Thursday, October 20, 2016

Four Things You Can Do to Avoid Overpaying for Prescription Drugs

We recently hosted a number of sessions to help staff learn more about prescription drug benefits. 
There is a delicate balance to having discussions like this with our staff. I don’t want anyone to feel bad about getting what they need, but we don’t want people to be taken advantage of either. We focused in on four things we can do as consumers to avoid overpaying for prescription drugs.

Look for Generics
This sounds like an obvious suggestion, but maybe not for the reason you think. Generics are not just cheaper. Generics are safer. Generic drugs have been on the market longer and have been taken over longer periods of time by more people. Because of this, the side effects and long term health implications are better known.

Choose a Pharmacy the Same Way you Choose a Gas Station
Prescription drug prices vary from pharmacy to pharmacy the same way gas prices vary between gas stations. Most of us want to strike a balance between convenience and cost when we make this choice. We showed staff how to use the GoodRX tool provided on our Magellan site to compare prices between pharmacies. Right now, this feature is only effective four our staff that have our high deductible plan with the HSA. (Anyone can use the GoodRX app.) 

Participants were shocked to see how dramatically prices vary. We looked up a number of drugs to see how much we could save by driving as little as two miles. For example, 

  • Rosuvastatin the generic for Crestor was $13.59 at Giant pharmacy and $60.46 at Walgreens. 
  • Aripiprazole the generic for Abilify was $100.19 at Harris Teeter and $292.61 at CVS. 

It’s easy to transfer a prescription--if you find it for less at a different pharmacy, just call the new pharmacy and ask them to help you. 

It's access to the GoodRX tool that lead us to Magellan. I liked the app, but wanted it integrated into our health plan so people with our insurance could use it, see our pricing and have what they pay track toward their deductible. That's exactly what Magellan has done. 

In all honesty, we got a little bleeding edge on this one and we spent a lot of time working out the glitches with Magellan, but they are pretty well sorted out at this point and we have a state of the art tool for our staff to use. If you have a high deductible health plan and you don't have this tool, talk with your HR folks and ask for it. 

Beware of Drug Combining
We asked participants to watch out for drug manufacturers combining two old drugs into a single, costly “new” drug. We had a $9,027 charge for Zegerid. Zegerid is a compound of omeprazole [over the counter Prilosec] and sodium bicarbonate [alka-seltzer] that could be purchased for $20.

Similarly, we had a claim for Treximet for $1,471. 
Treximet is a migraine medication that is a combination of generic sumatripan and over-the-counter naproxen [Aleve]. Bought separately, the components cost about $37 for a 90-day supply. 

My doctor shared that she no longer accepts free samples from drug companies because they only provide samples of the newest, most expensive medications. When she shared them with her patients, they either thought they needed that brand and insisted on it or quit taking it because of the cost. I wonder if that’s what led to the claims we have had for Zegerid and Treximet. Check out to see the payments your doctors received from pharmacy companies. It won't tell you if they accept free samples, but it will provide useful information.

Ask Five Questions

How can you avoid being taken advantage of by the prescription drug manufacturers? Ask the 5 questions recommended in the Choosing Wisely campaign before getting any test, treatment, or procedure and carefully considers all options before deciding among them:

► Do I really need this test or procedure?

► What are the risks?

► Are there simpler, safer options?

► What happens if I don't do anything?

► How much does it cost?

Interested in learning more? Take a look at the resources Consumer Reports has put together. Or, search my blog. I've written quite a bit on this topic most recently The Dark Art of Prescription Drug Pricing. Don't miss the John Oliver video in that post. It's definitely worth a few minutes of your time. 

I enjoy Sarah Kliff's reporting on health care for Vox. I recommend The true story of America's sky high prescription drug prices and If Trump wants to lower prescription drug prices, he's going about it all wrong

It's also worth giving some thought to who funds the studies. The Cochrane concluded: "Sponsorship of drug and device studies by the manufacturing company leads to more favorable results and conclusions than sponsorship by other sources. Our analyses suggest the existence of an industry bias that cannot be explained by standard 'Risk of bias' assessments." Learn more about the industry sponsorship and research outcome study here.

This Freakanomics Podcast is worth a listen too. 

Bad Medicine, Part 2: (Drug) Trials and Tribulations

ReleasedDec 08, 2016
How do so many ineffective and even dangerous drugs make it to market? One reason is that clinical trials are often run on "dream patients" who aren't representative of a larger population. On the other hand, sometimes the only thing worse than being excluded from a drug trial is being included. 

Monday, August 8, 2016

How We Think About Stress Matters

What Doesn't Kill Us Makes Us Stronger

I've never been a fan of stress management programs in the workplace. For a long time, I've believed that stress comes from how we respond to events at work, not the actually events themselves. Instead of managing stress, I've tried to focus on helping people build resilience so that we can better withstand the stressful events when they occur. 

Recently, I read an article in the Economist that expanded my thinking. It suggests that stress makes us stronger in the same way weight baring exercise makes our bones stronger. How we think about stress matters. And, knowing this gives us a few more ounces of control. 

Friday, July 22, 2016

The Student Debt Crisis: What Role Should Employers and Professional Associations Play?

Generations of Americans have been raised to think that money spent on education is always a good investment. If you study hard and get decent grades, the rest is supposed to work itself out. You'll get job, pay off your loans and live the American dream. Unfortunately, many students are lent more than they can pay back in the years after graduation. The rule of thumb I've read is that you shouldn't borrow more than what you expect to earn annually when you graduate. Years after earning their degrees, today's graduates can't buy a home or start a family because they can't dig out from under their student loan debt. The statistics are startling:  

Sunday, May 22, 2016

Ten Takeaways from Health & Benefits Conferences [#BenefitsConf & #WHCC]

I recently attended the HRE Health and Benefits Leadership Conference in Las Vegas and the World Heath Care Congress in DC. I sat down after the two events and made some notes about what stood out for me. Here are ten takeaways.

Bob Merberg, Fran Melmed and I at the HRE Conference.
One: We Need to Agree on What Matters

There was lots of agreement that we need one set of measures about what creates value and indicates quality. And, agreement that we need good functional level measures for patients too. This is the discussion that kicked off the Health Care Congress and Rajiv Leventhal captured it well in this post, so I won’t try to recap it again here.

Monday, March 28, 2016

10 Behaviors of An Engaged Healthcare Consumer Infographic

Just in time for my presentation at the HRE Conference in Las Vegas, I'm introducing my first infographic -- Ten Behaviors of An Engaged Healthcare Consumer. Practicing these ten behaviors will assure you receive the best and safest medical care. 

Unfortunately, few people have the knowledge necessary to successfully navigate the healthcare system and get themselves and their loved ones quality care when they need it. In most organizations, healthcare is the second-largest expense — second only to salaries — yet most employers don’t teach people how to get the most out of their investment. Employers implement consumer-driven health plans to encourage employees to behave as consumers, but until now no one had defined the behaviors an engaged healthcare consumer demonstrates, so employees don’t understand what they’re being asked to do. I've been on a journey to educate people to be more healthcare savvy and I hope to inspire other employers to do the same. 

You can view my presentation on Haiku Deck. I'm still putting the finishing touches on the slide notes, but they'll done before my presentation on Wednesday. I've included links to some useful studies and resources. 

Many thanks to Samantha Allen for developing this infographic with me. And, many thanks to all those who contributed to defining the behaviors. I'm eternally grateful. 

Tuesday, March 22, 2016

A Clear View of Our Own Data

The first time I loaded the Moves app onto my iPhone and looked at it, it creeped me out. I promptly deleted it from my phone. Then, I realized the app was just allowing me to see data that already existed and could be accessible to others. I thought, "Why shouldn't I have a clear view of my own data?" I downloaded Moves again. Maybe it's more cool than creepy. 

This seems to be a trend as our society moves toward greater data transparency. Now I can log onto my electronic medical record at my doctor's website and see her notes about my visit. I can log onto UMR and see information about all my health claims. I can create an account on Magellan RX and see every prescription I've filled. My credit union account shows every banking transaction I've made. And, the Fairfax County Government site shows all my tax payments right down to the $10 licenses for our dogs.

This week we rolled out a new human resources information system that integrates payroll. Staff can now see their salary, social security numbers, date of birth etc... ASHA has always had this information that's required to employ us, but now we can see it too. I think this fits with our organizational value of being transparent and I like that each staff has a clear view of their own data. Some folks were concerned about security, but once our IT Director assured us that our information is appropriately protected calmer heads prevailed. 

Our staff will have the same experience when they log into Health Advocate for the first time and see their personal health dashboard. It includes key information about benefits use and specific health indicators. Will they find it cool or creepy?

Related Reading:

Thursday, March 10, 2016

The Dark Art of Prescription Drug Pricing

Have you wondered how prescription drug prices are set? I attended a pharmacy seminar with Mike Zucarelli, a pharmacist and the National Pharmacy Practice Leader for CBIZ, to learn more this morning. Mike shared the chart in this image that illustrates how the money flows between drug manufactures, pharmacy benefit management companies, employers as plan sponsors and us as consumers or beneficiaries. No wonder I'm confused!

The incentives are crazy and unknown to most of us. Drug manufactures pushing off-label drug use -- doctor's prescribing medications for uses that have not been approved or proven to work. Insurance companies providing incentives for doctors to prescribe certain classes of drugs. Pharmacy benefit management companies negotiating rebates (aka kick backs) from drug manufactures not just based of the volume they purchase, but to take a competitors drug off the formulary. 

Wednesday, February 17, 2016

More Commonly Used Medications (PPIs) Linked to Dementia

See PPIs listed by NIH
We're bombarded with news about drug safety issues and it's easy to tune out. The last thing I read could impact a lot of folks I know--and a lot of ASHA staff--so I want to point it out. There was a study published in JAMA on February 15 linking dementia in older adults to the use of proton pump inhibitors like Nexium which is now available over the counter. Last year, it was anticholinergic drugs, including popular non-prescription sleep aids and the antihistamine Benadryl, and increased risk of developing dementia. This is scary stuff. 

Tuesday, February 2, 2016

10 Behaviors of an Engaged Healthcare Consumer

In the health and wellness arena, everyone talks about engaging consumers, but are we clear about what we're asking people to do? As far as I am aware, no one had defined the specific behaviors an engaged healthcare consumer demonstrates, so I crowd sourced a definition. This has been months in the making. Many thanks to everyone who contributed. Now, drum roll please... 

10 Behaviors of an Engaged Healthcare Consumer

An engaged healthcare consumer...

  1. Has a primary care physician who is a partner in managing his or her health—with scheduled visits as recommended, whether for regular follow-ups for existing conditions or according to the age-related recommendations for prevention by sources such as NIH
  2. Asks the 5 questions recommended in the Choosing Wisely campaign before getting any test, treatment (including taking a medication), or procedure and carefully considers all options before deciding among them:
    ► Do I really need this test or procedure?
    ► What are the risks?
    ► Are there simpler, safer options? 
    ► What happens if I don't do anything? 
    ► How much does it cost?
  1. Reviews hospital safety data—from sources such as Hospital Compare - Leapfrog, Hospital Quality Ratings - CareChex, and Surgeon Scorecard—before deciding where to seek care.
  2. Actively monitors and tracks personal health indicators like weight, as well as any indicators related to existing conditions such as high blood pressure or diabetes.
  3. Maintains a list of medications taken and shows it to medical providers when seeking care, and keeps the list up to date in electronic medical records. 
  4. Makes day-to-day decisions that support good health and takes any medications as prescribed and instructed.
  5. Develops a personal/family budget to manage healthcare expenses.
  6. Uses available tools to make cost-conscious decisions.
  7. Has an income-protection plan (e.g., short-term and long-term disability coverage) to rely on in case of an injury or illness that makes working impossible or limited. 
  8. Has an advanced healthcare directive that has been discussed with family members.

Monday, January 25, 2016

How to Clean Your Dryer Vent

Snowzilla 2016
Snowed in? Use the time at home to clean your dryer vent. When we got a new washer and dryer, I was shocked at how much lint was in the vent tubing. According to the U.S. Consumer Product Safety Commission, more than 15,000 fires are sparked every year by clothes dryers. 

First, make sure your vent to the outside is clear and not blocked by snow. Then, follow this step-by-step guide for cleaning out your dryer vent.

And, just in case, don't forget to clear the snow from around the fire hydrant in your neighborhood. 

Thursday, January 21, 2016

The Tax Favored Status of Employee Benefits (Enjoy it while you can.)

Image from
The real impact of the Cadillac Tax is that it begins to chip away at the tax favored status of employee benefits Most of the news coverage I've read seems to have missed this point; and I'm a bit bewildered that this isn't the focus. I know it's been delayed until 2020, but it's still worth pausing now to consider the impact. First, a bit of background...