March 29, 2017 Blogs

Focus on Prices for Patients

March 29, 2017

Dr. Clayton McCook, Edmond, OK

I’ll never forget December of 2015. My wife Cindy was diagnosed with stage I breast cancer. After her diagnosis, she underwent surgery, six rounds of chemotherapy, and received monthly infusions of a drug called Herceptin to fight her tumor.

Last month, she received the last of 18 infusions. When we received our explanation of benefits from our insurance company, we were surprised to learn that we were billed $12,000 per drug infusion.

Like many Americans, health care costs consume a significant portion of our family budget. Our oldest daughter, Lily, age 8, has type 1 diabetes. For those unfamiliar with T1D, it is an autoimmune disorder in which the body’s own defenses attack cells responsible for the production of insulin. Insulin helps the body utilize glucose (sugar) by moving it from the bloodstream into the cells for use as energy. Patients with T1D require daily injections of insulin to keep the amount of glucose in their bloodstream from reaching dangerous levels.

Diabetes is pretty simple. If you don’t receive insulin, you die.

Lily wears a continuous glucose monitor, which requires monthly supplies along with reservoirs and infusion sets for her insulin pump. Lily typically checks her blood sugar with a finger prick 5-10 times per day, and the test strips for her blood glucose monitor must be purchased from a pharmacy.

Under our insurance, my wife and I are responsible for every dollar of the cost of Lily’s prescription drugs until we meet our deductibles. A vial of insulin cost over $250. A three month order of supplies for her glucose monitor cost nearly $500, as will an order of insulin pump supplies. Test strips will cost us nearly $200. A visit to her endocrinologist will cost over $100 every quarter. We are responsible for all of these costs until she meets her $3,000 individual deductible.

The aforementioned explanation of benefits for my wife indicated that, after the insurance company negotiated the price down, our patient responsibility portion would cost $3,000 – the amount she needed to meet her individual deductible.

Between Lily’s diabetes and Cindy’s breast cancer, our family will incur about $6,000 in medical bills for 2017.

It’s a small sum to pay for their health. But an outrageous sum to pay for working families struggling to balance school tuition, home mortgages, or starting a small business.

While these costs are startling, I consider myself lucky. I am a practicing veterinarian and I work for a great company that pays well and gives our family access to quality health insurance. But drug prices don’t escape you as a doctor, and many other Americans are far less fortunate.

The public debate over healthcare and prescription drug costs in the U.S. is often filled with misinformation, incomplete truths, and in some cases, out and out falsehoods. Last year, drug corporations spent more than $150 million lobbying Washington politicians. The same drug companies spend only a penny of every dollar on basic research, but they spend 20-40 cents of every dollar on advertising and marketing

We are the wealthiest nation on earth, yet we pay more for drugs than anyone else. Something must change. And it is incumbent on all of us, as patients, to share our experiences, and keep the discussions focused on patients. These are the facts for my family.


Patients For Affordable Drugs is the only independent national patient organization focused exclusively on achieving policy changes to lower the price of prescription drugs.