I am a practicing allergist in Georgia. I appreciate the costs of medications for my patients and make sure we have the following before embarking on long term allergy and asthma therapy.
a. An accurate diagnosis. I have seen many patients errently diagnosed with asthma or allergies and treated with expensive medications for several months before being evaluated by me.
b. Trial of avoidance measures to reduce symptoms. This can reduce the need for medication to some degree.
c. Consider desensitization by allergy shots to air borne allergens as this strategy can reduce medication use and doctor visits thus cutting costs over a several year time frame.

If you are taking expensive medications that will be maintained for several months or years consider being referred to a specialist that diagnoses and treats patients with your problems.

I recommend the people im America needs to find alternative medical care in third world countryies which are world class with brightest doctors and best in class hospitals which cost 10-30% of the expense..esp in India. where medical tourism is a fastest growing industry

One of the biggest misconceptions driving health care inflation is something Dr. Gupta just stated on CNN: Generic drugs are not the same as brand drugs.

Here’s the truth from the FDA’s own Web site: “A generic drug is a copy that is the same as a brand-name drug in dosage, safety, strength, how it is taken, quality, performance and intended use.” So what isn’t the same? The brand drug companys’ inflated price tag and expenditure on marketing to mislead doctors and patients into believing generics are inferior.

Look for yourself: http://www.fda.gov/buyonlineguide/generics_q&a.htm

Generic drugs do accomplish the same outcome in treating whatever problem, however, many drugs and chemicals on the market today contain a melange of stereoisomers where only one of the stereoisomers in a simple compound produces the desired result; its mirror image is often inactive or the source of side effects. And in many instances, the body will process, store and excrete one mirror-image molecule differently from the other.

interesting article, from a while back, check it out:

http://query.nytimes.com/gst/fullpage.html?res=9E0CE2DD1F3BF931A25751C0A964958260

The real issue isn’t just about how expensive perscriptions can be with insurance; it’s about how 47 million people still are uninsured. The part that I find hilarious about CNN’s website right now is the fact that CNNMoney has a poll asking about the biggest issue in this year’s election: between taxes, jobs, and health care. This poll is heavily biased because the people who can’t afford health care can’t afford to get online or have a computer, so of course taxes will be a bigger issue in this online poll. The middle and higher class are on this website, including myself, and we are polled on issues. We’re worried about our taxes when we need to be worried about giving everyone an option of insurance. This might not hit home for many people online, but for me I graduate soon and am taking a year off before law school to work and pay for school, and I have to worry about finding any sort of benefits of basic health insurance. I can’t imagine what it’s like for someone working two part-time jobs without any health care.

Dr. Gupta,
I watched your segment this morning about the rising costs of prescription medications and health insurance companies adjusting co-pays from a standard dollar amount to a percentage. Although I do not have an answer, I can offer a zero fee tool for all, regardless of age, income or health condition. The New York Rx Card (26 additional states have the exact program) http://www.newyorkrxcard.com – offers savings on both brand (up to 50%) and generic (up to 75%) and it is free to all. No applications, no questions, no waiting simple visit the site, download a pre-activated card, present it to your pharmacist with your prescription and receive an instant discount.
I would love the oppurtunity to discuss this with you further.

Thank you,
Francesco Ciccone
1.800.726.4232
chez@newyorkrxcard.com

An even better solution to high drug costs is wherever possible, use generics. I know the cute drug reps don’t leave generic samples + chocolate chip cookies. And I know that all the drug ads on TV are for the latest and the greatest brand name drugs your patients want and think they need. But truth be told, Lipitor and Crestor offer no advantage over a generic statin such as Pravastatin. The cost differential is amazing! It is true that Lipitor and Crestor are stronger, and that has universal appeal to patients and doctors. (If it’s stronger it must be better, right? Wrong!!! The same result is possible with a few more mgs of pravastatin) In fact Crestor is so strong there are calls to take it off the market because it is more likely to cause dangerous side effects. A perfect example of the folly of DTC advertising. The only group that knows less about prescription medications than the doctors is the general public. That’s why Lipitor has been the best selling drug in history.(even better than marijuana) Microsoft and McDonalds could take marketing lessons from Pfizer. Do you suppose that “Doctor” Robert Jarvick likes Big Macs? As of last week, he’s out of a job.

Regarding the example given of Nexium and Prevacid – perfect example of the con job big Pharma plays on us. Over the counter prilosec is virtually identical to Nexium but at about 1/8 the cost. You know which one is heavily advertised. There are 100’s of similar examples. Worst idea we ever had – DTC ads on TV. Only other country in the world with DTC ads is New Zealand. Everyone else thinks we are crazy! The NEJM wrote about this, and said it’s too late to change our minds. DTC ads are now protected by free speech laws. Consumers have got to protect themselves now.

Ways to save money on RX drugs?

Buy generics. Sometimes people may REALLY need brand, but sometimes is defined as less than 1/100.

It seems people complain more about the controlled release type generic drugs than any other. I say titrate the dose yourself with multiple dosings of the generic, and then if you still feel the drug is inferior, try the brand.

~RX student

To answer L. Richardson’s comment on generic drugs_ the FDA only requires the dose of the generic drug to be within 20% range of the brand name drug- so a generic doesn’t have to have the exact dosage as the brand name drug. For some medicines a 20% difference doesn’t matter. HOwver, for some medicines like thyroid medication- a 20% difference between on manufacturer and another manufacturer can lead to a person being under or overtreated for their thyroid condition. Wellbutrin XL is the extended release brand name of buproprion XL. However, the brand name has been shown to work as an extended release. The generic has recently been shown to release all the medicine at once- causing and initial overmedication followed not enough medicine- before the end on the 24 hour period.
Generics can have the same active ingredient- but they don’t have to have the same inactivce ingredients. This can sometimes lead to different efficacy. Generics, don’t have to be tested for efficacy like brand names. If they did they would be a lot more expensive.

As a healthcare consultant, I see a number of reasons why the cost of healthcare has skyrocketed. In terms of medication, many pharmaceutical reps give providers a tier card which outlines the pricing bracket of the prescription with different insurance plans, which may or may not be accurate. Other insurance plans have started offering performance incentives which offers a bonus to a practice that meets certain criteria; one being related to offering specific prescription drugs.

The balance is a tricky one, in that some drugs are really needed for medical treatment. Some others are often pushed, wasted, but highly recommended at that golf resort package the provider may be enjoying at the expense of the pharmaceutical company.

As a tool, a patient may ask their insurance plan for a formulary. The problem is that many patients may not fully understand the terms or drug classifications.

Insurance companies can educate patients with chronic and/or common illnesses and discuss which medications are commonly used for treatment and the cost according to their specific healthcare plans.

Another remedy for patients is to investigate, research then inquire about coverage for providers of homeopathic treatments.

I am finding with the influx of imported prescription drugs sold under generic names are completely useless. An example is Lisinipril 40 mg from India, FDA does not show that this approved for import, they only approved 10 & 20 mg. The results of this is BP 144/96 with this prescription and 144/96 without. Cheap drugs do not mean Safe/Affective. State Board of Pharmicies said this is a real problem, I am not the first one to complain, but they are powerless because FDA is responsibile.

The cost of prescription drugs, usually is not only very high, it varies very highly from one pharmacy to another. Even at the same pharmacy, different insurance plans result in different rates. All these factors make it difficult to shop around to find least expensive place to buy the drugs. One of things that can work sometimes is to try to find the least expensive place for buying the drug without consideration of the insurance coverage and then checking if they would accept the insurance plan to cut down the amount payable.

I just want to vent a little. I picked up my pills Saturday that usually cost me $135.00. I am a 61 year old disabled person on medicare. The cost Saturday was $438.00 because my insurance company told me I hit the donut hole. Give me a break it is only April! Last year I hit it in June and one medication alone cost me $456.00. I take 13 medications. What am I going to do? I can tell you I will have to do without some of the medicine because I just can’t afford that. I draw a $1076.00 a month disability and two drugs alone will be $696.00. It does not take a rocket scientist to figure out something is wrong with this picture. We need help and need it now. Thanks for letting me vent a little of my stress. By the way I have severe heart problems and could do without the stress. Virginia – Houston, Texas

Prescriptions are a major part of the problem, but there’s an even more insidious issue that no one seems to be addressing: that healthcare is overpriced! I had a 10 minute procedure to remove a 1 to 2 cm growth from my thumb and my insurer was billed more than $6,000.00! My out-of-pocket costs were $1,200, which was 3/4 of my monthly take home pay. By contrast, my out-of-pocket costs for slicing off a portion of my finger a few months earlier were $450, while my insurer was billed $600. Heck, having my cat declawed only cost me $190 and that was a surgical procedure on ALL his digits!

The other part which rankled me about my $6,000.00 bill was that I certainly did not receive quality care from all parties involved, one nurse was surly, another couldn’t read my discharge instructions to me (I had to end up reading them to her!) and the front desk gave me another patients records to review as my own! In any other service industry, the “service” I received would have been laughable, but in the healthcare industry it’s par for the course and you’re charged a premium to be so lucky.

Under my drug plan, Prilosec prescribed is $52 for 30 days. Over the counter it is $28 for 30 days. I am a retired RN and asked my doctor for the generic, Omeprazole. This cost $5 for 30 days. Go figure!

Not knowing the cost of health care is one of the major issues with our system. In 2006 I had to have major in-depth blood testing a few years ago, which was necessary in order to diagnose and treat a chronic illness. I never received a bill from the lab — which is wonderful, and I know I was very fortunate to have that benefit. But when I received the statements from the insurance company, they would show thousands of dollars of testing — for which the insurance company paid only a fraction of the price. If it was a bill for $10,000 — the insurance company paid maybe $200. My question then, as now, is what’s the real value of the testing? The same thing is true with prescription drugs. If consumers pay a co-pay — do they even notice what the actual cost is? Do people go to the doctor for minor issues because they only pay a co-pay? When we have other people who can’t afford to go to the doctor at all — who then flood the emergency rooms, where we end up paying for them with tax dollars – does this make sense? In any other industry or profession, this way of doing business would be considered unethical and unprofessional. Meanwhile, the quality of medical care has gone downhill bigtime. Sick pets are treated more humanely than sick human beings. I want the American people to stand up and say — let’s start doing things in a manner that makes sense for individuals and doctors, and not just for insurance companies, hospital corporations, big pharma and corporate profiteers.

To reiterate Kumar’s comments. It is true that the same medicine can cost more at one pharmacy than the other. One thing that I have found useful is to ask my patients to shop around. Also, Costco and Sams club tend to have less expensive prices and you don’t need to be a member to be able to buy prescriptions from their pharmacies. I have also been told that some pharmacies give bonuses to their pharmacists for pushing generics, even if it may not save that much to the patient with insurance. This is probably due to the pharmacy making a higher profit margin on generics over brand names. I have had patients tell me that they were told that the brand name medicine was no longer being produced (even though this wasn’t true) or being given the price of the medicine as if they were paying out of pocket even if their insurance would normally cover the medicine.

There are no generics for many medications. I take a TNF for a severe type of arthritis. My co-pay for this weekly injection is $500 for three months worth of medication. The insurance co has refused to honor even that, by saying I only need the medication every other week and sent me that dosage 2 months ago. Thus I paid $500 for 6 weeks worth of medication, when I tried to stretch the medication, every joint in my body was screaming and I could barely move after missing only 3 days.

My other medications total about $200 a month. My job just pays for my medications, I can’t even help with the new high food bills AND I have to work no matter how bad I feel. I am only 50 years old.

Ben,

My health administration professor told us in class that the health care system in America is what the old subway system in New York used to be: to get from point A to point B, it took two or three different fare costs and there were less connecting points, so to switch from one train to another the passenger had to get out of one train exit, walk and re-enter another train entree.

Currently, you can see that the subway system is improving: better connecting points and for just one fare, you can complete an entire journey from point A to point B.

Similarly: Usually a patients needs to see one or more specialist. If the patient has his own personal patient medical record data stored in one place, new introduced specialists would have more knowledge about the patient history by accessing this data, instead of re-consulting the patient all over again.
If all is organized in one, so should the Health Insurance plan be supporting all the medication prescribed. THis is the same data, the pharmacist has access to. Generic drugs are lower in cost, so this system is possible. Why no one is thinking of establishing this so far..is up to our future President.

And most has to do with Pharmaceutical sales politics. Drugs can become affordable.

Universal healthcare for ALL citizens of the USA is viable. It shouldnt be just for inmates. We all need to be responsible for our health. We cant abuse the system either if one comes into effect. Lets get healthy now. Start w/ the schools. Provide actual gym class for all grades. Feed kids healthy foods. Provide afterschool activities free.
There isnt a quick fix to our healthcare crisis, but we must start somewhere. Grow our kids into responsible adults. Kids want to belong to something-rather pay it to our schools than to prison and jails, court costs and probation officers. Schools should be a sanctuary and place to grow educationally. A healthy child now will no doubt be a healthy child as he/she grows older too( for the most part).
Pay for it now or later (and more expensive). There is a way for this to work, bandaiding healthcare will only fail. We all make choices for our lives and must live w/ our decisions that we make. Universal Healthcare is a viable option….later.

Doctors prescribe antidepressant/anxiety medications –without warning patients that if they take this medication–they will no longer be able to purchase health insurance. I work full time to be able to have health insurance. I was refused health insurance because I took care of myself. What’s wrong with this picture?
I also had a mole removed in 2000 that was diagnosed as melanoma insitu. If I had never taken Paxil, they told me I would be able to buy insurance in 2010–but if I had had a breast removed (a major body part) I could have been insured two years following a mastectomy. Go figure!

Comment on the cost of Health Care: I am a unemployed MRI Tech. unable to obtain Health Ins. Unemployed because 2 years ago I suffered two sudden major verigo attackes at my place of work. Both attackes lasted over 6 hours and patients had be cancelled and my employor sent me home the first time and the hospital the second time. After all the medical work-ups were done, the Neurologist just to humor me ordered an MRI at which time I was informed I had , had a stroke and possible tumor on the pons/medullary junction or possible a AVM there. Two weeks ago I had another sever veritgo attach in public, ended up in an amblunence and 8 hours in an ER I have no Health Ins. and just PRN employed. Since I did not have Ins. the Doctor changed his MRI of the Brain order, to a CT scan just to see if there was leak bleed. Now this CT scan show possibly an aneurysm on the Tip of the Basilar Artery, but no doctor is willing to address this since I can not pay cash. I am 56 years old wondering now if I have verigo again or just a bad headach, if is a terrific stroke or growing tumor. Needless to say, I am looking for any form of a job, that offers Health Ins.
In a very sick way this all is very ironic, for foreigners come to America for their medical needs, as Americans we send money to third world counties for medical needs…but do we do for Americans? If they can not pay, to, to bad, tough love.

I feel the true medical crisis is how the elderly are kept alive, way beyond their natural course of life, just to feed the insatiably money-hungry medical machine.

Patients may have renal failure (natural for old age), heart failure (natural for old age), respiratory failure (natural for old age), inability to swallow (natural for old age). All of these medical conditions help an elderly person shut down and die a natural death.

However, the medical community keeps these patients alive in the hospital or long-term acute care and puts them on a ventilator, passes a feeding tube into their stomach, makes them undergo dialysis several times a week, inserts a central line into their body so they can continuously draw blood, puts a Foley catheter into their bladder, and often places them on 20 medications or more. Theses are terminally ill patients, being kept alive in an unnatural state for years, but they bring in billions of dollars to the medical community. These patients finally die of massive sores all over their body, which the medical community attempts to treat aggressively with amputation and cutting away the sores.

Please investigate the true cause of the medical crisis, and that is offering aggressive medical care to the eldery, while ignoring the children and families who truly need medical help. Thank you

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I am a healthcare economist doing evidence based research for over 18 years. During this time I have helped bring to physicians and their patients significant advances in medicine that markedly improve patients lives, in a cost effective manner. I am watching a documentary on Healthcare in the US. Two couples were shown each having children needing extensive neonatal coronary surgery, advanced life support, etc to keep their babies alive. Unfortunatley the “Payment” system caused hospitals to charge an exorbant amount due to the negotiated contracts they have with the payers. We all know a bill of $700,000 may actually be paind at less than $250,000 from the insurance company. The hospial then charges the patient the balance, or if the procedure is considered not covered by the insurance company, then the patient’s family is liable for the entire bill. Two points mentioned by the patrents that are NOT correct. The parents said they would have received better care for their children in different countries. This is NOT correct. If the baby were born in Canada or the UK, the baby would likely have died earlier. The skills and technology may not have been available, and advanced surgical interventions are not availabe in many countries due to budgeting contraints. For example, in the UK, oncology drugs are not paid for by the NHS. Patients need to go to other countreis and pay a handsome out of pocket amount for these advanced forms of treatment. So, yes our system has many problems, but clincally we have excellent advances in medicine, we have excellent physicians and care givers. A system that would be entirely subsized by a government organization would have the authority to limit what a patient can receive in medical care. Clearly being denied an advanced medical service, or told to pay out of pocket for these advanced services, puts us right back to where we are today. After 18 years here are my suggestions: Each private insurance company, pharmaceutical company,, device company, and some of the most profitable hospitals. but take a sliding scale of their profits to fund the un and underinsured population, creating a “social insurance fund”.. Patients would have to pass a means test to verify they actually qualify for the newly created insurance fund. If a person were employed with an insurance plan of their own, then they would be eliminated. People that particiapte in high risk behaviors such as smoking, have chemical dependency,or participate in high risk behaviors would be required to go through programs to stop the risky behavior. Those that choose to continue to behavior would receive less of the “. These people by the way, currenlty are not considered insurable by many health insurance companies today.
Certainly this is just one aspect of the solution, but what is not democratic is for the medical industries “selling” to the patients and physicians, making generally huge profits, and putting riska and costs on the patients.
Thank you for reading this far. I realize this plan would never materialize. Any politician that wants to stay in office would not have the nerve to propose such a solution.
By the way, do you really beleive employers, such as Wal Mart, or the bigger employers will take the money they paid in premums and pass that as added income to their employee is dreaming.

Dr Gupta
My wife and I watched your program on health cost, we found it very interesting a new born baby costing 40,000 dollars per day for its care.
My wife and I are retired but still work part time jobs to make ends meet.We own are house mortage free ,live in a rural Northeast Town and pay plenty to survive like the rest of the country.
My main purpose of contacting you is to inform you how much were paying for insurance monthly .
Our deduction from our social security check for medicare part A and B
we also have the supplement insurance Blue Cross and Blue Sheild to cover what Medicare does not pay for.A total of 640.00 dollars per month for both of us.Makes it tight for extras. Thank you Joe M

I watched a special april 26, 2008 titled “Broken Government, Crisis in Healthcare” on CNN. I would like to purchase a video. Please advise. Thank you, DBarlow

I think this sort of discussion ought to address a fundamental structural conflict of interest between the system of medical care as such, physicians, hospitals, and patients, and the pharmaceutical and health-care-access business. The conflict is in the fact the revenues and profits of both health care access providers and pharmaceutical companies is proportional to the total cost of health care services. Consequently, these companies’ business models achieve success by maximizing the overall cost of health care. The effects of this conflict of interest manifest in a variety of ways that do harm to the practice of health care.

For example, two of the largest components of the overall cost of health care in the US are obesity and consequent chronic medical conditions, notably type 2 diabetes. Pro-active wellness maintenance programs are by far the most cost-effective means of addressing obesity and its complications, yet there are very few examples of health care access providers pursuing such programs. Instead, health care providers receive massive incentives to avoid addressing wellness, because chronic acute care is one of their biggest sources of revenue.

A related example is the care of acid-reflux disease. A significant proportion of the GERD case load traces its root causes back to chronic stress and poor stress management. Health care access providers would best serve patients by empowering them to reduce and manage their daily stress, through pursuit of pro-active wellness programs and through education programs that would teach about the true cost of chronically excessive stress. Once again, there’s a huge disincentive to pursue disease prevention programs because chronic care is such a huge cash cow for both health care access providers and pharmaceutical companies.

This is the fundamental structural conflict of interest built into the business models of the health care access and pharmaceutical industries that seems obvious to me, but that I don’t ever hear spoken of in public.

Normal insurance business models are based on risk management, and profit by risk avoidance, but health care access providers and pharmaceutical companies profit most from risk realized and from growth in the cost of health care provided. This means that the business interests of health care access providers and pharmaceutical companies are in direct opposition to the interests of physicians and patients.

Unless this issue is brought into public view and a way is found to counter the incentives built into current business models, the priorities of health care access providers and pharmaceutical makers will continue to create a direct conflict between these businesses’ profit incentives and their stated mission to efficiently and effectively improve the health of patients. In the face of this conflict, I’ve never heard of a case in which patients won out over profits.

I think this is the most fundamental reason the US health care system costs what it costs. Succinctly, the health care system is what it is because it gets paid for treating the sick, and not for keeping people well.

Thank you Victoria. I read your comment on Medicare’s Prescription Drug Plan, Part D. I am also stuck in the coverage gap, donut hole. The way my insurance company does it, is that they add their cost with mine to the first 2.500 dollars spent on medications. I am then placed in the coverage gap until my cost alone, not with theirs, adds up to another 1,500 dollars. At this point they stop paying for brand name medications. After I accumulate the 1,500 they will than pay for all of my medications. The only problem with this is that with a fixed income where do I find the 1,500 dollars. I am saving my money, but it’s going to take months to collect it. This means that I will have to go without some of my medications, because my most important medications do not come as a generic. A months supply for one type cost close to 1,000 dollars. That’s for one. Right now I am trying to find the money to pay for a type of insulin that I need. It is not generic.

What I hope is that other people with this problem will write congress over and over to change this practice. I’m sure that there are other people traped in the hole and can not get some of their medications.

Continuation after I accidentally hit the enter button…

As an example: insulin vials are the prefered (by insurance) and insulin pens often are not covered while in Europe, pens are the standard dispensing form.

It would be nice if CNN could do a special on health care in the developed world outside the US, from the perspective of doctor, hospital, community clinic and patient.

Generic medications are a great way to keep your prescription drug costs down. I’ve seen ads on TV for Caduet. It has two ingredients. One is Amlodipine and the other is Atorvastatin. With my RxDrugCard I can get 30 tablets of Amlodipine for $9 and 30 tablets of Simvastatin for $9. I’ll bet they are charging more than $18 for this new drug! The unthinking public is going to pressure their doctors into giving them something just because it’s new, when something old or generic would do the job for cheaper.