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Chronically1 Ill, Traumatically Billed: $123,019 For 2 Multiple Sclerosis Treatments
AUDIE CORNISH, HOST:
Every month, NPR and Kaiser Health News take a close look at medical bills that you send us. Today we hear about a woman whose medical bill for a drug to treat multiple sclerosis was so high that she considered asking her doctor to put her on other medication. Dr. Elisabeth Rosenthal is editor in chief of Kaiser Health News. She joins us now in the studio. Welcome.
ELISABETH ROSENTHAL: Thanks for having me.
CORNISH: So tell us a little bit more about this woman and her situation.
ROSENTHAL: Sure. This month we spoke2 with an Ohio woman named Shereese Hickson. She was diagnosed with MS, or multiple sclerosis, several years ago. And she's on disability now and can't work because of her disease. But she's able to take care of her son, and she's fairly active given her condition.
CORNISH: And we should note that MS attacks the central nervous system, right? So there are a bunch of symptoms that can come with that - fatigue3, blindness, even the inability to walk.
ROSENTHAL: Yes, but the good news is that there are a bunch of new drugs over the last couple of decades which dramatically change the course of this disease. When I was a practicing doctor, many of the people with MS would end up in wheelchairs or in nursing homes. That doesn't happen today. So when Shereese was first diagnosed, she was severely4 disabled. And many of her symptoms resolved on some of these new medicines. But she had persistent5 fatigue, and she just was falling sometimes. So her doctor decided6 to try her on a new drug. And that's when this saga7 began.
CORNISH: Right. Reporter Marlene Harris-Taylor of Ideastream in Cleveland actually went to meet her.
MARLENE HARRIS-TAYLOR: Shereese Hickson is tenacious8. The 39-year-old single mother had to fight her way back. She was nearly fully9 debilitated10 by the time a battery of tests confirmed she had multiple sclerosis. That was 2012, when her son Isaiah was 2 years old. Shereese says she had to get better for Isaiah.
SHEREESE HICKSON: I had to learn how to walk and basically do everything all over again. And I was home right before his third birthday.
HARRIS-TAYLOR: Shereese says she's now stable. She can't work, but she's able to take care of Isaiah, who is full of energy, like most 8-year-olds.
What grade are you in?
ISAIAH HICKSON: Third grade.
HARRIS-TAYLOR: At times, though, Shereese's fatigue is overwhelming.
HICKSON: I fight through it, but some days it's really difficult. And some days it's like I need to sit down because if I take one more step, I'm falling on my face.
HARRIS-TAYLOR: Her doctor at the Cleveland Clinic about an hour west of her home in Girard, Ohio suggested Shereese try a new medication to keep her MS from progressing.
HICKSON: We have Ocrevus, which is the infusion11, and we would like to try this on you. And I was just like - I'm like, I don't want anything to do with needles.
HARRIS-TAYLOR: Shereese eventually agreed and received two Ocrevus infusions12 at the clinic. The drug is delivered through an IV drip like chemotherapy. After the second dose in September, Shereese was surprised when a bill arrived in the mail a few weeks later.
HICKSON: And I'm just like, what is this?
HARRIS-TAYLOR: Shereese is on disability and has both Medicare and Medicaid health insurance, so her medical bills are usually fully covered. But this time was different.
HICKSON: Total charges, $122,873.30.
HARRIS-TAYLOR: But as she continued to read the bill, Shereese realized she was not being asked to pay the full price. The hospital was, however, billing her for the copay.
HICKSON: Minimum balance due, $3,619.98.
HARRIS-TAYLOR: Shereese was confused. She thought it was a mistake, and she immediately called the hospital about the bill.
HICKSON: I can't pay this. I'm on a fixed13 income. I'm a single mom. And what you guys are asking me to pay is six months of my income.
HARRIS-TAYLOR: Cleveland Clinic eventually told Shereese she wouldn't have to pay because of her income. She's relieved. But her next appointment for another dose of Ocrevus is in January. She says it can take up to a year to know if Ocrevus is working. But Shereese is thinking of bailing14 and asking her doctor to find another drug.
HICKSON: It's unfair. It's very unfair. You're sick, and you have to now deal with another headache on top of being ill.
HARRIS-TAYLOR: Shereese says the whole ordeal15 was stressful, but she is lucky. She knows there are many who take the same drug who don't qualify for financial assistance. They get stuck with the outrageous16 bill, she says. For NPR News, I'm Marlene Harris-Taylor.
CORNISH: And we're back with Elisabeth Rosenthal, editor in chief of Kaiser Health News. Shereese Hickson's story raises a bunch of questions. First she was billed a few thousand dollars for a copay of her drug even though she had Medicaid and Medicare. Was that a mistake by the hospital?
ROSENTHAL: Well, apparently17 not because the hospital didn't say, oh, you know, Medicaid will cover this. They said, well, we'll write it off as charity care. And I think this is one thing people need to be aware of - that when you get an - infused drugs, the rules can - of your insurance can apply very differently.
CORNISH: Also, the full price of Hickson's two doses of this one drug was over a hundred thousand dollars. What explains that very high price?
ROSENTHAL: Well, MS drugs have followed this weird18 trajectory19. It's called sticky pricing. And when each new drug comes into the market, the new drug is priced slightly higher than the old ones. And instead of all of them competing and lowering the price, they all go up to that higher ceiling, that sticky ceiling. So what we've seen over time is all of the MS drugs in the U.S. go up and up and up in price, double what they were a decade ago. In the rest of the world, they go down over time because there is some competition.
CORNISH: So what should people do if they are faced with a big copay like this for an expensive drug?
ROSENTHAL: Well, you can be like Shereese and pick up the phone and say, what's this about? Are there any other solutions for me - because all hospitals have what they call financial aid or charity care programs. You may think, oh, I make too much money to qualify. That's often not true.
The second thing to keep in mind and what her situation illustrates20 so well is if you get a drug by infusion, something you need to get in a clinic or a hospital, there are all sorts of ancillary21 charges that can make the bill far, far bigger. So if you have a choice of taking a drug as an infusion or one that you could give yourself at home either as a pill or as an injection at home, you're often much better off with the latter because you won't be subjected to these surprise bills.
CORNISH: That's Elizabeth Rosenthal, editor in chief of Kaiser Health News. Thank you for being here.
ROSENTHAL: Thanks for having me.
CORNISH: And if you have a medical bill you want us to investigate, head on over to NPR's Shots blog.
1 chronically | |
ad.长期地 | |
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2 spoke | |
n.(车轮的)辐条;轮辐;破坏某人的计划;阻挠某人的行动 v.讲,谈(speak的过去式);说;演说;从某种观点来说 | |
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3 fatigue | |
n.疲劳,劳累 | |
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4 severely | |
adv.严格地;严厉地;非常恶劣地 | |
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5 persistent | |
adj.坚持不懈的,执意的;持续的 | |
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6 decided | |
adj.决定了的,坚决的;明显的,明确的 | |
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7 saga | |
n.(尤指中世纪北欧海盗的)故事,英雄传奇 | |
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8 tenacious | |
adj.顽强的,固执的,记忆力强的,粘的 | |
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9 fully | |
adv.完全地,全部地,彻底地;充分地 | |
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10 debilitated | |
adj.疲惫不堪的,操劳过度的v.使(人或人的身体)非常虚弱( debilitate的过去式和过去分词 ) | |
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11 infusion | |
n.灌输 | |
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12 infusions | |
n.沏或泡成的浸液(如茶等)( infusion的名词复数 );注入,注入物 | |
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13 fixed | |
adj.固定的,不变的,准备好的;(计算机)固定的 | |
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14 bailing | |
(凿井时用吊桶)排水 | |
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15 ordeal | |
n.苦难经历,(尤指对品格、耐力的)严峻考验 | |
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16 outrageous | |
adj.无理的,令人不能容忍的 | |
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17 apparently | |
adv.显然地;表面上,似乎 | |
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18 weird | |
adj.古怪的,离奇的;怪诞的,神秘而可怕的 | |
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19 trajectory | |
n.弹道,轨道 | |
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20 illustrates | |
给…加插图( illustrate的第三人称单数 ); 说明; 表明; (用示例、图画等)说明 | |
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21 ancillary | |
adj.附属的,从属的 | |
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