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Comparison Shopping for Health Care

Chicago Internist, Leslie Ramirez

Do used car shopping and health care have anything in common?  According to Dr. Leslie Ramirez, the answer is yes.  Dr. Ramirez is the creator of Leslieslist.org,  a website that helps people comparison shop for diagnostic tests and prescription drug prices.  On the site, users can shop around, negotiate, and price match to ensure that they are getting the best deal.

In an interview with GiveForward, she offered some tips for health care consumers and insight into the campaign for better cost transparency in health care.

What made you decide to start Leslieslist?
It is a given that the uninsured are not getting the care they need, but trends are showing even the fully insured are struggling. A succession of people came into my office who were choosing to delay or refuse care due to the cost.  Here are a few of their stories:

  • Debora M.* had blood pressure of 180/110, but didn’t buy the medicine I prescribed to her because she couldn’t afford the cost.

About a third of insured Americans don’t take their medicine the way they should. They split doses to stretch them out and buy them less often. 

  • Joan K’s* radiologist recommended that she get an MRI due to “a shadow that might be lymphoma.” Although insured, Joan had a very high deductible; her MRI would cost over $3,000. She worries whether she has cancer while she debates whether she can afford the test.

According to the Kaiser Family Foundation, since 2008 the majority of family deductibles have risen to at least $2,500, and the amounts continue to rise.   The economy and job loss are forcing families to make tough decisions.

  • Carmen R., who had recently lost her job and at 60 was still too young for Medicare, told her daughter that she would skip her yearly mammogram since she wasn’t sure when her next paycheck was coming.

Carmen R. is my mom.

I realized that I could (and must) do something to help them. I knew that the blood pressure medicine Debora needed could be bought for $5 at Kmart, and If Joan and Carmen got their tests done at an independent facility, they could pay a fraction of the cost. I made this website for them, and for the many many patients (and their doctors) out there who can relate to their stories.

*The names of patients have been changed

Since starting the website, has health care cost transparency improved? 

It’s definitely improving.  I’m seeing interest in Leslieslist from people of all backgrounds. New York and other states are passing laws to provide patients of the pricing of their top 100 medicines. This would be incredibly helpful if it was more widespread. Also, the market is starting to take notice.  One of my proudest moments was when I was contacted by a radiology facility.  They had lowered the cost of their MRI so they could be on top of the list, because Leslieslist is filtered by price!

What are top five things patients can do to be informed healthcare consumers?

5) Negotiate & Price Match… You can negotiate when buying medicines. Recently I called CVS and was given three different prices for the same drug.  You assume it’s set, but its not. Some pharmacies even participate in price matching, such as Jewel-Osco. Bring printed proof of the lower price to the pharmacist and ask if they can match it.

 4) Talk to your provider…Prices at the doctor’s office can be flexible. Often if you explain your financial situation, the doctor will work with you.  Every doctor I know feels this way.  Also, hospitals have a charity care requirement in order to maintain their budget requirements. They have a motivation to help you, you just need to ask.

 3) Opt for Independent Laboratory Facilities…Because they have less overhead costs, freestanding testing sites offer better prices; often as great as 1/10 of the cost of major hospital facilities. They are also more flexible with negotiations and may offer discounts if you pay up front.

 2) Buy from Costco and other wholesale clubs…Wholesale clubs often have strict parameters for drug pricing.  For Costco this is the wholesale price plus 14%–resulting in really affordable prices for consumers.  You do not need to be a member to shop at the pharmacy.

For generics, wholesale clubs are your best bet! Most retail pharmacies continue to charge a higher price after a drug is offered in a generic form–despite the fact that the drug is now more widely manufactured, thus cheaper–because they know you are used to paying the higher price.

 1) Shop around...In my presentation for students, I use the image of a used car salesman, because anything goes when it come the vast discrepancies in prescription and health care pricing.  Whether you use Leslieslist to track prices, or call around yourself,  you can make informed health care purchases.

Even if you comparison shop and take advantage of all of Leslie’s tips, health care is still expensive.  You can help a friend or loved one pay for their out-of-pocket medical expenses with a GiveForward fundraising page.

Whose world will you change?