Doctor Breaks Rules in Desperate Attempt to Help Patients Afford Insulin
The high cost of diabetes supplies hurts more than just diabetics. Doctors who truly want to see their patients’ health improve know that while insulin can help people live healthier, happier lives, the cost of insulin is sometimes so high that patients choose to go without. So their efforts to help a patient may be in vain.
It’s not that patients are being cheap. Diabetes costs a person, on average, $7,900 a year, and the average person with diabetes spends about $13,700 a year total on medical expenses. That’s about 2.3 times more than that of a person without diabetes. It’s difficult for everyone; for some it’s impossible.
Dr. Hayward Zwerling wants to change that. He’s tired of seeing patients with advanced diabetes come to him for help, not be able to afford their prescription, and then end up back in his office when symptoms become worse. So he’s found a roundabout way of providing his patients with more cost information—if they’re willing to do the legwork.
Insulin prices vary greatly by type, pharmacy, insurance plan, and price trends. One of Dr. Zwerling’s patients, Larry Rose, paid $15 for a three-month supply of insulin, but then had to pay $400 for the same insulin just three months later. Larry went to see Dr. Zwerling for help, and the doctor introduced him to his “game.”
Dr. Zwerling can’t tell how much a patient’s insulin will cost because of ever-changing (mostly rising) drug prices and varying insurance and pharmacy policies. The pharmacy isn’t able to give a patient a price unless a prescription is actually being filled. The doctor can’t tell which brand and type of insulin would be affordable, and therefor accessible, to his patients.
He wrote a letter to Larry’s pharmacy with a list of insulin brands and types. But the pharmacy still couldn’t give Larry specific prices without an actual prescription. So the determined Larry returned to Dr. Zwerling’s office, where Dr. Zwerling wrote him multiple prescriptions. This is a strategy he’s employed with a select few of his patients in an effort to help them get up-front pricing information.
Dr. Zwerling says. “And if I do that, I’ll write all over them in big bold letters, ‘this or this, not both.’ This would be a catastrophic mistake to take twice or three times the amount of insulin.”
Having the prescriptions in hand helps; Larry is able to find out which prescription wouldn’t be covered by his insurance and which one seems the most affordable. He won’t have exact numbers until the prescription is actually filled. Dr. Zwerling thinks the time that Larry, and his other patients, spend figuring all this out is unreasonable, and there is a risk that someone will fill two prescriptions. But the doctor is balancing that risk with the risk of patients not filling their prescriptions at all.
CVS Pharmacy is working on a partial solution by starting a program that allows pharmacists to share cost information with patients before a prescription is filled. The president of CVS retail pharmacy business, Kevin Hourican, said they started the program because “of the rising cost of drug prices in our country and the fact that consumers are somewhat flying blind on the cost of those medications.”
Dr. Zwerling realizes that his method comes with risks. “If I end up in court, God forbid, my argument is going to be, ‘I tried to do what I thought was in the patient’s best interest.’ “