No, that mammogram is not covered: an insurance saga

Posted by Jeanne Pinder on May 14, 2013

Our friend who was ordered to get a second mammogram, which was not covered by insurance, wrote to us again (if you missed it, here’s her first post.) Between insurance? You’ll learn a lot.

So, about my quest to find out the price of a second mammogram, because my insurance covers only $600 in testing in a year, and I’ve expended my budget . …

I did not deliberately buy insurance that leaves me exposed.

When I was laid off last summer, I elected to take the expensive COBRA group coverage at $1,094 per month. I didn’t want to shop for coverage that could leave gaps.

My employer was an entrepreneurial company insuring fewer than 10 people. It was Blue Cross/Blue Shield Horizon comprehensive, and had a $2,500 deductible on certain categories of treatment. When I was an employee, the premium was fully covered.

I’d have been able to get two mammograms covered and not need to think about it.

Four months into my COBRA plan, which I was expecting to last the entire 18 months, through the end of

2013, I was advised that what was left of my employer’s company was dissolving completely and I should start shopping for my own plan.

I turned to an online insurance shopping marketplace. This was probably a mistake because it created a barrier between me and the insurance company, but I only realized that after the fact.

I applied for a major insurer’s EPO Plus plan, and thus began a series of failed communications. I didn’t want to discontinue my COBRA until I got confirmation that the new policy had accepted my daughter and me, and at what rate.

My daughter has a history of sports injuries and I am youthful, but 55, the magic age at which all sorts of things can start to go wrong.

I was told I would not get accepted by the new policy until the old one was canceled. There could not be any overlap in coverage, even if I paid for both policies.

I had some misgivings, but instructed my employer to suspend my COBRA on Dec. 1, 2012. Through the first week of December I crossed my fingers that I had some kind of coverage, because no confirmation came.

After badgering the online insurance shopping marketplace by phone and by email, I finally got confirmation we were enrolled and at what price, which was the same amount quoted on the website of $744.55 per month.

But I was cautioned not to cancel my existing insurance until I had received the full written prospectus for the new policy. WTF?!

Then came the wait. It took two months and several phone calls to receive the written policy terms. That’s when I saw in big letters. THIS POLICY HAS NO MAJOR MEDICAL and NO CHEMOTHERAPY.

Mind you, I wasn’t setting out to get cancer, but the idea that chemotherapy coverage was non-existent made me a little bit crazy. It got worse. I called again to learn that in fact I didn’t have the exact right description of coverage and I had coverage if I were to be hospitalized but yes, I had no chemotherapy. At this point, I wasn’t sure what coverage I had, but asked to upgrade my policy to make sure that if I ever got cancer I would be able to get treated by SOMEONE!

“You have to wait for the open enrollment period in November,” I was told because I didn’t request an upgrade within the first month of coverage. “But it took two months for the documents to arrive,” I blurted. “Why is that?” they asked me.

“HOW WOULD I KNOW? YOU ARE THE ONES WHO SEND THE DOCUMENTS!!!”

I had expected to have a new full-time job by now with group health insurance. It’s true I have friends who have gone without health insurance for years. Everything is relative.

I’ve scheduled the second mammogram at the same place where I received the first one. They quoted me a self-pay price of about $365. but said that is not guaranteed.

Just breathe.

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Will burdening the sickest fix the health-care system? Healthcare Finance News

Posted by Jeanne Pinder on May 13, 2013

“Cost sharing, such as higher out-of-pocket expenses, seeks to bring down overall health expenditures by making individuals more careful consumers of healthcare. However, healthcare consumers who are sick or in need of emergency services are rarely in a position to shop around or second-guess the advice of their doctors, said Elise Gould, the Economic Policy Institute’s director of health policy and author of the report, ‘Increased Health Care Cost Sharing Works as Intended: It burdens patients who need care the most,’ in a news release,” writes Mary Mosquera in Cost sharing may not cut health costs,” Healthcare Finance News.

“Roughly 80 percent of health care costs are driven by just 19 percent of the population – encouraging healthy people to cut back on health care simply misses the majority of costs. … ”

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Buying birth-control pills (and other medications) online and overseas

Posted by Jeanne Pinder on May 9, 2013

People trying to save money on birth-control pills and other medications may look at online pharmacies — or at buying overseas (or across the border).

Online pharmacies — to use, or not to use?

We thought online pharmacies might be an important player. But most of the women we spoke with about buying birth-control pills were unenthusiastic about online offers. Many sites offer drugs cheap — really, really cheap. For some, no prescription is needed. That worried us, not just for birth-control pills but for other medications as well. There is a whole slew of web sites selling cheap drugs, and some look really sketchy.

The National Association of Board of Pharmacy gives the stamp of approval (known as VIPPS, or

verified Internet pharmacy practice sites) to online drug sellers that meet its standards. It keeps a running list of VIPPS, which could be useful if you are in the market.

The approved sites listed here are all U.S. sites.

There tend to be two kinds: one supported by insurance companies for their insured population (Aetna, Cigna, Caremark) and another group — rxdirect.com, kmart.com, drugstore.com.

“It is technically illegal for individuals to order drugs online from other countries,” according to Roger Bate, an American Enterprise Institute fellow who wrote an article about this topic in the Op-Ed section of The New York Times. “And yet no sooner does the F.D.A. shut down one dubious online pharmacy than another pops up. According to the National Association of Boards of Pharmacy, only 3 percent of the 9,600 online pharmacies it has reviewed complied with industry standards.”

Savings can be significant, but, as Bate points out, the safeguards are limited. Then again, safeguards in the United States are limited too — just recall the Vioxx scandal, or the compounding pharmacy scandal that killed and maimed pain sufferers whose doctors gave them supposedly soothing shots of steroids that turned out to be tainted.

We are hearing a lot about people with creative overseas solutions also.

A friend writes: “A lot of people I know — including myself when I was using them — get their pills across the border in cities such as Tijuana and Juarez (yes, Juarez. People still go there to socialize and buy things like medicine). A month of pills in Mexico costs $4 or $5 US dollars. You can also put together your own ‘Plan B’ dose using Mexican b/c pills (which are made by multi-national companies, the same ones as in the US). Birth control in Mexico is sold without prescription. Anytime you talk about the wild fluctuations in birth control pill prices, you should be comparing them to what they cost in Mexico, and it also helps to recognize that many Americans who live near Mexico, or travel there frequently, economize by getting their medication just a few feet from the US.”

She also told us that she goes across the border to buy antibiotics and other common medications.

When we last wrote about buying birth-control pills overseas, we talked to women who were buying birth-control pills in Bangkok, Thailand; Cape Town, South Africa; and Ankara, Turkey, quite often when they were on vacation, visiting family or the like. One woman told us she has a friend who travels frequently to Hong Kong and brings back supplies.

Meanwhile, there’s a debate going on about whether birth-control pills should be available over the counter. Here’s an opinion piece by Libby Rosenthal from The New York Times about that.

And, in reproductive pharmaceutical news from all over, we note that Pfizer is now selling Viagra, its erectile dysfunction drug, via its Web site, apparently in a move to make it easier for men to buy it (and also save them the embarrassment of going to the pharmacy for this medication). The New York Times article about this development noted that Pfizer could be losing millions to black-market pharmacies selling counterfeit Viagra online.

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What Medicare actually paid: Wild variations

Posted by Jeanne Pinder on May 8, 2013

Charges are not the same as payments.

This morning’s news brought a big helping of Medicare charge information: the release of a dataset of charges to the government’s Medicare program by hospitals across the U.S., as described in this article from The New York Times.

What’s charged by hospitals, of course, is seldom what’s paid by either Medicare or individual insurance companies.

The wide variation in charges made the biggest headlines today. But what did Medicare actually pay? The payments also vary widely, something we have reported on before.

We have a map based on slightly dated Medicare payment information, for about 70 different diagnoses in hospitals across the U.S. Take a look at the map here. It’s based on 2011 data.

As our map’s FAQ says: “Medicare pays well below market price, so this would not necessarily be the cost that you would get walking in the door. That said, these numbers carry some correlation to market prices. Insurance companies and providers often use Medicare prices as a negotiating point.” We’ll be updating our map with the new figures.

The release of data today by HHS is a good step in the right direction. But it’s only part of the transparency picture. Hospital charges are sort of like the MSRP, an aspirational price. Those charges are applied to uninsured people, and that’s a huge problem: the people who are asked to pay those high prices, often, are those who are least able to afford them.

There’s another big important collection of information that we’d like to see: charges and payments for routine procedures, for the non-Medicare population. What does an MRI cost? We’ve found it could be from $400 to $3,500; here’s one of our pricing spreadsheets. A common prescription? From $9 to $63; here’s our partnership with the Brian Lehrer show on WNYC radio to bring to light the prices of common things like birth control and mammograms.

It’s hard to get the charge information from providers, but much harder to get the payment information from insurers. Insurance companies, you see, may not want Provider A to know she is getting $400 for an MRI, while Provider B is getting $2,300. (True story.) So getting the payment information from private payers is at least as important as getting the government payment information.

Another downside of the data release today: Most people don’t “shop” for the diagnoses that are posted in this data set: “Extracranial procedures w/o CC/MCC,” for example, means any extracranial procedure (?!) without complications or comorbidities, or without major complications or comorbidities. Many of us don’t need such treatment, and when we do, we tend to arrive in an ambulance and not with a shopping list. Plus, the data sets are delivered by diagnosis, not by isolated item or procedure (MRI, 1/2 hour in the operating room, for example). Here’s the data, on the Medicare site. Enjoy!

What the data released today includes: ”Data being released for the first time by the government on Wednesday shows that hospitals charge Medicare wildly differing amounts — sometimes 10 to 20 times what Medicare typically reimburses — for the same procedure, raising questions about how hospitals determine prices and why they differ so widely,” The Times writes.

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Your doctor ordered a second mammogram? Sorry, it’s not covered

Posted by Jeanne Pinder on May 6, 2013

A friend writes:

I need to get a second mammogram and my $743.55 per month Blue Cross insurance will not pay for it.

I have a (single parent/child) Blue Cross/Blue Shield independent Horizon EPO Plus health insurance policy. I’ve been told that I’ve already reached my maximum for the calendar year of $600 in testing. I live in New Jersey. The second test is necessary because there was not total visibility on the first one, and the technician would like to try it from a different angle.

So how much does a mammogram cost? Glad you asked.

Trying to get a straight answer to what it will cost to pay for myself, I have been sent into multiple loop-de-loops at the facility where my first mammogram was conducted, which is also where my daughter was born 16 years ago. My employer-sponsored Oxford plan at that time required a mere $100 co-pay for my entire pregnancy and delivery, including two weeks of intensive neonatal care in the hospital for my baby.

I turned to clearhealthcosts.com to find a facility to do my second mammogram at a price I can afford to pay. I also want to share my story of how an educated professional who at this time last

year had a six-figure income and 100% company-paid insurance could wind up in this position.

Technically, I needed to get a doctor’s prescription for the second one, but they asked for another angle. So I don’t know that it was a “screwup” or if maybe they saw something they wanted to investigate further and are just staying mum until the second one.

I saw the movie “Sunlight Jr.” recently during the TriBeCa Film Festival. Depicting the story of people living on minimum wage and at the financial edge, it also showcases the impact a lack of health insurance has on day-to-day life choices.

In one scene, the lead character, played by Naomi Watts, goes to a hospital for a sonogram because she is bleeding and thinks she may have miscarried her unplanned baby. In fact, it is a false alarm and she gets to see the beating heart and movements of the fetus for the first time.

This blissful moment is shattered when her partner, a paraplegic alcoholic played by Matt Dillon, rages at her for going for medical care, screaming “You should have called me. I know how these hospitals work. How are we ever going to pay for this? “

After the film and a Q-and-A with the director, my girlfriend expressed surprise that she had not picked up that the point of the movie was to shine a light on the real lives of people who are living this way.

I told my friend I related to the story because I too am living a variation of that nightmare.

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Free birth control. Really? Well, sort of. And sort of not.

Posted by Elizabeth Celms on May 5, 2013

Free birth control under the Affordable Care Act (ACA)? Really? For everyone? Well, maybe not. You might have to wait until 2014.

The Affordable Care Act’s stipulation that preventive services should be free went into effect in August 2012, and many women were ready to pick up their free birth control. Indeed, the ACA’s preventive care without out-of-pocket fees is an exciting prospect for many. But like almost all good things, the perks may come only after waiting.

But just how long will we have to wait? This depends.

Although the ACA has already gone into effect, many employer-provided insurance plans are exempt from

the provisions. Why? Because any employer plan that existed when the ACA passed in 2010 is officially grandfathered. That means the provider can continue to require co-payments for preventive services such as birth control (and mammograms, STD tests, cancer screenings, vaccines and more). Women’s health and rights expert Jodi Jacobson wrote a great opinion piece on this in the Huff Post last August.

But how do you know if your plan is grandfathered or not? Who do you call? What do you say? Check out this article by the National Women’s Law Center (NWLC) for a step-by-step guide.

So what if it turns out your plan is grandfathered? There’s still hope. The NWLC estimates that 90 percent of large U.S. companies will lose their grandfathered health-plan status by 2014.

You can also turn to HealthCare.gov for answers. According to HealthCare.gov, as of last August “approximately 47 million gained guaranteed access to additional preventive services without paying more at the doctors office.” So, clearly, some women are benefiting.

During our reporting on the price of birth-control pills, we have heard repeatedly from people who thought their pills would be free and found that they weren’t, or thought that they wouldn’t be free and found out that they were. Another common scenario: prices that vary month to month at the same pharmacy. In some of these cases, we think it’s simply an error somewhere in the system: a processing problem, perhaps. We have also heard about women who got a free IUD under the law, but that doesn’t seem to be common. Most of what we know is fragmentary and anecdotal.

We’d like to know more. Do you have free birth control under the ACA? Do you work for a company where the plan is grandfathered? Had problems finding a clear answer? Share your story with us: comment here, or email info [at] clearhealthcosts [dot] com.

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Birth-control pills: What’s in a name? Oh, and what do they cost?

Posted by Elizabeth Celms on May 2, 2013

Birth-control pills come in what looks like a bewildering collection of names for the lay person. Tri-Sprintec, Tri-Lo-Sprintec? Why do some have 21, 24, 28 in their names? Yikes.

Here’s a handbook. For further information, see our preceding posts about birth-control pricing here (how much do they cost?) and here (chain stores vs. indies).

For many common pills, the combination of ethinyl estradiol and a progestin inhibits ovulation and influences the cervical mucus and endometrium to discourage implantation. A woman’s cycle is usually 28 days, so the number of pills is generally based on that.

A friend who’s an adolescent medicine specialist writes: “It used to be simple in the days before generics, but now the number of different names is mind-numbing. But the good news is that prices of the generics are much lower! I often get calls from patients double-checking to make sure they’ve gotten the correct pill after the pharmacy dispenses a brand they’ve never heard of.

“I generally write prescriptions using the brand name but specifying that a generic substitute is OK. That’s

better than writing for the generic brand because the different brands seem to come and go as pharmacies and insurance companies deal with different manufacturers. Some patients do report different side effects with different generics, and there are tons of posts on the web by women about their preference for one or another. I assume the differences are related to the inactive ingredients or variations in hormone content that is within the FDA requirements but enough different for occasional patients to notice.

“The numbers following the name of a birth control pill usually refer to the amount of the synthetic hormones, progesterone followed by estrogen, separated by a slash (/). Almost all U.S. birth control pills use ethinyl estradiol for the estrogen, but the amount varies from 15 to 35 micrograms (a few 50 mcg pills exist but are used for specific indications, not routine birth control). There are a handful of different progesterones used in different pills. They include norethindrone, norgestrel, levo-norgestrel, norgestimate desogestrel, drospirenone and ethynodiol. The different progesterones have different side effect profiles, so doctors may recommend a particular pill based on the patient’s particular situation – some help with excessive bleeding, others with acne or excess body hair, etc.

“Most pills are 21 day monophasic pills, meaning they are packaged with the same dose for 21 days. During a week of placebo pills (containing no active medication) or no pills at all, hormone levels drop so a menstrual period occurs. The same brand may be packaged in a 21- or 28-day pack. In that case, the number 21 or 28 will occur after a dash in the name. A few brands now include a much lower dose of estrogen during the last week in a pack or an insignificant amount of iron (Loestrin FE) or some folate (Vitamin B in Beyaz).

“I avoid using the 21-day packs because many patients forget to restart their pills after a week. With the pills packaged with placebo pills, they take a pill every single day, starting a new pack immediately after finishing the previous pack.

“A few pills are packaged with 24 days of the active pill and only 4 placebo pills. As a result, the menstrual period is shorter. There are also a few extended cycle preparations, with 84 active pills followed by 7 placebo pills, so menstruation occurs every 3 months.

“There are also triphasic pills which are packaged with slightly different concentrations of hormone throughout the month. They are generally in 28-days pack. One of the most popular pills is Ortho-Tri-Cyclen. The triphasics generally have ‘tri’ in their names or have 7/7/7 in the name.”

She adds: “I love smalltown, individually-owned pharmacies, but many of my patients use Target for Orthocylen/Sprintec/Mononessa/Prevafem or their Tri sisters for $9/pack. There aren’t many Walmarts around, so I haven’t had experience with them, but their website does list it on their inexpensive med list. Both companies’ websites have long lists of generic drugs available for $4-12/month supply and even bigger discounts for 90-day supply.”

The page pictured here is a great reference for brand names, issues and side effects. We also find a lot of good information on MedScape.

Here’s an example: LoEstrin is made by Teva Pharmaceuticals. It comes in several different generics, including Microgestin and Junel.

A common generic is Junel 1.5-30, meaning 1.5 mg norethindrone acetate) and 30mcg ethinylestradiol. There’s also Junel 1-20, which has 1 mg norethindrone acetate, and 20 mcg ethinyl estradiol.

Junel Fe/1.5-30 (Junel Fe/1-20) is the same prescription, but it has 7 iron pills, so the woman takes 21 active pills and then 7 iron pills.

For Junel, Microgestin, and Loestrin, we know of Junel 1.5/30, Junel 1/20, Junel Fe 1.5/30, Junel Fe 1/20.

Microgestin 1.5/30, Microgestin 1/20, Microgestin Fe 1.5/30, Microgestin Fe 1/20,

Loestrin Fe, Loestrin 21 1.5/30, Loestrin 21 1/20, Loestrin 24 Fe, Loestrin Fe 1.5/30, Loestrin Fe 1/20.

Loestrin 24 Fe, then, has 24 days of active pills and four days of iron in the placebo pills.

A note of caution: When you’re buying, you might find that some independent or chain pharmacies carry one generic, while some carry another. This can be confusing (“I’ve been taking Microgestin, so why are you giving me Junel?”). It can also be true, as our doctor friend notes, that certain pills work better for some women than others, even though both are considered equivalent generics. And then you will encounter the term “formulary,” as in — when you try to fill a prescription at a different pharmacy or on a different insurance plan — you are told “that’s not on our formulary” or “we don’t carry that.” In other words, pay full price or go somewhere else — or choose our club-discount card, if you’d like.

Some pills use drospirenone as the first ingredient. Yasmin, Ocella, Zarah, Safyral, Syeda all have 3 mg drospirenone and 30 mcg of ethinyl estradiol for 21 days, then one inert tablet for 7 days.Their cousins, Yaz, Beyaz, Gianvi, Loryna and Vestura have 3 mg drospirenone and 20 mcg ethinyl estradiol for 24 days, then one inert tablet for 4 days. Source: Medscape.

Ortho-Tri-Cyclen has several generics: Trinessa and Tri-Sprintec. But Ortho-Tri-Cyclen Lo, as far as we can tell, has no generic yet; MedScape’s dictionary of drugs, again, is our source for that.

Confused yet? Don’t get us started on how a brand-name drug becomes a generic, or how a brand-name drug that is eligibile for generic manufacture might suddenly become a slightly different drug, and therefore not something that can be turned into a generic. We wrote about this in this blog post: for example, when Yaz, the popular pill, became eligible for generic manufacture, then acquired an added chemical, the vitamin folic acid, which is important for women planning to get pregnant to overcome spinal bifida and other birth defects. So Yaz became Beyaz.

Of course, you can find a lot of information on the web: Here’s a Microgestin-vs.-Junel conversation from a Web site called Treato, which distills patient discussions about various medical issues from online sources, and compiles them for medical professionals. From their compilation of 900 patient comments about Junel and 2,239 from patients on Microgestin, Junel has a better satisfaction rate. For whatever it’s worth.

Further information? Here’s the FDA Web site. And here’s the Mayo Clinic Drugs and Supplements site.

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Want still more information? See our preceding posts about birth-control pricing here (how much do they cost? $9 to $63? Really?) and here (chain stores vs. indies).

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What do birth control pills cost? Indies, chains, and finding the best price

Posted by Elizabeth Celms on May 1, 2013

As we wrote in an earlier blog post, when you need to fill a prescription, it pays to shop around.

What do birth control pills cost? Prices can vary a little or a lot. Compare big box pharmacies, such as Rite Aid, CVS, Costco or Walgreens, with the little independent guys. The same is true for other prescriptions, too — prices vary — though our recent research project focused on birth-control pills because they’re widely used, and interesting for a number of reasons.

(We’ll talk about free birth control in another post. As you guessed, it’s complicated.)

Paying cash? Costco has a reputation for rock-bottom-low prices. Here’s the lowdown from our friend Dr. Leslie Ramirez, head of Leslieslist.org in Chicago:

“Costco has a well-publicized pricing strategy of charging the wholesale price plus a standardized 14% mark-up on everything it sells, including prescriptions. ” She writes in this blog post that others’ drug pricing involves hefty markups, noting that the pricing of medications, brands to generics, is opaque in the extreme.

Insured? It might be that Costco will still be your best option. We don’t have deep experience with this, but anecdotally people keep telling us that they can buy cheaper outside of their insurance plan depending on the medication.

While reporting on birth control prices in New York, New Jersey and Connecticut, we spoke to dozens of neighborhood and chain drug stores, asking for their cash or self-pay prices. Those prices ranged

broadly: one pill, Tri-Sprintec 28, ranged from $9 to $63; another, Yaz-28, ranged from $68 to $112. Several pharmacists said they often reduce the cash price for uninsured customers to make pills affordable.

While independent pharmacies may have more control over their prescription prices, what they don’t usually offer are “club card” discounts. CVS, Rite Aid, Kmart … almost every big chain pharmacy has a discount program. Some are free. Others require a $10 or $20 annual membership fee.

But how great are these discounts? According to our research, club members can save anywhere from $5 to $25 for a prescription, depending on the chain and the prescription. But before signing up for the club card, know that once you do, the chain will track your history.

Furthermore, we’ve had people tell us they’re pretty dissatisfied with some club cards, both from stores and from third parties — the city, the county, the Chamber of Commerce or whoever offers the card. The discounts aren’t always as advertised online and are often arbitrary – some prescriptions are discounted, others are not. So it’s good to do a bit of research before you sign up.

Another option: online coupons. Goodrx.com (a site with price comparisons) shows coupons that offer a variety of discounts on prescription drugs. Again, we’ve heard of coupons being rejected at local chain stores. Apparently not all retailers honor these discounts.

Also, manufacturer’s coupons are available for many medications, including some popular birth-control pills. A site that’s a clearing-house for such coupons is CouponDoc. To get many of their coupons you need to click through to the manufacturer’s web site, fill out a form, get a coupon with identifying data, and only then will you be able to see if the coupon works for you, at your pharmacy, with (or without) your insurance. Terms and conditions often apply. The manufacturer wants to issue a coupon to keep you using their medication; are you willing to give information back to them? And CouponDoc makes money out of uniting the pharmacy and the purchaser. There’s nothing wrong with that, of course, but you need to be informed. CouponDoc has also launched its own club discount card.

As we so often hear online, “if something is free, then you are the product being sold.”

Many people who know and trust their neighborhood pharmacist will patronize that drug store for years, even if the price at CVS is a few bucks cheaper. Why? Because of the personal connection, knowledge of your history and a trusted face behind the counter.

Meanwhile, young people who live far from their hometown, those who relocate often, and those who travel a lot might favor the big name pharmacies they see on every city corner.

The big takeaway: It pays to shop around. If you’re operating by habit, you could easily be spending more than you need to.

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Q: How much do birth-control pills cost? A: $9 to $63, or $68 to $112.

Posted by Elizabeth Celms on April 29, 2013

When you need to fill a prescription, it pays to shop around. Prices for common drugs vary depending on where you go. This is true for big chains and small neighborhood pharmacies.

We did some fairly thorough research just recently on birth-control pills in the Tri-state area (New York, New Jersey and Connecticut). Price differences were sometimes shocking. For example, one popular birth control pill, Tri-Sprintec 28, ranged from $9 to $63, depending on where you shop. Another common one, Yaz-28, ranged from $68 to $112. Here are the results of the survey.

Here’s another thing: If you’re insured, you might be surprised to find out that, in many cases, prescriptions can be filled for less by paying out-of-pocket. Here’s a blog post we wrote about a man who found that a prescription would cost $12.10 without insurance, and $38 with.

This is not uncommon; here’s an article about an internist who sends patients to Costco to buy their prescriptions without invoking their insurance. The internist, Dr. David Belk, maintains a website with a lot of cost information; the section on medications notes that the cost of copays actually can have the effect of raising prices. So the Wal-Marts and Costcos of the world buy at cost, mark up a

bit and sell for cash, rather than going through the co-pay insurance route. He practices in California, and we have anecdotal information confirming that the same is true in New York, among other places we’ve collected pricing.

Many people are surprised to find how much prices vary, not just for birth-control pills but for a lot of other prescriptions. Our recent research project focused on birth-control pills because they’re widely used, and interesting for a number of reasons.

If you’re comparison shopping, one place to start is goodrx.com. This easy-to-navigate website allows you to punch in the prescription you need with the city you live in and – voila – it returns a full list of price comparisons at local drug stores. The site also includes discount coupons, but they’re not always accepted at your local store.

Here’s a New York State website that also allows you to look up competing prescription prices. But use sound judgment – some of the prices we found we just don’t believe. For example, the list includes a number of common birth-control pills for well over $1,000 at several New York pharmacies. Really?

Here’s a price comparison site for New Jersey.

Looking for one for your state? Here’s a somewhat dated list from the Robert Wood Johnson Foundation of state drug price lists.

These are all great resources but should be used with skepticism. During our phone reporting, we found several pharmacy prices listed online were outdated or inaccurate.

In New York, pharmacies are required to supply price lists to consumers on request: “Every pharmacy that sells drugs at retail must make Drug Retail Price Lists available” for the top 150 sellers, according to the New York State pharmacy regulation Web site. “Pharmacies should update their lists at least weekly. Consumers may request a computer-generated list to take with them when they leave the pharmacy.”

But those lists can have mistakes: in one case, we called a Brooklyn pharmacy with a price listing of $467 for one pack of a common birth-control pill. When we asked if the cash-pay price was really that much, they checked their database and sheepishly told us the price was actually $93. Apparently their software had “miscalculated.”

A friend who’s an adolescent medicine specialist writes: “I love smalltown, individually-owned pharmacies, but many of my patients use Target for Orthocylen/Sprintec/Mononessa/Prevafem or their Tri sisters for $9/pack. There aren’t many Walmarts around, so I haven’t had experience with them, but their website does list it on their inexpensive med list. Both companies’ websites have long lists of generic drugs available for $4-12/month supply and even bigger discounts for 90-day supply.”

In general, we recommend that you also ask about discounts. We had one pharmacist in New Haven tell us that he’d bring a $30 birth-control prescription down to $20 if the uninsured customer couldn’t afford it. That’s one of the perks about your independent neighborhood drug store (more about this to come.)

But why does the price vary so much? It’s not like the price of strawberries, which depends on a good harvest.

According to a recent story in the LA Times by David Lazarus, brand-name drugs will always carry the highest prices possible – mostly due to millions in research and development costs – while generic drugs are a little trickier. Lazarus quoted Bob Toomajian, who worked for 16 years as Kaiser Permanente’s drug purchasing manager for Southern California, as saying: “A lot of the prices for generics can’t be justified. Manufacturers are basically starting with the exorbitant prices that the branded guys charged and then setting their own prices at whatever level they think the market will bear.”

Moral of the story: prescription pricing websites are great, but it’s always best to get your quotes from the horse’s mouth -– so make a phone call before rushing out the door for that $12 birth control prescription.

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Q: How much do birth-control pills cost? A: $9 to $63, or $68 to $112.

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