This story comes from our partner

As he makes his case for overhauling the American health care system, President Obama has used the analogy of patients getting a choice between a blue pill and a red pill. The blue pill is just as effective as the red pill, but costs half as much. If everyone would just choose the blue pill, the analogy goes, we could save our health care system a lot of money.

In the real world, that battle over blue and red pills is decades old and involves billions of dollars, but it’s invisible to most of us.聽

Serra stumbled onto the battleground because he’s got pimples – and a Solodyn Patient Access Card. “It looks like a little credit card,” Serra says.

That white-and-blue piece of plastic is also a kind of weapon. It’s the drug company’s way of getting a patient like Serra to choose its name-brand product, even when it costs more, by subsidizing his high copay.

Solodyn’s maker, Medicis, wouldn’t answer questions, but you can see how the system works from Serra’s experience.

Serra, a paralegal, went to his doctor a few months ago for help with acne. She prescribed Solodyn. Serra told her he’d previously taken a generic drug called minocycline that worked well. The doctor told him that the two compounds are basically the same, but that you have to take the generic version in the morning and the evening. With Solodyn, you take one dose a day.

Serra told her that if the name-brand medicine was going to cost a lot more, he’d prefer the generic. “And then she presented this card,” he says. She explained that it was a coupon, and that he should give it to the pharmacist for a break on his insurance copay.

Without the card, Serra’s copay would have been $154.28. But when he got to the pharmacy, he presented his card. “They went to ring it up at the register,” he remembers. “And when it came up, the price was $10.”

Insurance Companies Win A Round

Eileen Wood is situated on one side of this war over red and blue pills. She works as vice president of the Capital District Physicians’ Health Plan, an insurance company in Albany, N.Y.

Ask Wood about the war, and she’ll open the drawer in her file cabinet where she keeps zippered pouches of her least-favorite brand-name drugs. Among them is Minocin, an acne drug. She says a generic version of it costs about $50 a month. But a newer brand-name drug, Minocin Pac, costs $668.

The difference? “It has these lovely calming wipes, so that when your skin’s all red you can pat this on,” Wood says. “It’s basically stuff you can buy over the counter.” She says the marketing is very slick.

Minocin Pac may be an extreme example, but Wood says the only reason for such a disparity in prices is that insurance executives are the only people who see the full cost of the drugs. Patients don’t know or care, because the majority of patients have health insurance.

Wood and her insurance colleagues went on the attack over copays. They instituted higher copays for expensive drugs with generic options as a way to encourage consumers to choose the cheaper option. In essence, they told customers that they could choose a drug like Minocin Pac and that insurance would even pay most of the cost – but with a $40 copay. If you choose the generic, you would pay only $10.

The copay strategy worked so well that in 2003, more than half of all drugs picked up at pharmacies were generics.

Drug Companies Fire Back

The drug companies quickly caught on. They made a counterargument: that insurance companies shouldn’t be steering patients’ care.

“We want treatment decisions to be based on what the physician feels is best for the patient, not just the cost to the patient or what another player may decide is in their interest,” says Sally Beatty of Pfizer, which makes Lipitor, the world’s most popular drug.

Facing tight competition from generic drugs, Lipitor saw its sales drop after the insurance industry raised copays for name-brand drugs. By July 2007, sales were down 13 percent from the same quarter the year before.

In the case of Lipitor, there is no approved generic substitute, no drug that is chemically identical. There are generics in the same class of cholesterol-reducing drugs, but tests show a small group of patients respond better to Lipitor. For some of those patients, a $40 copay stops them from getting the medication.

By 2007, the pharmaceutical industry had mounted its counterattack: coupons to subsidize the cost of copays for consumers, like the one Serra used to buy his acne medicine – the one that brought his copay down from $154.28 to $10.

Serra’s insurance company ended up paying $514 a month for his once-a-day Solodyn. Minocycline, the twice-daily generic, costs $109 a month.

But Serra never saw those numbers. He saw a deal, and he likes deals.

An investigation by Wall Street Journal reporter Jonathan Rockoff found that in the past year, drug manufacturers have broadly expanded their subsidy programs as copays and drug costs have risen. The Journal notes that copays do affect consumer behavior. Every 10 percent rise in copays seems to lead to a 6 percent decrease in spending on drugs.

Wood says she understands the allure of the manufacturers’ coupons, but she says those coupons come with a consequence. If everyone started using coupons to get the more expensive drugs, “we’d have to raise premiums,” she says. “There’s no question about that.”

Consumers like Serra don’t want to see premiums go up. But they’re caught between enormous insurance companies and enormous drug companies.

Obama talks about choosing the blue pill over the red one, but the coupon cards make it hard to know which is which. It’s uncomfortably clear that these cards are not the biggest weapons in this war. Drug consumers are.

This <a target="_blank" href="/news/npr-drug-coupons-cost/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story comes from our partner

For all the attempts to lower the cost of health care in the United States, it remains expensive. Overall medical spending accounts for more than 17 percent of America’s entire economy.

As lawmakers look for ways to trim costs and extend insurance coverage to more people, one of their greatest challenges has been pulling apart the many layers of expense.

Their work is as intricate as that of cardiologist Dr. Paul Teirstein. On a recent day he stands in an operating room at Scripps Health in San Diego, looking down at a patient under light anesthesia. The patient lies half-conscious, with tubes coming out of her chest and beeping monitors keeping track of her vital signs. At least a dozen professionals shuffle around the room.

Teirstein holds up a single small piece of metal – it costs $2,000, and it’s destined for one of her arteries. He turns the overhead lights on to better show the stent. “They’re very small,” he says, “and very flexible.”聽

Teirstein turns his attention to a screen showing the patient’s arteries. They look like narrow, winding tree roots. Teirstein has to put this stent somewhere in there. He assesses the size of the problem and calls for a 23-millimeter stent. Someone repeats the order, then hands it to him. Teirstein threads it around a bend and up the clogged artery.

He looks back at the screen. “Too big, I think,” he says aloud. “What do you guys think? A little bit too long? Want to try an 18?”

Teirstein pulls the stent back down out of the patient’s artery and tosses it aside. He calls for an 18-millimeter stent and starts over.

“It’s one of the advantages of having a lot of different stents in your cabinet,” he says, noting that he can try several sizes to find the best fit.

The Cost Of Precision

And what happens to the stent that didn’t look right? It goes back to the company, which throws it away.

Teirstein’s hospital has a special deal with the stent manufacturer – the hospital doesn’t have to pay for stents it doesn’t use. But from an economic perspective, trashing stents raises the price of all stents, because the manufacturer has to factor in that cost.

In this single operating room, doctors might go through a dozen stents in a day. The rolling metal shelves are stacked with boxes of stents, with what amounts to piles of money.

Teirstein is casual not just with stents but with all his tools. When a tiny wire that looks like it belongs in a piano annoys him during the procedure, he gets rid of it. The wire costs $50.

Then a catheter doesn’t sit right in an artery. He calls for another. “You really need a lot of tools to do this procedure,” Teirstein says. “They’re all kind of expensive. This catheter is probably about $60.” It’s just a piece of plastic, but it’s an FDA-approved piece of plastic that has to bend in the right away and perform its role exactly.

It feels bizarre to stand here not as the patient and not as the doctor but as a sort of accountant. Teirstein goes through five of these $60 plastic tubes in an hour, and three of the $2,000 stents.

You might ask whether the stent needs to cost $2,000. Part of the answer is simply that it’s critical to life. It’s got to live inside a human being, next to the heart. It needs to be precise, and precision is expensive. Getting a new stent approved by the FDA costs millions of dollars. The $2,000 price lets the manufacturer recoup some of that expense.

The Cost Of Being New

There’s another simple answer to why the stents cost so much. Doctors like Teirstein handle new technology, so new that the market hasn’t figured out yet what it should cost.

Harvard economist Ken Rogoff says that some materials you see in hospitals, like bandages, have been around long enough to become ordinary and cheap. “But the kind of fine scalpels used in heart surgery are really pretty new, and there are lots of different varieties,” he says. “The market is still sorting itself out.”

Over time, most products become mass-produced, familiar, and less expensive. Think of Band-Aids, TVs and calculators – they’re all ordinary, and they’re all generally affordable.

We don’t get to know scalpels and stents the way we know calculators. We don’t really understand just how perfect they need to be. And we tend to accept that marginally better medical technologies are worth the cost.

Because we’ll pay for the new, better stent, manufacturers are constantly trying to make a new, better stent. Americans have been incredible innovators in medical technology. We benefit from that. The world benefits from that. We also pay for it. A lot.

This <a target="_blank" href="/health-industry/npr-health-costs/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story comes from our partner

In the current hunt for savings in the health care system, one idea sounds simple: Just get doctors to quit ordering unnecessary procedures and tests. Evidence suggests that some doctors dole out more treatment, and yet their patients don’t fare better.

If you talk to doctors, though, the idea of cutting back starts to sound more complicated. Take, for example, Drs. Paul Teirstein and Eric Topol. Both are interventional cardiologists practicing at Scripps Health in San Diego. Yet the two physicians see their field, and health care in general, from opposite poles. Teirstein calls Topol a good friend, but says, “We disagree a lot. I find him challenging.”

One of their biggest disagreements concerns stents, tiny metal tubes that cardiologists use to open clogged arteries and relieve chest pain. that cardiologists sometimes use stents in scenarios where research would indicate they are unnecessary.

Topol says he believes as many as 20 percent of all stents aren’t really needed. He notes that annually, 1.2 million patients undergo a stent procedure. “Undoubtedly, that’s more than we need to do,” he says.

Sitting in the same California hospital, Teirstein says he’s not convinced by the research Topol leans on. Teirstein is an ardent believer in the technology and puts in an average of seven stents a day. “I definitely have a bias towards stents,” he says. “I have a lot of experience with stents. I’ve seen patients do so much better.”

Conflicting Research, Competing Motives聽

It’s clear that many patients with serious blockages in their arteries have benefited greatly from stents. But a lot depends on the exact type of treatment involved. A trial called COURAGE – short for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation – found that for patients with “stable angina,” stents are no better than drugs at preventing heart attacks or death.

Drugs take a while to work, Teirstein argues, while stents offer an “instant fix.” After surgery to receive a stent, patients tend to go home quickly and feel better almost immediately.

Topol counters that cardiologists, like most doctors, get paid on a fee-for-service basis. The more stent procedures they do, the more money they make. Topol says that dynamic has to drive up the number of stent procedures. “Some of it is financially motivated, but at a subconscious level,” he says.

Teirstein says income is not the driving factor. “The physicians I know do what I do, which is say, ‘If this was my mother or father, what would I do?’ Financial incentive is the last thing you think about,” he says. “What is inspiring is trying to help a patient.”

If policymakers are to uncover health care savings in curbing unnecessary procedures, they’ll need doctors to believe that at least some of what they do is wasteful. As the ongoing conversation between Teirstein and Topol shows, individual doctors make sense of the available research differently, as each makes choices for individual patients.

The one thing Topol and Teirstein agree on is that they want to be able to make those choices. They’re fine with telling each other what to do, even when they don’t agree. They just don’t want the government or insurers telling them what to do.

This <a target="_blank" href="/health-industry/npr-stents/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story comes from our partner

As he makes his case for overhauling the American health care system, President Obama has used the analogy of patients getting a choice between a blue pill and a red pill. The blue pill is just as effective as the red pill, but costs half as much. If everyone would just choose the blue pill, the analogy goes, we could save our health care system a lot of money.

In the real world, that battle over blue and red pills is decades old and involves billions of dollars, but it’s invisible to most of us.聽

Serra stumbled onto the battleground because he’s got pimples – and a Solodyn Patient Access Card. “It looks like a little credit card,” Serra says.

That white-and-blue piece of plastic is also a kind of weapon. It’s the drug company’s way of getting a patient like Serra to choose its name-brand product, even when it costs more, by subsidizing his high copay.

Solodyn’s maker, Medicis, wouldn’t answer questions, but you can see how the system works from Serra’s experience.

Serra, a paralegal, went to his doctor a few months ago for help with acne. She prescribed Solodyn. Serra told her he’d previously taken a generic drug called minocycline that worked well. The doctor told him that the two compounds are basically the same, but that you have to take the generic version in the morning and the evening. With Solodyn, you take one dose a day.

Serra told her that if the name-brand medicine was going to cost a lot more, he’d prefer the generic. “And then she presented this card,” he says. She explained that it was a coupon, and that he should give it to the pharmacist for a break on his insurance copay.

Without the card, Serra’s copay would have been $154.28. But when he got to the pharmacy, he presented his card. “They went to ring it up at the register,” he remembers. “And when it came up, the price was $10.”

Insurance Companies Win A Round

Eileen Wood is situated on one side of this war over red and blue pills. She works as vice president of the Capital District Physicians’ Health Plan, an insurance company in Albany, N.Y.

Ask Wood about the war, and she’ll open the drawer in her file cabinet where she keeps zippered pouches of her least-favorite brand-name drugs. Among them is Minocin, an acne drug. She says a generic version of it costs about $50 a month. But a newer brand-name drug, Minocin Pac, costs $668.

The difference? “It has these lovely calming wipes, so that when your skin’s all red you can pat this on,” Wood says. “It’s basically stuff you can buy over the counter.” She says the marketing is very slick.

Minocin Pac may be an extreme example, but Wood says the only reason for such a disparity in prices is that insurance executives are the only people who see the full cost of the drugs. Patients don’t know or care, because the majority of patients have health insurance.

Wood and her insurance colleagues went on the attack over copays. They instituted higher copays for expensive drugs with generic options as a way to encourage consumers to choose the cheaper option. In essence, they told customers that they could choose a drug like Minocin Pac and that insurance would even pay most of the cost – but with a $40 copay. If you choose the generic, you would pay only $10.

The copay strategy worked so well that in 2003, more than half of all drugs picked up at pharmacies were generics.

Drug Companies Fire Back

The drug companies quickly caught on. They made a counterargument: that insurance companies shouldn’t be steering patients’ care.

“We want treatment decisions to be based on what the physician feels is best for the patient, not just the cost to the patient or what another player may decide is in their interest,” says Sally Beatty of Pfizer, which makes Lipitor, the world’s most popular drug.

Facing tight competition from generic drugs, Lipitor saw its sales drop after the insurance industry raised copays for name-brand drugs. By July 2007, sales were down 13 percent from the same quarter the year before.

In the case of Lipitor, there is no approved generic substitute, no drug that is chemically identical. There are generics in the same class of cholesterol-reducing drugs, but tests show a small group of patients respond better to Lipitor. For some of those patients, a $40 copay stops them from getting the medication.

By 2007, the pharmaceutical industry had mounted its counterattack: coupons to subsidize the cost of copays for consumers, like the one Serra used to buy his acne medicine – the one that brought his copay down from $154.28 to $10.

Serra’s insurance company ended up paying $514 a month for his once-a-day Solodyn. Minocycline, the twice-daily generic, costs $109 a month.

But Serra never saw those numbers. He saw a deal, and he likes deals.

An investigation by Wall Street Journal reporter Jonathan Rockoff found that in the past year, drug manufacturers have broadly expanded their subsidy programs as copays and drug costs have risen. The Journal notes that copays do affect consumer behavior. Every 10 percent rise in copays seems to lead to a 6 percent decrease in spending on drugs.

Wood says she understands the allure of the manufacturers’ coupons, but she says those coupons come with a consequence. If everyone started using coupons to get the more expensive drugs, “we’d have to raise premiums,” she says. “There’s no question about that.”

Consumers like Serra don’t want to see premiums go up. But they’re caught between enormous insurance companies and enormous drug companies.

Obama talks about choosing the blue pill over the red one, but the coupon cards make it hard to know which is which. It’s uncomfortably clear that these cards are not the biggest weapons in this war. Drug consumers are.

This <a target="_blank" href="/news/npr-drug-coupons-cost/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story comes from our partner

For all the attempts to lower the cost of health care in the United States, it remains expensive. Overall medical spending accounts for more than 17 percent of America’s entire economy.

As lawmakers look for ways to trim costs and extend insurance coverage to more people, one of their greatest challenges has been pulling apart the many layers of expense.

Their work is as intricate as that of cardiologist Dr. Paul Teirstein. On a recent day he stands in an operating room at Scripps Health in San Diego, looking down at a patient under light anesthesia. The patient lies half-conscious, with tubes coming out of her chest and beeping monitors keeping track of her vital signs. At least a dozen professionals shuffle around the room.

Teirstein holds up a single small piece of metal – it costs $2,000, and it’s destined for one of her arteries. He turns the overhead lights on to better show the stent. “They’re very small,” he says, “and very flexible.”聽

Teirstein turns his attention to a screen showing the patient’s arteries. They look like narrow, winding tree roots. Teirstein has to put this stent somewhere in there. He assesses the size of the problem and calls for a 23-millimeter stent. Someone repeats the order, then hands it to him. Teirstein threads it around a bend and up the clogged artery.

He looks back at the screen. “Too big, I think,” he says aloud. “What do you guys think? A little bit too long? Want to try an 18?”

Teirstein pulls the stent back down out of the patient’s artery and tosses it aside. He calls for an 18-millimeter stent and starts over.

“It’s one of the advantages of having a lot of different stents in your cabinet,” he says, noting that he can try several sizes to find the best fit.

The Cost Of Precision

And what happens to the stent that didn’t look right? It goes back to the company, which throws it away.

Teirstein’s hospital has a special deal with the stent manufacturer – the hospital doesn’t have to pay for stents it doesn’t use. But from an economic perspective, trashing stents raises the price of all stents, because the manufacturer has to factor in that cost.

In this single operating room, doctors might go through a dozen stents in a day. The rolling metal shelves are stacked with boxes of stents, with what amounts to piles of money.

Teirstein is casual not just with stents but with all his tools. When a tiny wire that looks like it belongs in a piano annoys him during the procedure, he gets rid of it. The wire costs $50.

Then a catheter doesn’t sit right in an artery. He calls for another. “You really need a lot of tools to do this procedure,” Teirstein says. “They’re all kind of expensive. This catheter is probably about $60.” It’s just a piece of plastic, but it’s an FDA-approved piece of plastic that has to bend in the right away and perform its role exactly.

It feels bizarre to stand here not as the patient and not as the doctor but as a sort of accountant. Teirstein goes through five of these $60 plastic tubes in an hour, and three of the $2,000 stents.

You might ask whether the stent needs to cost $2,000. Part of the answer is simply that it’s critical to life. It’s got to live inside a human being, next to the heart. It needs to be precise, and precision is expensive. Getting a new stent approved by the FDA costs millions of dollars. The $2,000 price lets the manufacturer recoup some of that expense.

The Cost Of Being New

There’s another simple answer to why the stents cost so much. Doctors like Teirstein handle new technology, so new that the market hasn’t figured out yet what it should cost.

Harvard economist Ken Rogoff says that some materials you see in hospitals, like bandages, have been around long enough to become ordinary and cheap. “But the kind of fine scalpels used in heart surgery are really pretty new, and there are lots of different varieties,” he says. “The market is still sorting itself out.”

Over time, most products become mass-produced, familiar, and less expensive. Think of Band-Aids, TVs and calculators – they’re all ordinary, and they’re all generally affordable.

We don’t get to know scalpels and stents the way we know calculators. We don’t really understand just how perfect they need to be. And we tend to accept that marginally better medical technologies are worth the cost.

Because we’ll pay for the new, better stent, manufacturers are constantly trying to make a new, better stent. Americans have been incredible innovators in medical technology. We benefit from that. The world benefits from that. We also pay for it. A lot.

This <a target="_blank" href="/health-industry/npr-health-costs/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story comes from our partner

In the current hunt for savings in the health care system, one idea sounds simple: Just get doctors to quit ordering unnecessary procedures and tests. Evidence suggests that some doctors dole out more treatment, and yet their patients don’t fare better.

If you talk to doctors, though, the idea of cutting back starts to sound more complicated. Take, for example, Drs. Paul Teirstein and Eric Topol. Both are interventional cardiologists practicing at Scripps Health in San Diego. Yet the two physicians see their field, and health care in general, from opposite poles. Teirstein calls Topol a good friend, but says, “We disagree a lot. I find him challenging.”

One of their biggest disagreements concerns stents, tiny metal tubes that cardiologists use to open clogged arteries and relieve chest pain. that cardiologists sometimes use stents in scenarios where research would indicate they are unnecessary.

Topol says he believes as many as 20 percent of all stents aren’t really needed. He notes that annually, 1.2 million patients undergo a stent procedure. “Undoubtedly, that’s more than we need to do,” he says.

Sitting in the same California hospital, Teirstein says he’s not convinced by the research Topol leans on. Teirstein is an ardent believer in the technology and puts in an average of seven stents a day. “I definitely have a bias towards stents,” he says. “I have a lot of experience with stents. I’ve seen patients do so much better.”

Conflicting Research, Competing Motives聽

It’s clear that many patients with serious blockages in their arteries have benefited greatly from stents. But a lot depends on the exact type of treatment involved. A trial called COURAGE – short for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation – found that for patients with “stable angina,” stents are no better than drugs at preventing heart attacks or death.

Drugs take a while to work, Teirstein argues, while stents offer an “instant fix.” After surgery to receive a stent, patients tend to go home quickly and feel better almost immediately.

Topol counters that cardiologists, like most doctors, get paid on a fee-for-service basis. The more stent procedures they do, the more money they make. Topol says that dynamic has to drive up the number of stent procedures. “Some of it is financially motivated, but at a subconscious level,” he says.

Teirstein says income is not the driving factor. “The physicians I know do what I do, which is say, ‘If this was my mother or father, what would I do?’ Financial incentive is the last thing you think about,” he says. “What is inspiring is trying to help a patient.”

If policymakers are to uncover health care savings in curbing unnecessary procedures, they’ll need doctors to believe that at least some of what they do is wasteful. As the ongoing conversation between Teirstein and Topol shows, individual doctors make sense of the available research differently, as each makes choices for individual patients.

The one thing Topol and Teirstein agree on is that they want to be able to make those choices. They’re fine with telling each other what to do, even when they don’t agree. They just don’t want the government or insurers telling them what to do.

This <a target="_blank" href="/health-industry/npr-stents/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">