PERSPECTIVE | GLOBE MAGAZINE
When being your own health care advocate is an exercise in frustration.
Photograph from MERCK
“If you had chickenpox, then the shingles virus is already inside you.”
That’s what Terry Bradshaw says in that TV commercial, the one where he basically performs a home invasion on three middle-aged football fans and then frightens the bejesus out of them with medical scare talk.
The ad promotes Zostavax, a vaccine sold by Merck & Co. that helps prevent shingles in people 50 or older. And when I first saw it, I found myself in the unusual position of actually agreeing with a Big Pharma company.
I’m comfortably in the target demographic for Zostavax, and several people close to me had just gotten shingles. My 70-year-old neighbor, who had only recently given up motorcycle racing, was out of commission for six weeks, barely able to move from his bed to his easy chair. Another friend in her 40s got shingles that left her with residual nerve pain shooting through her left ear, which she tried to alleviate with a cannabis-based cream. (It didn’t work, but it smelled good.)
So at my annual physical, I did as Terry instructed and asked my doctor about shingles. It was the start of a hallucinatory journey that underscored, in its own small way, just how hard it is for patients to navigate today’s medical-industrial complex. In recent years, medical experts and policy makers have been telling us we need to become better health care consumers and think of medicine in the same way we think of other products and services we buy. I found that was almost impossible to do.
In his office, my doctor told me that the risk of getting shingles increases after 50, and it would be a good idea for me to get the vaccine. He paused to let this sink in, then said, “The vaccine isn’t covered for people under age 60.”
I didn’t mind. My company funded a medical spending account that could be used for out-of-pocket expenses like this one. My doctor suggested I go to my local pharmacy and get the vaccine.
At CVS Health, I went to the “Consultation” counter and asked to get the vaccine. It seemed like a reasonable request, because CVS has been trying hard to get people to think about it more as a health care company and less as a place where you walk down aisles of Doritos on the way to pick up your cholesterol meds. “We don’t actually have the vaccine in stock,” the pharmacist said. “You could call us back next week to see if it’s in.”
Operating under the assumption that getting a vaccine was somehow like buying a half-pound of provolone at the deli counter, I asked how much it would cost. “We actually can’t tell you until you get a prescription from your doctor,” the pharmacist said.
The doctor hadn’t mentioned a prescription.
But roughly about how much would it cost?
“I can’t get into the system without a prescription.”
After more phone calls to my doctor to extract this state secret, and more waiting, CVS told me the injection would cost $279.99 — but the vaccine wasn’t in yet. Also, the pharmacist reminded me, it wasn’t covered by my health plan.
At this point, I was eager to be done with it. I called my primary care office at Atrius Health in Watertown and explained I had spoken to my doctor and I wanted to get the shingles vaccine there. “It’s not covered for people under age 60,” the health aide said.
It was as if I had fallen into a medical version of the old Abbott and Costello “Who’s on first?” routine. Still, I had to ask, “How much does it cost?”
“I can’t tell you, but I’ll have the nurse practitioner call you.”
She called me and said the cost was $236.30. Naturally, she reminded me, “This isn’t covered by your health plan.”
So it had taken about a week and five phone calls, but I finally got Zostavax — and even saved $43.69 by shopping around like a good consumer. Yet I had to wonder why the process was so difficult. After all, the ads were being aimed directly at me.
The United States is one of only two developed countries that allow direct-to-consumer ads that tout the benefits of prescription drugs (the other is New Zealand). And in the roughly two decades since the US Food and Drug Administration relaxed the rules about what drug companies could say in these ads, spending on them has skyrocketed. Last year alone, according to Kantar Media, the figure grew by 19 percent to a near-record $5.4 billion.
Academics are divided on whether this spending is doing any good. They can produce a long list of positive and negative impacts, one being that doctors now have to use a lot of their limited appointment time persuading patients they actually don’t need the drug they saw on TV.
What we really need is a better road map for patients who want to take charge of their health care, rather than simply releasing them to the whims of the free market. A little more spent on health counselors to guide patients and less spent on celebrity ads would be a good start.
To patients who are moved to action by TV, gird yourself for frustration. Being on hold with the cable company is a breeze compared with trying to buy health care. In the end, the best thing about the experience may be that you’ll be ready if Terry Bradshaw knocks on your door.
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