Category: Price Transparency

Insulin Affordability

marciarillegmailcomLeave a comment

Over nearly three decades … Lilly has raised the list price on its most widely used insulin product, Humalog, by more than 1,000 percent, which is why I greet Lilly’s announcement of the $35 a month out of pocket cap for the commercially insured with both joy and sorrow.

Is it, Lilly had a great gig going with those Humalog price run ups and now knows all good things must end? Or, give a little to avoid being forced to give a great deal more on general pharmaceutical pricing? And, what about those who are not commercially insured, who must seek this insulin price relief for out of pocket purchases, for example, by applying to Lilly’s co-pay support program? What will happen to them?

Why Does Health Care Transparency Matter?

Ann Marie MarciarilleLeave a comment

I visited a Walgreen's Take Care Clinic this past weekend. Patient registration is completely automated and completely self-serve at the Walgreen's closest to my home in Kansas City.  At the very end of registering for a vaccination appointment, I was asked to review my potential financial exposure for the clinical encounter. 

Here, I perked up.  I am interested in health care price transparency to consumers.

What did I see on the screen?  I was shown a split screen: on the left a scrolling menu of vaccination and innoculation prices for the uninsured or those paying out of pocket and on the right a static screen advising that the clinic would provide services, bill my insurance, and then — possibly — bill me some more.

Now, a quick thinker could extract the out-of-pocket price of the relevant vaccination from the left hand scrolling menu and assume that would be the maximum exposure for any services to be submitted to commercial insurance on the right hand of the screen.  The problem with that is there were some pretty spendy items on the out-of-pocket left hand screen — the zoster vaccination was $220, for example.

A slower thinker could get out their cell phone and begin to mine their insurer's coverage documents for indications as to the likelihood of insurance coverage for the health care services sought. This, of course, could be a lengthy endeavor — the kind of lengthy endeavor that might cause you to exceed your Walgreen's Take Care Clinic appointment window.  One of those registration screens, after all, required me to acknowledge that my appointment time would be considered missed if I were more than 20 minutes late for the appointed time.

We make it hard to for insured health care consumers to gain accurate pre-treatment information on health care cost. Emergency or urgent health care consumers may not all be particularly price sensitive, but elective services and procedures leave a wide window of opportunity to provide easy-to-access simplified data on coverage and cost to consumer.

There are few services we buy this way, where the cost of an important service is hidden from us in advance. The insured are often insulated from health care cost by their insurance itself, leaving them focused only on the cost to themselves: co-pay, deductible, premium contribution, and scope of coverage. The other payer is the health insurance plan sponsor — an employer for most commercially insured Americans — and they are, once again, growing restless at the lack of price transparency in health care.  You can read about the Catalyst for Payment Reform's (and employer not-for-profit) lates price transparency initiative here: http://www.modernhealthcare.com/article/20121101/NEWS/121039998/commentary-catalyst-for-payment-reform-calls-for-price-transparency?utm_source=frontpage&utm_medium=newsitem309&utm_campaign=carousel-traffic#

Up soon: Is price transparency a panacea for health care cost inflation?