March 19, 2021
How can Hearthside Family Health SAVE me money on my healthcare?
I can honestly say that I had no idea the costs my patients were being charged when I prescribed a medication, ordered a lab or sent them for an x-ray in my previous job working for a hospital-owned practice. I barely had time to breath between visits and was just trying to do what was “right” and get through my schedule without being an hour late. I would create a list of orders and hope the patient “complied” by doing what I asked. Often, however, I was unaware of the burden I was placing on them; often those studies were completely unaffordable for the average patient with a high-deductible insurance plan or no insurance at all.
Once I learned more about Direct Primary Care, I learned the sorry truth that prices vary greatly between different insurance plans, different pharmacies and a HUGE burden is being put on patients when it comes to healthcare costs. AND, the resultant healthCARE isn’t always so caring.
When I became a doctor, I vowed to DO NO HARM and I think that vow should also include doing no FINANCIAL harm to patients. If a patient can’t afford their care, they will often delay or avoid care in order to financially survive. Sometimes this delay has negative consequences for their long-term health.
So, how is it that a membership-based primary care practice (where you pay a monthly fee in addition to insurance premiums, if you have it) could SAVE YOU MONEY??
-Let’s start with labs.
Ask most doctors what a CBC or CMP costs at their facility and they’ll likely furrow their brow and reply, “I don’t know-It depends on your insurance”. These days, so MANY things depend on your insurance.
Did you know that hospitals can charge whatever they want for labs and insured patients will get a discount from their insurance company but uninsured patients are not sheltered from those “contracted rates” and shoulder those high costs?
We do labs in our office. At a local hospital, a cholesterol panel (lipid panel), CBC (complete blood count) and CMP (comprehensive metabolic profile) will cost about $280. Those SAME labs, done at our office will cost a patient $39. How is that possible? We contract a client rate with QUEST labs and they offer our office 60-90% off lab prices.
-Next, let’s look at medications.
There is a wide variability in the cost of generic medications from pharmacy to pharmacy. A study in St. Louis found that the prices for 3 common generic medications varied from a low of less than $20 to a high of $397!! That is ridiculous!
How are prices at retail pharmacies set? These retailers can markup costs as high as 300% in some cases. Next, middle-men called Pharmacy Benefit Manager (PBMs) also play a role. Their job is to negotiate the formulary (medications covered by your insurance plan) and their costs at the local pharmacy. However, this system of PBMs often makes more money for themselves by inflating the costs of your medications.
Here is an explanation from a fellow DPC doctor, Dr. Paul Thomas:
“To illustrate, you should be familiar with the term “clawback.”
A “clawback” happens when the patient's copay is more than the pharmacy's cost for the drug. For example, if a customer's prescription copay is $20 but the pharmacy's cost is $5, the PBM claims -- or “claws back” -- the extra $15, which it keeps as profit.
That’s right - if your son or daughter has strep throat, and you want to buy Amoxicillin, and the cash price is about $5, as it should be, but the PBM “negotiated” the price to be $20, and you buy that Amoxicillin with your insurance, you’d pay $20 for the $5 medication and the PBM keeps the difference.
So how can you save on prescriptions? SHOP AROUND. Many of you are familiar with discount cards such as GoodRx that can save you money. If your insurance-based price is high, research the cash price or ask about a savings cards through the state (NH Rx Card). Every New Hampshire resident is eligible for this discount card program.
Another option is to buy directly from Hearthside Family Health as a member of the practice. We buy medications at wholesale prices and markup about $.50-$1 on each medication to cover the cost of supplies and shipping. For many medications, our price is even lower than GoodRx.
Here are some examples:
|
Medication |
GoodRx price locally |
Our price |
|
Losartan 100mg (generic Cozaar) #30 |
CVS- $27.00 Rite Aid $19.66 |
$9.00 |
|
Atorvastatin 20mg (generic Lipitor) #30 |
CVS- $19.20 Rite Aid $15.00
|
$4.00 |
|
Bupropion XL 300mg (generic Wellbutrin) #30 |
CVS $35.70 Rite Aid $25.60 |
$6.00 |
|
Fluconazole 150mg (generic Diflucan) #2 tabs |
CVS $14.80 Rite Aid $10.66 |
$7.00 |
|
Sulfamethoxazole/Trimethoprim 800/160mg (generic Bactrim) #20 tabs |
CVS $10.75 Rite Aid $9.11 |
$4.00 |
*the GoodRx prices were checked 3/19/21. The listed prices are not necessarily the lowest prices but they are the local Peterborough prices. Other NH pharmacies with lower estimates may be inaccessible to those with inadequate transportation.
If you are taking multiple daily medications, these savings could really add up! Compare our prices to your current copays or uninsured costs.
-Finally, let’s consider copays.
What is the copay to see your Primary Care Provider (PCP)? Most are between $10-$50. How about for specialists? (average $30-50). In our office, there are NO copays. You can be seen as many times as you need each month and it’s all included in your monthly fee. Since our visits are extended and we have the time to address your concerns, we can often avoid specialist referrals, as well.
And our availability also helps avoid the ER and urgent care centers, where copays can be $75-$300!
If this all sounds like something you want to learn more about, visit our website at www.hearthsidefamilyhealth.com or call us at 603-312-1600.
Both Siobhan and I are currently still accepting new patients.
Carrie Klonel, D.O. with Hearthside Family Health
