Sometimes it takes a creative approach to get the healthcare you need.
You know how when you go to the pharmacy, your prescription is handed over in a white bag? What’s that about, maybe privacy? The white bag has evolved to facilitate prescriptions via non-traditional routes.
“White bagging” usually means a drug is purchased through a specialty pharmacy and shipped to the provider’s office for administration. It may be called “brown bagging” if the package first goes to the patient’s home. For cancer treatment, it’s a tactic to obtain oncology drugs at a cheaper rate. It’s also an insurance strategy to shift coverage of chemotherapy from the medical benefit bucket to the pharmacy benefit bucket, transferring greater cost responsibility onto patients. The devil is always in the detail.
I’ve been trying for 6 months to get my insurer to cover Synvisc-One, a lubricant for my aging knee. With my history of orthopedic surgery, I’m an ideal candidate. I tried a cortisone steroid injection, a conventional method which helped for 2 weeks. I then submitted appeals – 3 times, including an external independent review. Patient advocacy is what I do for a living; this is not my first rodeo. All appeals were denied for lack of medical necessity. However, once I turn 65 (in 9 months) the drug is magically covered by Medicare. This seems to be more about money than outcomes.
- Cost of steroid: $7. Efficacy: variable. And there’s a reason you can’t get more than a few injections per year, side effects include cartilage damage.
- Cost of Synvisc: $1000 USD – the out-of-pocket amount, whether cash or through insurance as my deductible has not been met. Efficacy: excellent results for most people, pain free for at least 6 months with minimal reactions. It’s like using synthetic motor oil in your car engine to help it run smoother. One day this brand drug will go generic and arthritic baby boomers will demand it to delay joint replacement.
- Cost of Synvisc from a Canadian mail order pharmacy: $486 USD. Timeline: 2 weeks with expedited shipping (regular postal service would have taken 2 months).
Of course I went Canadian. Customer service was excellent with tracking and courteous communication. I apologized for tormenting their country and promised I would visit soon.
My primary care physician was happy to do the injection. The procedure was coded as a simple office visit (that pesky deductible again). He’s properly trained; I didn’t need to wait weeks for a specialty consult. We didn’t sneak into a back alley. The documentation is detailed and honest (“patient brought in her own supply”). I even got a flu shot as a bonus.
What’s the lesson? Don’t take no for an answer. Do your research. Find resources outside of the box. I took the advice I’ve been giving clients – look beyond America for significant savings, not just for drugs. Investigate medical tourism for high quality, accredited hip and heart surgeries, dental implants, and more.
For international price comparisons, here’s my plug for pharmacychecker.com. There are many ways to reduce costs. If you have a complicated scenario, contact me for an initial consultation (at no charge!).