Think about it this way Elmer, the Cost of Living Index for Stanford, Ca is a whooping 195.2%. So in the average of the rest of the country your bill was approximately only $5,000. That doesn't sound like a high bill.

In Canada each province has there own healthcare coverage. So even when traveling inside Canada, it's advisable to get insurance.

We don't have personal benefits, so whatever the province doesn't cover comes out of our own pocket, unless under specific circumstances. For instance, hubby's cancer drugs and other injections to strengthen his bones weren't covered unless he were 65, which he wasn't. I guess cancer only happens to seniors.

The oral chemo drug was $3,713.65 per month, the monthly bone strengthening injections were another $1500, his hormone therapy injections were $969.11. I still have the receipts.

His monthly radium injections were covered by the province but only for 6 treatments as they were $5,000 each. They had to come in from the Netherlands.

After we picked our jaw up off the floor, the nurse told us that she would appeal to the province and see if they'd cut us a break. They did. With the hormone injections the dr approached 2 pharmaceutical companies for compassion pricing. One said a flat out No and the other gave us 1 year for free.

Most people including most Canadians think our prescription coverage is free, and I thought they were covered as long as they were administered by a doctor or in his office, by a nurse. Not so, as we found, as these were not covered.

I know 2 families who couldn't get coverage, and they cashed in all of their savings and mortgaged and financed everything they had to the hilt.

Bankruptcy definitely happens here, due to the high cost of living.

Here's a little more "food for thought"

Some years ago I was working at two hospitals. One was private and patients were required to pay up-front for services so all patients paid for their care. The other hospital was public and didn't require all patients for pay for their care.

Within the same month I had a CBC (blood test) at each hospital. The first private hospital charged me $12 for the test. The second hospital charged me $100 for the same test. Why the difference, because at the second hospital my payment was covering the cost of tests for other patients that didn't pay.

Hospitals that take insurance bill high amounts knowing their negotiated payment amounts will be much lower. The cash patients are the ones who get screwed by being billed the full amount and not the reduced amount (though sometimes can negotiate). It's no wonder many can't pay. Such a broken system.

TooMuchGlass, I also consider myself (and my Hubs) very lucky when it comes to medical care and prescriptions. The total cost of our Medicare premiums, our Medicare supplement premiums, and our drug coverage premiums are completely reimbursed by our CalPERS retiree benefits. We have absolutely no out-of-pocket costs for medical care, other than co-pays for prescriptions. Last year when I had to have a cardiac stent, I paid $0.00 even though the cost was well over $100,000. I was prescribed Effient, which is a "platelet modifying agent." I was given a 90-day supply of the generic (not the authorized generic) (prasugrel) for which I paid $10. It made me horribly, horribly dizzy, so when it came time to refill the prescription I switched to the brand name drug and haven't been dizzy from it at all. I pay $100 for a 90-day supply of the brand name. Below are screen shots from the claims for the first (generic) prescription as well as my most recent refill of the brand name. Even the amount my insurance paid for the generic is outrageous.

Raye, you've demonstrated another instance of finding misinformation from internet searching.

"Stanford, California" is a goofy little mapping and zip code unincorporated subdivision that mostly contains the campus. And dorms, and Greek houses, and faculty and grad student housing and a small residential district. But the residential area is adjacent to the school and the surrounding area has high real estate costs. A bit more but not all that out of line with many parts of the area it's in.

20 minutes in one direction from Stanford is a hospital in the working class East Bay area. 20 minutes in another direction is the county-run Santa Clara Medical Center (in San Jose). Both the East Bay and Santa Clara Valley have large working class and lower socio economic level residents. I'll bet prevailing insurance-negotiated and Medicare negotiated reimbursement rates for these three hospitals are similar.

Raye, if you had medical insurance, why wasn't the cost of the lab tests the same?

Elmer, I'm sure Raye's actual out-of-pocket cost for the two Complete Blood Count tests were identical. But the $100 charged by the second hospital is the amount they billed her insurance.

Nope, this was back in the days when insurance worked better and didn't dictate care. At that time, the bill was paid by the patient and the patient filed with the insurance for reimbursement. Yes, I had insurance but I hadn't met any deductibles yet. So I paid $12 for one test and $100 for the other.

When does insurance "dictate care" for common services and procedures? Blood tests shouldn't require pre-approval, only an order from a doc. Same with most other things for that matter.

You seem to be confusing plan deductibles and provider charges. Even in cases where there are unmet deductible amounts, what the patient pays is based on the insurance carrier's contracts and those vary little in a given area.

Maybe our docs and hospitals have gotten pre-approval for various procedures but nothing has ever been denied or changed.

I'm retired, this was long ago when insurance was much different. At that time insurance only reimbursed the patient after the deducible was met. There was no such thing as insurance based provider charges and co-pays at that time.

My experience was to give a "window" into why medical charges can be so different.

Okay, I had insurance like that but it was more than 35 years ago, hardly relevant to talk about today. The industry and employee benefit practices were different, it was truly insurance for catastrophic losses, not payment for services as much as it is now. Things have changed greatly since then. But I believe even then insurance companies negotiated charges.

What is relevant is that health care pricing is still affected by those that don't pay.

Don't assume that those that don't pay don't have insurance. When I didn't have medical insurance for a short time I paid my bills out-of-pocket & in full. I know someone that had insurance and both adult members of the family worked. But instead of paying the portion of a major hospitalization bill not covered by insurance they chose to move to another state and never paid those bills. They could have easily afforded to pay that bill. It still goes on today and affects all areas of health care.

Jasdip, our family experience with payment for cancer medication and treatment is different here in Manitoba. DDIL and DBIL didn't pay anything out of pocket for surgeries or medications for their serious bouts of cancer. In fact, Cancer Care even covered the cost of DDIL's wig when she lost all her hair from chemo treatment.

I see what some drugs cost in the US then I go into our computer at work to see what the same drug is here. What a huge difference! You all can't afford to be sick.

I'm in the US. I think it was about ten years ago a friend of mine had a toddler who became diabetic. He changed jobs to get on where the offered insurance would pay more for the meds and supplies they needed, yet I know prices have increased on insulin since then.

Doesn’t our taxes pay for a lot of

R&D?

What’s really sad is if a drug is proven to be bad and you cannot return for a refund.

Jose, no taxes don't cover all of pharmaceutical R&D, just selected early stage development in the U.S. The rest is paid by the company. Your taxes do go to pay for others to receive medical care.

Debby, there are programs to provide health care free for those below certain thresholds, the wealthy can afford to pay outright for their care, it's the middle class that is stuck with making decisions and choosing if they afford care in the U.S.

Debby mentioned being able to go online and check drug prices in her country, we need that ability to be selective about purchasing healthcare. I can research and find the best deal on purchasing a vehicle but I can't do that for prescription, procedure or even a simple doctors office visit.

I live in an economically repressed area and suspect a lot of people do without at the expense of their health. It's easy to site social programs for a lot of these people, but we see a lot who are proud and won't use such a program. So sad that prices are so out of control that many people just can't.

My RX drug story dates back about 12 years and was a small issue, but had an impact on how I view the whole system. My cat needed a thyroid med that used for humans so the vet told me she would write an RX and it could be purchased at any regular pharmacy. Being not long on funds, but needing the meds, I started calling around local pharmacies to find out what the price could be. Wow, the walls that were thrown up. The only place that would provide a price was Walmart (who eventually filled the order), but other places, all national chains, refused to provide the information, including costco who had a selection on their message service to request a price for an RX???? It seems like it might be better now with these apps and programs like Good RX, but that experience left me with a less than stellar view of the industry.

josephine you can return the drugs! But: you won't get a refund. Trust me, I hear a lot of customers complain about that, but it's not store policy, it's law. Once that medication has left the counter it's yours. We do take back medications, but it all goes into our "dead drug" bin for incineration.

Quasifish - that's what I'm talking about! Prices will go down when comparison shopping reveals the true cost of medications. The only other business that I can think of that is as opaque in their pricing is the airlines.

I would expect that a pharmacy that dispenses a wrong or expired medication would reimburse the patient, that's surprising that it's illegal to do so.

In my home, we have been buying insulin for 50 years. Insurance helped pay for the insulin for my daughter, so I really don't know the actual cost in those early years. In 1985 I started buying insulin for my dog, which I paid less than $7 for a bottle. No insurance help of course. Today my husbands insulin is over $200 a bottle or so my providing pharmacy tells me. Thankfully with my insurance I pay only $30. Why do these drug companies advertise so heavily??? TV commercials for drugs are everywhere.

Raye, you remind me that after our cat got situated on her meds, we were able to purchase in full bottle quantities and were then able to use mail order veterinary pharmacies- extremely easy to navigate and prices wide out in the open.

Not to get OT, but there's an article in the latest Saturday Evening Post about the costs of medical procedures and insurers. The main story of the article is about a guy who had a joint replacement and found out after the fact that he was on the hook for $7000. The medical center and his insurer had negotiated the price in advance behind closed doors, and the information about his share was never made available. The businesses defend this practice. To paraphrase, they summed it up as it being a 3 party payment system where only 2 know their costs beforehand and the consumer is the one who is left out in the cold.

" The medical center and his insurer had negotiated the price in advance behind closed doors "

Insurance companies negotiate prices in advance for set contract periods with providers. Always, and all providers. Behind closed doors? Hardly, but I hope you aren't suggesting that insured individuals have any role in this or any other business dealings of the insurance company.

You wouldn't buy a car or contract for services without an estimate of the cost. I'm sure that could have been obtained from the insurance company. Maybe they didn't advise him as a standard practice but it sounds like he didn't ask either. It also seems like this was an annual deductible or a limit of service reimbursement and that information would certainly be given to every policy holder on the front end of coverage. Unless for this too the individual didn't know what he was paying for or didn't understand or pay attention to information he was given.

Raye wrote, "Debby mentioned being able to go online and check drug prices in her country, we need that ability to be selective about purchasing healthcare. I can research and find the best deal on purchasing a vehicle but I can't do that for prescription, procedure or even a simple doctors office visit."

Hubs and I both have Medicare Parts A and B, and a Medicare supplement policy from Anthem Blue Cross. Our prescription drug coverage (Medicare Part D) is included with the supplement policy. OptumRx provides the coverage for the medications. We can go onto the OptumRx website and check prices for medications. As for visits to the doctor, we don't pay anything. Between Medicare and our supplement policy, our fiscal responsibility is zero. But, everything that is done at any medical facility has a code (for insurance billing purposes), and each code has a price assigned to it. You certainly can call your doctor's office to inquire about costs. Don't just speak to the person who answers the phone - ask to speak to the office manager or to the finance officer.

Elmer, it is an interesting/ thought provoking article if you happen to come across it at some point. One can always make the argument that the patient should have known better and done more due diligence (which he undoubtedly will next time), but it can also be argued that medical procedures and costs are things a lot of us don't deal with on a regular basis and sometimes the practices are conveniently withheld from the consumer- whether intentional or accidental omission.

I'm all for being a savvy consumer, but it can be very hard for many of us to be savvy consumers in some of these systems. How do you know what you don't know?

ETA: Had to laugh at myself after posting this when I realized that I couldn't get a price quote for 15 thyroid pills for a cat. Maybe a slightly different system, but I can't imagine trying to get $$$ answers about a major surgery.

There have been a lot of meds going on backorder lately and we have to look outside our usual vendors to try and order them. One item is usually $17 for a 30ml tube. Now since it's on "backorder" these outside vendors are charging anywhere from $160 to almost $300 per tube. It's ridiculous. And I say backorder in quotes because how are these outside vendors always able to locate these meds that are having trouble being produced for one reason or another?

It's illegal to price gouge on gas but perfectly ok with medications.

I'd surmise that the "outside vendors" are buying all that is available through the regular channels at the regular prices, so that they can then provide them at a greatly increased price. And are probably kicking back some of the spoils to someone involved in the initial manufacturing or distribution of the medicine.

It probably already is illegal, but those whose jobs it might be to investigate such goings on, are pointedly not doing so.

Lindsey, I'm not quite old enough to be on Medicare so I'm on hubby's work insurance. It's a nationally know company but the website has very little information. One of the problems with pricing in health care is that there are so many variables. If you go in for a procedure there could be complications that necessitate additional care. When going to a doctors office they may not know ahead of time what tests they will need to run.

But a prescription is different, think about how you shop for vitamins. A common practice would be to shop by price but decide the store that is cheapest is too far away (or too dirty, employees are too rude...) so I'll spend a little more to get the item from my preferred store.

quasifish, I'm not sure what to say to you. Someone who goes forward getting something potentially expensive done without checking in advance what it might cost him out of pocket foolishly caused his own problem. He's the reason for the shock, not the others.

It sounds from your description that his problem is not that he's not a savvy consumer but rather that he's lacking common sense to manage his life and his affairs. That's a shame but it's not a symptom of a systemic problem to me.

raye, "nationally known" insurance companies administer many hundreds of different policies. There's no way to have one neat place to go to look for "information" because it's going to depend on the policy. Whether the coverage is purchased directly from an insurance company or provided in a group way through an employer, they (and the employer, in such cases) are required to provide information on coverage. It's often done both in hard copy form and accessible over the internet.

The most important information for someone with medical insurance is usually NOT what the providers charge, how much a blood test is, etc., but rather, what the specific policy rules are for covered services and co-pays, co-insurance, annual deductible amounts and whether there's an out of pocket maximum. These policy specific provisions are provided BEFORE the insurance is effective. Look on your insurance card, there's certainly a number to call to get this information.

bob, there are no conspiracies nor major black market activities in pharmaceutical drugs. Some specific instances of high prices, sure. But the major retailers, the customers of the drug companies, aren't ignorant rubes,

As I said before, the situation exists because of a lack of interest and attention from Washington.

"It's illegal to price gouge on gas but perfectly ok with medications."

Not so. A gas station can charge anything they want for gas. If they charge too much more than their nearby competitors, they lose business.

Most drugs most people buy have generic replacements. The high price of brands is why many plans don't cover them to the same extent as generics and also why people without drug coverage buy generics. The generic market is VERY competitive with often more than one source for each particular drug. That and the fact that generic companies do no drug development is why these versions are so much less expensive. If one generic provider tries to charge much more than a competitor, just like with gas stations, the buyer will switch to a cheaper source.

Elmer - there are state laws (in 35 states) on price gouging, anyone that's been through a hurricane knows about that.

"Price gouging" is a generic term.

Limited laws that apply ONLY when a state of civil emergency exists- which is to say, very infrequently and in very limited areas - are hardly relevant to a general discussion of national drug pricing. They don't apply, do they.

Elmer wrote, "Most drugs most people buy have generic replacements. The high price of brands is why many plans don't cover them to the same extent as generics and also why people without drug coverage buy generics. The generic market is VERY competitive with often more than one source for each particular drug. That and the fact that generic companies do no drug development is why these versions are so much less expensive. If one generic provider tries to charge much more than a competitor, just like with gas stations, the buyer will switch to a cheaper source."

Yes, generics are cheaper to the consumer and to the insurance companies, but they aren't always necessarily "cheap" or "inexpensive" by any means. Take a look at the screen shots below. I paid $10 for a 90-day supply of Prasugrel, which is the generic of Effient. My insurance paid $696.91. But, because I was dizzy 24/7 for 90 days on the generic, when it came time to refill I switched to the brand name Effient (and no longer got dizzy!). Well, actually, for that first refill I switched to the authorized generic (AG) but the pharmacy only had a 60-day supply because the pharmaceutical company that marketed the AG had ended its contract with Lilly (manufacturer of Effient). I still paid $10, even though it was only a 60-day instead of 90-day supply. My insurance paid $120.09. Now, if all things were equal, my insurance would have paid $464.61 for that 60-day supply, based on what they paid for the initial 90-day supply. Or, you could say that the original 90-day supply of a random generic should have cost my insurance company $180.14, based on what they paid for a 60-day supply of the authorized generic.

Since the authorized generic is no longer available, when that 60-day supply ran out I refilled with the brand name Effient. I still get the brand name, and will do so for the next 18 months. I pay $100 for a 90-day supply of Effient, and my insurance pays $1,089.73.

I personally do not like generics. There are so many recalls of generics, but one of the main things that bothers me is the fact that generics do not go through the same testing as a newly developed brand name drug. As long as the generic has the same active ingredients, they're good to go. But the "inactive" ingredients can, and do, vary widely. I'm sure that's why I was so horribly dizzy on the generic Prasugrel. Authorized generics, on the other hand, are exactly the same as the brand name drug. Same active ingredients, same inactive ingredients, same size, color, and markings. Holding one of each, you cannot tell them apart.

I'm sure to the people going without the medication it is an emergency. And the medication I was talking about is a generic. They are over charging and it's ridiculous and greedy.

hareball, tell me more about the people you know or encounter who have trouble getting medications they need. Is it only medications they're doing without? What else is going on in their lives?

Read these Elmer, it will explain the ongoing issues with drug shortages:

http://bulletin.facs.org/2018/11/drug-shortages-the-invisible-epidemic/

https://news.aamc.org/patient-care/article/running-empty-hospitals-face-prolonged-drug-shorta/

https://www.fda.gov/Drugs/DrugSafety/DrugShortages/

Though I wrote my post in a hurry, I've not got things jumbled up, Elmer. After Martin Shkreli jumped the price hugely on the epipen and everyone screamed and yelled, other heads of pharm companies seemed to feel free to do the same. Insulin

In this political climate, the sky's the limit if you are selling what others need to live.

raye, what do the shortages in Puerto Rico after the hurricane have to do with this conversation? Other supply problems, yes, I've heard of that issue, mostly production related, no?. Was that the essence of what anyone was talking about here?

sjerin, I still see no connection between the scoundrel Shkreli and the rest of the drug industry. He's not mentioned in the article you linked to.

You asked why a would someone have issues obtained medications and the articles explain the answer to your question:

• "hareball, tell me more about the people you know or encounter who have
  trouble getting medications they need."
  

Shortages are causing patients to do without or face higher
prices. The articles explain these issues. There are and have been problems with shortages of both hospital and pharmacy drugs. One of the causes sighted is the hurricane in Puerto Rico, there are other reasons.

Elmer, I know Puerto Rico comes into play as far as IV bags are concerned.

Ah, okay, I was thinking about it backwards. Thanks and sorry. I forgot that many phama companies manufacture in PR and manufacturing was disrupted. They're there because of US tax laws. Weather related problems will always occur and, again, are not a sign of a systemic problem. Other shortages, yes to an extent, something for government oversight. IF that were reasonable to expect.

Back to drug pricing, what I thought hareball had in mind was people of limited means who, lacking insurance, found drugs too expensive to buy. My reaction was, for many people of limited means, money for needed drugs may be the least of their problems. And those in the worst of circumstances are usually covered by Medicaid and its local equivalents. Except to a lesser extent in states that have minimized Medicaid funding.

Jasdip, I was about to post that I believe it is B.C. that pays for oral cancer drugs, but Ontario does not, when Stacey_mb posted about coverages in Manitoba.

I agree that a lot of people think that OHIP will cover them throughout Canada and as you certainly know, it won't. We always take out of of country and province medical/trip cancellation coverage.

I can't take generics. So many brand name drugs are no longer sold because of generics so it is a good thing I suppose that I am extremely sensitive to most drugs out there or I would be in serious trouble. And it isn't just the preferred generic it is all of them, and I am not the only one.

We are both over 65. I have only one prescription and it has gone generic so how long the the brand name will be available and not stale-dated remains to be seen since we are in year 5. I pay the extra between the generic and the name brand cost under the ODB. Then there is the annual deductible for the ODB which of course I don't even begin to meet. Also, the drug and its use have to be approved to be covered by the ODB.

I have been told when in the U.S. that Canadians enjoy free dental, vision and drug coverage. We do? News to me! Obviously not all Americans think this but it is frightening the ones that do. And we do "pay" for our OHIP coverage. I think of this whenever I go to the dentist or the eye doctor - and my husband sees 2 eye doctors.

I hope you are coping as well as can be expected. My husband's sister when through the same horrible issue as you when she was your age.

Wow, there's a lot of misinformation in the US re. Canadian health care.
I was under the impression that everything health-related is covered
100%, no matter where in Canada you live. Had no idea that it depends
on the province and other particulars.

Toomuchglass, Thanks for starting this thread and mentioning GoodRx. I wish I had known about it sooner. With the insurance I had last year, I had a couple of prescriptions that cost $50 each per month. It looks like they would have been around $30 using a GoodRx card instead of my insurance card. Luckily I have a different insurance company this year and my co-pays are lower - around the same price as GoodRx is listing.

My husband takes a prescription that is still pretty affordable but I called the pharmacy to ask why the price had gone up so much. Their answer was that it was harder to get because it is made in Puerto Rico and production is down.

You're welcome CH. We cancelled our prescription insurance - it was cheaper with the RX card !! That good RX card is a lifesaver. I actually have another RX card on file at Walmart ( I can't even remember which one ) but when I pick up my meds - they check to see which card has the best discount and they run it through that one.I had a $300 med . a few times - I paid $128 . Can't beat that ! :)