Hidden in Plain Sight: Inflated drug prices

I remember being ten years old, sitting in the living room and trying to read while my visiting grandparents sat discussing the kinds of things old folks always seemed to discuss: roughage, price increases, recent surgeries, why doctors no longer make house calls. Somewhere in the midst of all that, I remember my granddad complaining that he’d gone over his medical bills and found that, for two aspirin, the hospital had charged him the price of an entire bottle of aspirin: $1.25 for a four-cent aspirin. Living with today’s prices, a buck and a quarter hardly seems worth a moment’s sweat, but this was forty years ago, and the markup was pretty outrageous: just over 3,000%.

Imagine that. A three-thousand percent markup. They certainly had some strange notions back in the ‘60s. Oh those wacky 20th century hospital administrators. They must have thought us pretty dense.

And today’s hospitals? Well, when I went over my medical bills, I didn’t find any aspirin tablets. I did find a couple of Tylenol, though—which I can buy at the neighborhood drugstore for $25.99 for 290 caplets (or roughly 9 cents apiece)—for which the hospital charged me $6.00 ($3.00 apiece). Markup in a 21st century hospital? 3,233%.

Astounding. Patients have been complaining about this problem for at least forty years, and it’s still going on.

I looked over the drug prices charged in my hospital bills and compared them with the local Walgreens, CVS, and QVL pharmacies. Some of these products were items I was already using before I was admitted. Some, like the Hibiclens soap, are O/R necessaries.

Product Function Hospital cost Local pharmacy cost Mark-up
Hibiclens Pre-surgical cleanup $25 for 4 oz $12.99 for 32 oz 1,424%
Hydrocodone 10 mg Pain relief $8/pill $0.71/pill 1,027%
Neurontin 300 mg Nerve pain $11.62/capsule $2.27/capsule 412%
Duragesic 50 mcg/hr Chronic pain $150/patch $53.20/patch 182%
Desyrel 100 mg Sleep $6.25/pill $3.57/pill 75%

At first glance, the last couple of entries in that list don’t look too bad. One thing bothered me, though. I have always been conscious of the difference between generic and name-brand prices. I didn’t ask for Neurontin, for example, I asked for Gabapentin, which retails for approximately $1.09 per capsule. By giving me Neurontin instead of the requested generic, the hospital doubled my cost. The same is true for the Duragesic patch, a very expensive version of the Fentanyl patches that sell for $26 in the drug stores.

I’m more concerned, though, with the way medical personnel throw around brand names for everything—even when what they’re giving you is a generic. This habit reaches the billing offices. Now, I don’t know whether the hospital actually gave me Neurontin or the cheaper Gapapentin. They look pretty similar. In the case of the Desyrel, however, I know that I was given generic Trazadone. I’ve seen Desyrel pills. They say “Desyrel” right on the pill. The difference is an order of magnitude. Trazadone retails for just 42 cents per pill, making the actual markup a whopping 1,388%.

In past blog entries in this series, I’ve been trying to take the high road on these costs. In cases of upcoding, double-billing, even erroneous claims, I’ve tried to find a reasonable explanation. On unwarranted inflation of drug prices, though? I can’t even begin to fathom how this keeps going on year after year.

Still, as I’ve said before, fixing the blame won’t fix the problem, and finding fault won’t find the cash you need to burrow out from under a mountain of medical debt. So, just like the other problems, when you review your bill, check the drug prices against area pharmacies. Determine the price markups, and add them to your list of bill errors and grievances.

Don’t get mad, though. Don’t let any of these errors make you mad. Just be astounded. Let your astonishment fuel your desire to negotiate a reasonable medical bill.