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http://www.azcentral.com/business/articles/20120831scorpion-sting-leaves-woman-big-bill.html
This article has been bouncing around the interwebs the past 3 days, reposted/reblogged, and is currently the primary example of how dumb/corrupt/outrageous the US healthcare system is. So far most places are attributing the charge to that particular hospital being at fault because its for-profit (no surprise there). Additionally, reading the article, it looks like she was out of network with some sort of 80%/20% coverage, but the 80% that the insurance paid should have EASILY covered the actual cost + some profit.
The more I think about it though, I'm sure people are going to end up asking questions like "why the hell is this particular pharmacy charging 10x AWP, and why are other hospitals charging 2-3x AWP". Pharmacy upcharging isn't anything new, I've seen plenty of anecdotes for $60 tylenols and whatnot, and every other hospital department does it too. What I really want to know is, why?
From what I understand from working 5+ years in health sytem pharmacy, the cost of giving a pt an IV med includes but is not limited to
In any case, I can't imagine the actual cost would be even 2x AWP (for a drug that costs $3700/vial, assuming 1 vial = 1 dose). I understand that hospitals need to make money, pharmacists/techs and physical facility aren't cheap. And I vaguely remember that "cash" price for hospitalization is inflated due to lower negotiated insurance reimbursement based on artificial "cash" price, charity care, and etc. But does running an inpt pharmacy actually require charging 10x AWP on a high-cost item?
So I guess my question to any experts reading this (mainly Z or any other DOP/management type) is whether you can shed some light on this or whether this kind of stuff is determined by hospital finance types who have been creating spiraling healthcare costs. I probably shouldn't bite the hand that feeds me but I'm kind of sick of people not considering the immediate costs of overutilizing expensive drugs or future implications of ridiculous healthcare costs.
This article has been bouncing around the interwebs the past 3 days, reposted/reblogged, and is currently the primary example of how dumb/corrupt/outrageous the US healthcare system is. So far most places are attributing the charge to that particular hospital being at fault because its for-profit (no surprise there). Additionally, reading the article, it looks like she was out of network with some sort of 80%/20% coverage, but the 80% that the insurance paid should have EASILY covered the actual cost + some profit.
The more I think about it though, I'm sure people are going to end up asking questions like "why the hell is this particular pharmacy charging 10x AWP, and why are other hospitals charging 2-3x AWP". Pharmacy upcharging isn't anything new, I've seen plenty of anecdotes for $60 tylenols and whatnot, and every other hospital department does it too. What I really want to know is, why?
From what I understand from working 5+ years in health sytem pharmacy, the cost of giving a pt an IV med includes but is not limited to
- actual acquisition cost (probably more than AWP)
- some sort of pharmacy dispensing/IV admix charge to cover making it + distribution
- IV line placement
- IV pump & tubing, flushes, whatevs
- the RN's time to actually give it
In any case, I can't imagine the actual cost would be even 2x AWP (for a drug that costs $3700/vial, assuming 1 vial = 1 dose). I understand that hospitals need to make money, pharmacists/techs and physical facility aren't cheap. And I vaguely remember that "cash" price for hospitalization is inflated due to lower negotiated insurance reimbursement based on artificial "cash" price, charity care, and etc. But does running an inpt pharmacy actually require charging 10x AWP on a high-cost item?
So I guess my question to any experts reading this (mainly Z or any other DOP/management type) is whether you can shed some light on this or whether this kind of stuff is determined by hospital finance types who have been creating spiraling healthcare costs. I probably shouldn't bite the hand that feeds me but I'm kind of sick of people not considering the immediate costs of overutilizing expensive drugs or future implications of ridiculous healthcare costs.
