Cost of Prolia

Prolia is a drug used to treat osteoporosis. I was recently prescribed Prolia. It is an injection delivered every six months. Prolia is an expensive drug and in the past, my insurance covered an appreciable amount.  I am not sure what changed but the last time I had the injection at my doctor’s office, we received a bill for over $7,000.

The insurance form had the standard explanation about how “they” had worked with the hospital to bring the cost down so that we owed only about $4,000. Curious, I went online to see exactly how expensive this drug is. I found coupons for Prolia from numerous pharmacies for about $1,000, sometimes a little more, sometimes a little less. It occurred to me there was no way it could cost any hospital $6,000 to administer a single injection.

My doctor was as appalled as I was and was open when I suggested different approach.

Before you can have the injection, you need to be tested to measure the amount of calcium in your system. My doctor wrote lab slip for the blood draw which I would took to the lab I usually go to for this kind of thing. Then, after the doctor received the results and all was well, she wrote the prescription for Prolia and submitted it to a pharmacy, one which offered a coupon. When the prescription was filled, I collected it and then had a health professional administer the injection on my own time.

There are two points I want to make. The first is that one must be vigilant in looking over charges from hospitals. We all know of instances when mistakes were made, like the man who was charged for a pap smear. We also need to be mindful of costs. In addition to mistakes, some of the charges are simply way out of whack. Ice packs for $40.00 dollars, for instance. (Bring your own).

The second point is that it is incumbent on us to take further charge of our health care. My experiment saved us over $5,000, which is substantial. It took work on my part to set this up. Getting the blood work was standard, but then I had to talk to several people about exactly how this was going to work and it also took some time to get all the parts moving in the right order. But I did and I got the prescription filled and the injection given.

Health care costs a lot and we often feel helpless in the face of that, but there are things we can do.

Ask what things cost. You would be surprised at how many people who work in healthcare have no idea what anything costs. Insist they find out.

Check your bills and insurance claims. Mistakes do happen and they are rarely in your favor. If they are, you can be sure the insurance companies will let you know. Similarly, you should let them know when the mistake is in their favor and that you are due a refund.

Participate with your healthcare team to figure out the most cost effective way of receiving your healthcare. Do your own research and come prepared to discuss options.

Horton, in Horton Hears a Who, got all the little voices to speak together in order to be heard and save their community. Likewise, all our voices speaking together about the obscenely high costs of particular medical treatments can make a difference. We need to make sure that hospitals and insurance companies know that we are paying attention.

Posted on 11 Nov 2016, 13:26 - Category: Health Care