Talking Money with Your Doctor: Drugs and Tests for Less

ld you buy groceries without knowing their prices? I suspect not. You probably compare the costs of different boxes of cereal in order to get the best deal. But when it comes to medical care, do you even ask for the prices involved?

While it's true that good health is priceless, and cutting corners on health care is risky, there is still much you can do in order to obtain the same good value in medical care that you insist upon in other areas of your life.

If you lack a prescription plan that pays for your medications, it's high time you discussed the cost of drugs with your doctor. Your doctor's number-one choice in medication for your medical condition might be expensive. There are usually reasonable alternatives that cost less. You should take advantage of your doctor's expertise in estimating trade-offs involved with each of your options.

Apart from prices, your doctor is already balancing a number of important factors in making a drug recommendation. First, of course, the drug needs to be medically effective-otherwise, why bother? The doctor also takes into consideration what other medications you are taking, what other illnesses you have, your age, your gender, the drug's side-effect spectrum, and also its convenience aspects, like how many times per day it has to be taken and whether or not blood-tests are required to monitor it. A drug that might score high on effectiveness and side-effects might still be inconvenient. An alterative might be both convenient and effective, but pose a higher risk of side-effects.

So the truth of the matter is that your doctor is already sorting through all sorts of trade-offs in choosing a medication to prescribe. Factoring in the prices of alternative drugs just builds on the comparing-apples-to-oranges process you are paying your doctor to do for you in the first place. But if the doctor doesn't know that you lack a prescription plan, he or she might not include the cost of drugs in these reckonings and you might be stuck with a prescription that wrecks your budget.

The next step in obtaining maximum value for your investment in medication is to shop it around. Let your fingers do the walking by phoning several pharmacies for a price-check. I even write out a script for my shy patients who get nervous when they talk to medical personnel. It goes something like this: "Hi, I'd like to do a price-check on my prescription medication. How much would it cost to buy thirty furosemide 20 milligram (or whatever) pills? Thank you very much. Have a great day!"

In repeating this process with different pharmacies you will discover there can be quite a spread among even nearby drugstores. Suppose that your ten minutes on the phone saves you $20 on your prescription. Then you have just earned money at a rate of $120 per hour each month for your efforts. It is time well spent.

Cost-consciousness is also valuable when it comes to medical tests. If the cost of a medical test is prohibitive (as is often the case) and you don't have the luxury of letting someone else pay for it, then encourage your doctor to talk through your alternatives with you. Does the same test cost less at one facility than at another? How important is the test? What could go wrong if you skip it, delay it or substitute a less expensive test? What are the chances of a serious repercussion?

Unfortunately, your doctor usually has less latitude when cost-optimizing your medical tests, but what could it hurt to ask? You might be glad you did.

And how about optimizing the doctor's fee? This is also a fair topic for discussion. When you are considering an appointment with a new doctor it is certainly appropriate to ask for typical fees. However, in the current U.S. medical marketplace, the doctor's time is usually the least expensive component of medical care. The doctor's fee is usually much less than the costs of medications and tests. So while it is perfectly reasonable to shop around for affordable doctor fees, when it comes to choosing a doctor, quality issues should come first.

(C) 2005 by Gary Cordingley

Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles see his website at: http://www.cordingleyneurology.com