Anne Soloviev, 76, was charged almost $3,000 for two prescriptions to treat a toenail fungus without knowing the medication’s hefty price tag. A woman was handed an 11-month prescription for toenail fungus that she didn’t know would cost her an eye-watering $16,456.
Anne Soloviev, a 76-year-old retired French teacher, went in for her semi-annual dermatology appointment in January and was diagnosed with a fungus in two of her toenails, although she hadn’t noticed any symptoms.
She told NPR that, since she has health insurance, cost didn’t even cross her mind when the physician assistant prescribed 11 months of topical treatment Kerydin.
About a month later Soloviev went to pick up a different medicine and was told she had no money left in her prescription account.
It was then that she learned the price tag on the two toe fungus prescriptions she’d already received: $1,496 each and $2,992 total.
Despite cancelling the remaining nine months of the prescription, she will be forced to pay out-of-pocket for any other medications she may need for the rest of the year.
A manager at the clinic in Washington, DC, defended the bill by saying they don’t take cost into account when making treatment recommendations and instead focus on what they think will lead to the best outcome.
Soloviev’s experience highlights a big flaw in that approach to patient care: ignoring cost can lead to patients getting prescriptions that they don’t know they can’t afford until it’s too late.
Soloviev hadn’t been experiencing any symptoms before her checkup but a physician assistant diagnosed the fungus in two of her nails and prescribed topical solution Kerydin
As with many early cases of toe fungus, Soloviev hadn’t noticed a problem when she went in for her checkup at Braun Dermatology and Skin Cancer Center.
The early symptoms, such as discoloration and brittleness, are easy to ignore, but as the fungus progresses from the tip of the nail toward the cuticle it can cause pain and inflammation.
If left untreated, the fungus can migrate to the other parts of the body, which occurs in less than one percent of cases – typically in older people.
The fungus can also create cracks in the skin where bacteria can enter and cause infections.
When toe fungus was found in two of her nails, Soloviev didn’t question the assistant’s prescription recommendation especially because she has extensive insurance.
Soloviev is covered by Medicare parts A and B, has supplemental coverage for prescriptions from her late husband who worked for the government and has a health reimbursement account (HRA) that provides nearly $1,500 for uncovered medical expenses each year – which she uses for the medicines she takes regularly.
After she had been using the Kerydin for a few weeks, Soloviev went to a CVS to pick up a different prescription and was told that her HRA was empty.
In January she had been billed $1,496 for the first prescription of Kerydin – most of which had been drawn from the HRA and about $50-worth was covered by a patient assistance program.
In February a manufacturer coupon had been applied to cover what was left of her $2,000 deductible and her insurance covered the rest.
‘I just find it is outrageous for a fungal medicine to cost $1,400, to be prescribed for 11 months, and for neither the physician assistant nor the pharmacy to warn you,’ Soloviev told NPR.
Soloviev’s bill for two months of the Kerydin treatment is shown above. She didn’t realize how expensive it was until after first refill came in February
Xavier Davis, practice manager at Braun, said prescribers don’t pay attention to the cost of a drug when writing a prescription for treatment.
‘When our providers are treating patients, we’re not treating them based on what the cost’s going to be. We look for what’s the best care for the patient,’ Davis told NPR.
‘If the patient calls and says that’s too expensive, then we’ll look for alternatives.’
But in many cases such as Soloviev’s, the patients don’t see the price of the drug until it’s too late.
Soloviev’s fungus could also have been cleared up by other less expensive treatments, according to Dr Shari Lipner, an assistant professor at Weill Cornell Medicine in New York and director of its nail unit.
Lipner said that pills for toe fungus are more likely to be covered by insurance plans and typically only take three months to work, while topical treatments such as Kerydin take a year.
In two separate trials, a year-long treatment of Kerydin found to completely cure toe fungus in 6.5 percent and 9.1 percent of patients respectively.
Soloviev has since cancelled the prescription, but will have to pay out-of-pocket for other medications until the end of the year.