the crowd or taking on too much risk for the mere hope of improving returns (see nearly all actively managed hedge funds) overcomes their sensibilities, and they find themselves doing the same thing that everyone else is doing. This results in the same results that everyone else gets.
Physicians are no different. In fact, as a group, we are a case study for why having any amount of brains can actually be far more dangerous than helpful. As one of my mentors in residency said, "Some of the most intelligent physicians you will ever meet can't make two plus two equal four." Quite simply, common sense can oftentimes escape those that are considered the most intelligent.
The medical field is in the beginning stages of a transformation. Value is the new buzzword and the very nature of how transactions are made in healthcare will be changing from a fee for service, pay when you get seen environment to a value based, pay for results environment. Many physicians do not grasp this and have no idea the type of change this will have on their daily medical practice. Today, we discuss just one small part of this change, colonoscopies.
Every one that has hit the magical age of fifty and been to a doctor has gotten to have the lovely conversation with their doctor of screening for colon cancer. Millions of Americans have then gone from their physician's office to the closest facility and gotten a colonoscopy, all in the name of prevention and wellness. Unfortunately, many people do so without realizing their options.
What would you say if I could replace that unpleasant, costly, and risk laden procedure with a simple at home, yearly test? As a matter of fact, I can. A fecal occult blood test looking for blood in the stool can be done in the privacy of one's home and, when performed yearly, give the exact same results as a colonoscopy.
In fact, America is one of the few places in the world where a colonoscopy is the first thing offered for colon cancer screening. The idea is considered laughable in Europe where fecal occult blood tests are even done every two years and usually not starting until age 60. Why are the Americans pouring all this money into an expensive, risky test that can be reproduced with a simple stool sample collected at home? It's ludicrous, and it's another example of how Warren Buffet would simply shake his head at us.
So this is a shout out to all of my gastroenterology friends. Save your money now. When insurance companies and Medicare/Medicaid change to a value based system, you can bet that regular colonoscopies will be on the chopping block. No one is going to pay for a procedure that can be replaced with a stool sample. That's one test that is most definitely worth a crap.
Buffet constantly harps on the ability to think clearly, not get too high or too low, and never follow the crowd. He uses his catchphrase, "circle of competence," to describe how investors should spend a lot of time determining what they know well and never venturing outside of it. He maintains that any one can invest well if they simply stick to what they understand, no matter how large or small that "circle of competence" is.
Many people are simply incapable of doing this. The attraction of following the crowd or taking on too much risk for the mere hope of improving returns (see nearly all actively managed hedge funds) overcomes their sensibilities, and they find themselves doing the same thing that everyone else is doing. This results in the same results that everyone else gets.
Physicians are no different. In fact, as a group, we are a case study for why having any amount of brains can actually be far more dangerous than helpful. As one of my mentors in residency said, "Some of the most intelligent physicians you will ever meet can't make two plus two equal four." Quite simply, common sense can oftentimes escape those that are considered the most intelligent.
The medical field is in the beginning stages of a transformation. Value is the new buzzword and the very nature of how transactions are made in healthcare will be changing from a fee for service, pay when you get seen environment to a value based, pay for results environment. Many physicians do not grasp this and have no idea the type of change this will have on their daily medical practice. Today, we discuss just one small part of this change, colonoscopies.
Every one that has hit the magical age of fifty and been to a doctor has gotten to have the lovely conversation with their doctor of screening for colon cancer. Millions of Americans have then gone from their physician's office to the closest facility and gotten a colonoscopy, all in the name of prevention and wellness. Unfortunately, many people do so without realizing their options.
What would you say if I could replace that unpleasant, costly, and risk laden procedure with a simple at home, yearly test? As a matter of fact, I can. A fecal occult blood test looking for blood in the stool can be done in the privacy of one's home and, when performed yearly, give the exact same results as a colonoscopy.
In fact, America is one of the few places in the world where a colonoscopy is the first thing offered for colon cancer screening. The idea is considered laughable in Europe where fecal occult blood tests are even done every two years and usually not starting until age 60. Why are the Americans pouring all this money into an expensive, risky test that can be reproduced with a simple stool sample collected at home? It's ludicrous, and it's another example of how Warren Buffet would simply shake his head at us.
So this is a shout out to all of my gastroenterology friends. Save your money now. When insurance companies and Medicare/Medicaid change to a value based system, you can bet that regular colonoscopies will be on the chopping block. No one is going to pay for a procedure that can be replaced with a stool sample. That's one test that is most definitely worth a crap.
Welcome!
Welcome all! This is my inaugural post on this blog. My name is Robert Glass, and I am an internal medicine physician hailing from the great state of South Carolina. This blog is dedicated to all of my medical related tips and tricks. I really enjoy helping my patients navigate the health care system and especially enjoy showing them how to do so in the most cost effective way. There are big changes happening in American health care, and my aim is to pull back the curtain a little bit so you can see exactly what is happening behind the scenes. Have fun and let me know if you have any questions!
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