Tagged An Arm and a Leg

‘An Arm And A Leg’: Why Are Drug Prices So Random? Meet Mr. PBM


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Surely, an old-time, generic drug can’t cost $720 — for a three-month supply?

After a close call with an outrageous Rx tab, host Dan Weissmann tackles the health care cost puzzle he’s been avoiding: figuring out prescription drug prices.

Here’s what he found: Your insurance company is probably in cahoots with a pharmacy benefit manager — and the negotiations that go on between them are trade secrets. No wonder it’s so hard to know what you’ll pay at the drugstore counter!

On Episode 4 of “An Arm and a Leg,” meet the behind-the-scenes negotiator that helps decide how much you pay at the pharmacy counter.


Season 2 is a co-production of Kaiser Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all Kaiser Health News podcasts, click here.

And subscribe to “An Arm and a Leg” on iTunesPocket CastsGoogle Play or Spotify.

Why You Should Take A Peek At Your Doctor’s Notes On Your Health

When Pamela DeSalvo read the clinical note from her doctor’s visit, the words on the page hit her hard: “clinically morbidly obese.” She knew she was overweight, but seeing those three words together shocked her. It also inspired her to start losing weight.

“I needed to see it in black and white, what I actually in my heart already knew. It forced me to get honest with myself,” DeSalvo said.

“Reading that note saved my life.” Studies show that, indeed, reading your doctor’s notes can improve your health.

DeSalvo lives in Metuchen, N.J., and works in health information technology. In the years after reading her doctor’s notes, DeSalvo kept that experience in mind as she helped Atrium Health implement a system that allows doctors to share clinical notes.

Many patients go home with a summary of their office visit. That recap often includes a list of medications or reminders to schedule a follow-up. The full doctor’s note has many more details —all the stuff the physician types into the computer during and after your medical appointment. Your medical history. The complaint that brought you to the office. Sometimes, physicians write down exactly what patients say. Mixed in are billing codes and the doctor’s thoughts about what might be happening with the patient.

A research project in Boston, called OpenNotes, encourages doctors to share their notes with patients. On the flip side, it invites patients to ask for access to their doctor’s notes. The project is housed at Beth Israel Deaconess Medical Center.

In one study, when researchers surveyed patients who’d looked at their doctor’s notes, the majority of patients reported they felt more in control of their care and said they were more compliant taking medication. A small share — from 1% to 8% — said the notes caused confusion, worry or offense.

Liz Salmi, a woman living with brain cancer in Sacramento, Calif., was an experienced patient advocate and blogger when she first got a look at her doctor’s notes on her. After Salmi’s insurance changed, she requested her medical records. For $45, she received a 4,839-page PDF on a disk along with her brain scans.

And she got curious. “I was, like, what is on these disks?” Salmi said.

There was no big revelation. And she didn’t uncover any mistakes.

But it was a nice way to re-hear what her doctors had told her through the years. Salmi said the records are a time capsule of sorts. As Salmi scanned the pages, she said, she discovered “meaningful nuggets” where her doctors quoted her verbatim.

“Just that level of detail made me feel like they were listening,” said Salmi, who is featured in this week’s episode of the podcast “An Arm and a Leg,” which is co-produced by Kaiser Health News.

Eventually, Salmi went to work for OpenNotes, and today she’s a senior strategist who does outreach and communications for the research group.

The Health Insurance Portability and Accountability Act, or HIPAA, which has been the law since 1996, allows patients to review and get copies of their medical records.

But researcher Dr. Harlan Krumholz said a legal right doesn’t guarantee easy access.

Krumholz, a cardiologist and professor at Yale University, published a study in 2018 that examined the records-requesting process at 83 top-ranked hospitals in the U.S.

The results varied widely. Some hospitals didn’t meet state deadlines for delivering the records, others charged exorbitant fees for the documents — well above the federal government’s recommendation for electronic records.

“What is clear from this is, it is hard for Americans to get access to their own medical records,” Krumholz said.

OpenNotes — the research group that advocates for better access — says that today about 40 million patients are a part of a health system that shares clinical notes through their electronic health record software. But each medical system is different, and it can take time and effort to navigate an online portal to find what you’re looking for.

“I’ve been under the assumption for years that patients could access the notes whenever they wanted to, so I keep them objective and matter-of-fact,” said Dr. Neda Frayha, an internist who practices at Ascension Medical Group in Baltimore.

She encourages her patients to review her notes.

“Being a patient is hard. Appointments take forever, and often clinicians don’t spend a lot of time with patients,” said Frayha. “For many patients, it is hard to make sense of what is happening. If access to their note provides them with knowledge and assurance, then that is important to provide.”

Frayha said having her notes on display hasn’t changed her behavior or note-taking much. But, she said, “I think it’s actually good for us as a profession to be more mindful of the words we use.”

‘An Arm And A Leg’: Can You Shop Around For A Lower-Priced MRI?


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An MRI is one of those standard tests that doctors order routinely. But the price you’ll pay can be unpredictable.

Sometimes the price tag depends on where you live: It could reach $10,000 in San Francisco. Or be as low as $1,000 in St. Louis — if you’re willing to haggle. And the kind of imaging center you choose often makes a difference: Was it a fancy specialty hospital linked to a university or a standalone facility at the mall?

Liz Salmi — of Sacramento, Calif. — has been living with brain cancer for more than 10 years and gets an MRI every six months to make sure the cancer’s not growing. On her old insurance plan, she paid $50 for a brain scan. Then her job changed, her health insurance changed, and she was billed $1,600.

Not everyone has the time or patient know-how, but Salmi shopped around and found a deal that saves her hundreds of dollars every year.

On Episode 3 of “An Arm and a Leg,” find out how she did it.


Season 2 is a co-production of Kaiser Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all Kaiser Health News podcasts, click here.

And subscribe to “An Arm and a Leg” on iTunesPocket CastsGoogle Play or Spotify.