Cost Transparency and Medical Ethics

I want to start by discussing motivations and ethical standards. Here at Integrated Health, profits are made in one way and one way only: a monthly membership fee. The vast majority of companies who operate in the HRT space make the bulk of their money by selling products. Because we understand human nature, we established a hard and fast rule that forbids us from selling products. I am going to reveal some industry secrets that are going to upset some of our competitors. When looking for an HRT company, the first thing to inquire about is, “Are there options regarding how these medications are obtained?”. If the answer is no, and the medications must be purchased through their company, this will reveal they are more than likely up-charging the medications and making a profit on the medications themselves. On the surface, it may seem that perhaps their client fees are lower; however, when adding up the cost of the medications, most will find that far more expensive. Consider this: if I’m selling a particular brand of medication from a company and I profit from this sale, it will inherently create an ethical dilemma where in the provider is now motivated to push that particular product which can sometimes lead to a loss of focus on good health and what benefits the patient. On many occasions, we have changed the products that we recommend and use because of cost, quality issues, and insurance coverage of medications. Another question to ask, particularly with injectable testosterone for men, is, “Will insurance cover the cost?”. For this to happen, a prior authorization would need to be initiated through the insurance company. Depending on your insurance company and what their requirements are for coverage, this may or may not be covered. If medications are being sold, there is no motivation to utilize insurance because then there is no longer any profit to be made from the medication prescribed.

Ask for transparency. Ask the company where these medications are coming from. If possible, do some research and obtain an inventory list from that company which should reveal the wholesale cost of that medication. Then ask the company how much each medication costs. Many times, these costs are variable and change per patient. It should be a red flag if the cost of medication is not transparent. The costs of all our medications are clearly displayed on our website in full view and are transparent to not only our clients but also our competitors. We have nothing to hide. A bottle of testosterone cypionate should never cost more than $45-$60 for a 10 mL bottle. There are no supplying companies who sell these bottles for a higher price.

William White, PA-C