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Coming next week: The price of insulin

As we started working on season two of this podcast, there was one topic that seemed like we just had to look at: insulin.

… and I wondered:  There are stories about insulin prices everywhere.  Would we really have something to add? Something that wasn’t just more of the same? (Enraging, terrifying, depressing.)

Turns out: OH YES WE DO.

And some of it is… hopeful.

We are holding it back a week, so you can take a break for the holiday, come back fresh, and be ready for something epic.  See you then.

(If you’re new here, welcome! All our episodes so far are on our home page, or wherever you get podcasts.  You can sign up for our newsletter , share a story, or check us out on Facebook and Twitter @armandalegshow.)

Why are drug prices so random? Meet Mr. PBM

I filled a prescription recently, and the drugstore said they wanted more than 700 bucks… for an old-line generic drug. My insurance ended up knocking that down, but it was WEIRD.  And it meant a big homework assignment for me.

Oh no! Now I have to learn how prescription drug pricing works.

Luckily, I got help. Both from some experts, and from the classic Christmas movie It’s a Wonderful Life (source of the pictures above and below, of course).

I totally cracked it, man!

I mean, what I actually learned was not a hundred percent cheerful.

We get these unpredictable prices thanks to companies that — surprise! — make a big profit from driving prices up.  (They’re called “pharmacy benefit managers” — PBM for short.)

Theoretically, they work for insurance companies and employers who pay the premiums, and they’re supposed to keep drug prices down.

Economist Geoffrey Joyce used to think they did OK at that, but he’s changed his mind.

One thing that turned him around:

They got sued in several states, saying, ‘Hey, you should be acting in the best interest of your clients.’ And they’ve won in court saying, ‘No, we have no obligation to do what’s best for our clients. We do what’s best for us.’

So, not all sunshine. 

But: Feeling a little smarter about the whole thing? It’s a victory. Also kinda fun.

How much for an MRI? Well, that depends…

This week, we look at three MRIs with four different price tags, and an enormous range.  

Liz Salmi and a view of her brain. (Photo: Kaiser Health News)

The first two price tags come from listener Liz Salmi, who has been living with brain cancer for more than a decade.

Liz gets MRI scans twice a year, to make sure the cancer isn’t growing.  

A couple years ago, Liz changed insurance, changed providers… and got serious sticker-shock when she saw the bill for a scan: $1,600 — AFTER insurance.

So when she needed a follow-up scan, she shopped around — and found an option that set her back less than 90 bucks.

Which is great news, and useful — as far as it goes: As Liz points out, not everybody has six months to shop around.

But Liz’s experience isn’t even the craziest MRI-price-tag story we look at this week. Stick around for that.

Coming in to bat cleanup — to help us understand why these prices are so crazy, and so variable — is journalistic super-star, friend of the show, and my new colleague:

Elisabeth Rosenthal, editor-in-chief of Kaiser Health News and author of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. She breaks it down in an authoritative, funny, clear-as-glass way.

(Reminder: Kaiser Health News — our co-producers for this season — is not affiliated with the health care provider Kaiser Permanente. It’s a great story, and we’ve got it for you right here.)

This is the first of three episodes where we look at where health care prices come from. So this week it’s MRIs.

Next up: Prescription drugs.  

And then: Insulin. Yep, we are going there.

To get paid, hospitals get creative

Hospital bills are too high, and insurance doesn’t cover enough. Turns out, that’s a crisis for hospitals too: more and more of us aren’t paying those bills, because we can’t. So, they’re getting creative about collecting — and offering discounts. Which raises questions about why the bills are so high to begin with.

Photo courtesy James Crannell

We start with Chicago woodworker James Crannell, who — and there’s no non-scary way to say  this — stuck his finger in a table saw.

Even more scary: He didn’t have insurance. “I don’t know which was worse. The pain in my hand, or the fear of: What is this going to cost me?”

Spoiler alert: The emergency-room didn’t charge him full price.

This episode kicks off a series where we start asking: How did prices get so high to begin with?

 

We thought we had adulted properly

Caitlin and Corey Gaffer got a surprise letter from their insurance company — saying they were being dumped for non-payment. Except, as far as they knew, they were paid up.

As it turned out, they’d made a couple of small mistakes, which they were eager to fix. But their insurer was definitely not interested. Caitlin and Corey spent fruitless weeks on the phone.

And then, Caitlin’s pregnancy — more than six months along — ran into complications.

They scrambled for months to get covered, while racking up about $30,000 in hospital bills.

There’s a happy ending. Two, in fact.

First, their baby was born healthy (and insured) in January. She’s in the episode too, and she’s adorable.

Maggie, Corey, and Caitlin Gaffer, with Luna the dog. (Photo by Lauren Cutshall.)

Second: In March their old insurer offered an apology — and offered to reinstate them. (This was the day after a reporter called to ask the insurer for their side of the story.)

… but the whole journey was harrowing, and opens up questions about what kinds of safeguards consumers have — or should have — against getting dropped.

Welcome to Season Two!

This story — like a lot of this season — came straight from my inbox. A few days after the show launched, I got an email with the subject line “Pregnant woman and her husband in Minnesota need help.”

We’ve got new friends!

We’ve got co-producers for Season Two, Kaiser Health News. Three things to know:

First: Kaiser Health News is not affiliated with the giant health care provider Kaiser Permanente. They share an ancestor — which is a fun story I’ve written all about here.

Second: They ARE a great non-profit newsroom covering health care in America, an editorially independent project of the Kaiser Family Foundation. (There’s that name again. And again, here’s the story.)

Third: Their editor-in-chief is one of the people who inspired this show.

YEP. The whole story is worth reading. I am so pleased and proud to be working with these folks.

Catch you next time. Till then, how about…