Posted On: April 21, 2014 by Patrick A. Malone

Cost of Drugs Depends on Where You Live

Now that the Affordable Care Act (ACA, or “Obamacare”) is in full force, insurers no longer can exclude you from coverage because of pre-existing conditions. And, under the act’s provisions, certain preventive services are free.

But that doesn’t mean the cost of care doesn’t vary -- a lot. One reason, according to a recent story on the Washington Post’s Wonkblog, is because what you pay for drugs depends on where you live.

The Post used the example of drugs to treat wet macular degeneration, a chronic, age-related eye disease that can lead to blindness. “There is no evidence that the disease varies from place to place,” it said. “But as recent Medicare data show, the way that doctors treat it does, and those choices have huge effects on the U.S. and personal budgets.”

This color-coded map demonstrates where doctors are more or less likely to prescribe Lucentis, the most expensive of three drugs for treating macular degeneration. Lucentis costs about $2,000 per dose, Eylea somewhat less and Avastin only about $50.

Clinical trials have shown that Lucentis and Avastin are both effective, but Avastin isn’t sold in doses that are convenient to use, so it must be divided. That adds another step, and a small risk of contamination. But is that difference worth $1,950?

“Such variety in treatment, analysts say, calls into question whether doctors are treating patients based on the best available evidence, or other considerations,” says The Post. “It’s not just this disease either.”

According to the map, Lucentis isn’t necessarily used more often in places typically known for the most expensive doctor and hospital services (New York, San Francisco, Los Angeles).

Another map on the blog shows the cost of doctor-administered drugs per Medicare patient. It’s somewhat more “traditional” in terms of where you’d expect costs to be higher, but still surprising in where they spend the most — Wichita? Fresno? Trenton?

The take-away here is that whenever your doctor prescribes medicine, especially if it’s not a generic, ask if there are alternatives that might be less expensive, and what the risk-benefit trade-off might be.

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