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Watchdog launches probe into KEMH’s pricing of generic drugs

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Are some medications overpriced at King Edward VII Memorial Hospital? Government’s pharmacy inspector, Lynanne Bolton is investigating such a claim. You would think that generic brands would be cheaper than their brand-name counterparts, but one senior citizen claims pharmacists at KEMH told her that’s not always the case. My mother Carol Stovell became so infuriated when she learned that retail pharmacies were charging less than half what the hospital charged her that she filed a formal complaint with the Government pharmacy inspector. My mother has high blood pressure and had been taking the drug Vasotec for the condition for a number of years. Her doctor told her in April that she could get the generic version of the drug, Enalapril.“I was really glad about that because I’d be paying less,” she said. On a fixed income and with no health insurance my mother has to be careful with her expenditures. She said she was happy when the KEMH pharmacist told her they had the generic Enalapril. “I said to the pharmacist: ‘Oh great! That is going to cost me less’,” she said. “But the pharmacist said no, that the generic would cost the same as Vasotec. “I said that that was unfair. I spoke directly to the pharmacist and asked why the generic brand wasn’t cheaper, and the pharmacist told me they don’t set the price.” Although not pleased with the answer, she accepted it and paid $124.30 for that prescription, the same as she had paid for Vasotec. She had the prescription refilled at KEMH in July and paid $125.95. “But when I had my physical on October 13 I complained about it to my doctor. He suggested I check private pharmacies, so I did,” she said. My mother was shocked to discover the cost of filling the same prescription at White’s Pharmacy was only $67. “And on top of that I got a ten percent senior’s discount so I only paid $60.30,” she said. Surprised, she said she called the hospital pharmacy when she got home and complained at their pricing. “I was told again that they don’t set the pricing,” she said. “I feel so stupid that I didn’t check other pharmacies before. “I assumed that the hospital would have the best prices. But I also would have thought that since I complained about it, the pharmacists should have suggested I check elsewhere.” KEMH would not comment on this case specifically but said the cost of all medications is dependent on the price it paid for them. “The hospital always requests generic drugs, unless the medication remains under patent. The pricing for all medication depends on the procurement price,” a spokeswoman said. According to the pharmacy inspector, Enalapril has been available for well over ten years and is not new to Bermuda. Local health insurers explained that they offer 100 percent coverage for generic drugs and 80 percent for brand name versions. This is, they explained, to encourage the use of generic drugs, which cost less and will help lower overall healthcare costs on the Island. So when an insured person gets Enalapril what does KEMH charge the insurance companies? None of the companies would say what the hospital is charging them for Vasotec or Enalapril, prescriptions commonly used to treat high blood pressure in Bermuda. Kathy Perry of Colonial Insurance explained that the question is difficult to answer. The reason for that is “a universal coding system is not used for prescription drugs in Bermuda therefore as an insurer we do not receive detailed coding information on the drugs utilised”, she said. “KEMH only put in the generic names of drugs into their billing/pharmacy system. “If they dispense a brand-name version, they bill us at 80 percent, but the claim still says the generic name. If it is the generic that they are dispensing it is billed at 100 percent,” she explained. Holly Flook, vice president of BF&M alluded to the same. “Currently the availability of public literature which outlines a cost comparison between generic drugs compared to brand is absent in Bermuda. However, BF&M is supportive of activities aimed at evaluating cost structures in this regard,” she said. Argus refused to comment. “It really looks like the hospital is actually driving up our healthcare costs,” said my mother. “I think it’s unfair and something should be done about it. I really want a reimbursement because I paid almost double.”

Package Proof: Government Pharmacy Inspector Lynanne Bolton confirmed this is the generic blood pressure medication- Enalapril. KEMH pharmacists told Mrs. Stovell it cost the same as the brand name version- Vasotec.
Package Proof: Government Pharmacy Inspector Lynanne Bolton confirmed this is the generic blood pressure medication- Enalapril. KEMH pharmacists told Mrs. Stovell it cost the same as the brand name version- Vasotec.