Durango resident Robert Harlan had back surgery in 2014 at Mercy Regional Medical Center.
He has Medicare and supplemental insurance, so he didn’t expect to owe anything on the medical procedure, he said. If Mercy planned to charge him, he asked to be informed ahead of time. The hospital staff didn’t mention anything about medication charges, so he left believing he was in the clear.
But shortly after his surgery, Harlan received a bill for $321 from Mercy. It did not include a breakdown of charges.
When he requested a breakdown, he found his charges included $43.19 for two 5 mg oxycodone tablets, $76.90 for two more 5 mg oxycodone tablets and $79.76 for one celecoxib tablet, a pain medication, according to his bill.
“My thought was, ‘They are ripping me off,’” said Harlan, a former prosecuting attorney.
The cost of prescription medications has risen dramatically in recent years, leading patients and others to call for change.
Medication prices can be particularly high for hospital patients.
A nationwide survey showed the amount spent on drugs in community hospitals increased from $468.50 to $555.40 per patient admission between 2015 and 2017, according to a January report from American Society of Health-System Pharmacists.
The high costs have been driven, in part, by shortages of medications. As of March, 325 medications were in short supply, according to the association.
Price-fixing by some major drug manufacturers may also play a role in the high prescription costs.
A multistate lawsuit Colorado joined this week alleges that 20 generic drug manufacturers, such as Pfizer, conspired to fix drug prices for more than 100 different generic drugs.
In 2013 and 2014, these companies raised drug prices by 448%, according to the Colorado Attorney General’s Office.
Harlan said he was grossly overcharged for his pain pills at Mercy.
At the time, a single pain pill equivalent to the oxycodone he received would have been 44 cents at Walmart, he said. Currently, an equivalent 80 mg pain pill costs $6, according to the Connecticut Center for Prevention, Wellness and Recovery, a group by the state’s health department.
Some of the difference between a medication in a hospital and at a pharmacy may be attributed to the expense of doctors and nurses who administer medication, hospital equipment and costs related to ensuring quality patient care, said Julie Lonborg, a spokeswoman for the Colorado Hospital Association.
Harlan said he didn’t expect the bill because he asked to be informed of anything Medicare wouldn’t cover, and hospital staff didn’t tell him about potential medication charges. Harlan has Medicare and supplemental insurance, so he shouldn’t owe anything on medical procedures, he said.
He studied Medicare policy and learned medications taken by mouth are not covered in an outpatient setting. But, he said he was not informed of the Medicare policy up front, which is not in compliance with Mercy’s policy.
When he met with Mercy officials in 2016 about his charges, they agreed to drop the charges after he threatened to sue, Harlan said.
However, before his bill was dropped, he was hounded by collections notifications on a daily basis. He described the collections methods as “draconian.”
“They are setting you up to ultimately collapse and pay the bill,” he said.
Patients agree to be contacted by a live person, text message, pre-recorded message and other methods when they consent to receive medical treatment, according to Mercy’s consent form.
Mercy spokeswoman Sarah Silvernail declined to comment about Harlan’s care, even though he offered to sign a release form to allow the hospital to discuss his medical care.
Silvernail said the hospital is required by Medicare to inform patients about the costs of medications they receive in an outpatient setting. Patients must sign forms acknowledging they understand those rules, she wrote in an email to The Durango Herald.
Harlan said his own high charges are part of a larger problem with the high cost of prescription drugs.
“We really have capitalism working against us,” he said.
Patients with similar experiences started Patients for Affordable Drugs, a national nonprofit, to help advocate for lower prices. They would like to see hospitals be held accountable for high markups of medications and manufacturers lower list prices, said Juliana Keeping, a spokeswoman for the group in an email.
“The entire supply chain is a black box; it’s impossible to know who is making money and how much,” she said.
Harlan is starting a similar nonprofit to advocate for lower prices called Patients for Fair Medical Charges.
“I believe others are being taken advantage of, mostly because they don’t understand how things work,” he said.
Those interested in joining may email Harlan at firstname.lastname@example.org.