Dr. Zorba Paster: Drug costs confound doctors, too

Dear Doc: Loved your column on generic drugs — how the potency may not be the same with all “generic Ritalin” drugs. Good job. But you left out one important thing: combination pills.

My doctor prescribed a combination of amlodipine and benazepril, two blood-pressure pills I take. When I bought them separately, they were only about $7 each for a three-month supply. So for a total of about $15 I could get three months of treatment. That’s a bargain.

But here’s the problem: My doctor wanted to make life easier by prescribing a combination pill. That prescription cost me a whopping $75 per month. So now I pay $225 for three months, just for the convenience of having everything in one pill.

Why is that? Doesn’t my doctor know about the higher cost? It’s a rip-off if there ever was one. — Mary Lee, Spokane, Washington

Dear Mary: Here’s why: The combination pill you’re getting is a name-brand pill, Lotrel. There is no generic. No generic drug company has decided to put these two medications together, test the drug and submit it to the Food and Drug Administration, as required.

So you’re paying top dollar for what you can get separately for a pittance. You’re right to be miffed. Who wouldn’t be?

Could your doctor know about this? Maybe. But the way medicine is practiced, we doctors rarely know how much things cost.

With the advent of the electronic medical record, this is changing. When I prescribe some drugs for some patients, I see information about the drug. It may say “generic” or “not on formulary,” or there might be dollar signs – $, $$ or $$$. That helps alert me to potential costs.

The problem is, I don’t have access to all insurance carrier formularies – and let me tell you, there are a gazillion of them. That means I, as your doctor, or you, as the patient, won’t know the cost of the prescription until you pick it up at the pharmacy.

Now, let me go one step further into this screwy system, with something that happened to me the other day. I had a patient using a QVAR, which is a steroid inhaler, and I had prescribed a good one, usually well-priced.

Well, the patient’s insurance company decided to contract with another pharmaceutical company, making the prescribed QVAR jump from a $25 co-pay to more than $230 a month. My patient was, as you would expect, disturbed, to say the least.

I had my nurse call the pharmacy to see which inhaler would be covered under the revised plan. The pharmacy told her, get this, that they couldn’t tell until I generated a prescription and they ran it.

You got it: They couldn’t quote the price until I prescribed the drug.

Is there anything in America that is more screwed up than this system? I doubt it. And all of us consumers pay for this dumbness.

Now, with this particular patient, we ultimately fixed the issue by figuring out, through trial and error, which inhaler was equivalent and cheaper.

But what about the less informed patient who just picked up a prescription, assuming it was the inhaler I wanted and there was no equivalent substitute? Who wins in that case? You guessed it – not the consumer.

Dr. Zorba Paster is a family physician, professor at University of Wisconsin School of Medicine and Public Health, and host of the public radio program “Zorba Paster on Your Health,” which airs at noon Wednesdays on 91.1 FM, and noon Sundays on 91.9 FM. His column appears twice a month in The Spokesman-Review. Write Dr. Zorba at askzorba@doctorzorba.com with any health question you have. He loves mail.