Opportunities to help our patients get a good value extend beyond those who wish to avoid surgery. The most common group of medications prescribed by Ob/Gyn’s are oral contraceptive pills (OCPs), given for a variety of non-contraceptive indications ranging from endometriosis to irregular menstrual cycles. Although there are hundreds of readily available OCP formulations, most of us generally prescribe a small subset that we are most familiar with and consider a limited set of clinical factors. It appears that making cost one of those factors would be particularly worthwhile. Prices of OCPs vary by an order of magnitude. Many available generic options cost less than $10 per month while the newest brand formulations can cost closer to $100.
Despite routine opportunities to help patients make high value decisions, this is often easier done in theory than practice. Patients may present for care with fixed expectations and taking the time to counsel them about the full range of available options is already challenging. Adding cost information to this task creates an extra dimension of complexity. Moreover, cost and value are not always easily ascertained and will typically vary according the patient’s clinical circumstances, personal preferences, and particular insurance plan.
Fortunately, there is a growing body of resources available to help. Medication costs can now be queried online by pharmacy at sites like GoodRx.com. Professional societies, including the American Congress of Obstetrics & Gynecology, are developing lists of high yield opportunities to improve value. Organizations such as the American College of Physicians and Costs of Care provide online training opportunities in cost-conscious care. Choosing wisely and delivering value in obstetrics and gynecology is not always easy or straightforward but I truly believe that we are up to the task.
About the Author
Dr. Neel Shah is the founder and executive director of Costs of Care, and a Harvard-affiliated ob/gyn who delivers babies, provides primary care and performs surgery. His patients have taught him that even the best doctors sometimes overlook something critical—the bill. His writing, research, and medical practice have focused on deflating medical bills by helping caregivers make high value clinical decisions.