The Cost of Hormone Replacement Therapy

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Hormone Replacement Therapy (HRT) compares favorably to other anti-aging treatments.

Episode 75 of the BioBalance Healthcast covers the cost of bioidentical hormone replacement therapy for both men and women. Brett Newcomb and I compare the cost of hormone pellets with the cost of treatments for age-related health problems that occur when you don’t have your hormones balanced. The truth is that the difference is minimal, and often, HRT is less than the total cost of traditional medicines and treatments.

Transcription:

The Cost of Hormone Replacement Therapy, BioBalance Healthcast 75
with  Dr. Kathy Maupin and Brett Newcomb
Recorded on March 28, 2012
Podcast published to the internet on April 23, 2012

Dr. Kathy Maupin: Welcome to BioBalance Healthcast. I’m Dr. Kathy Maupin.

Brett Newcomb: And I’m Brett Newcomb. And today we’re going to be talking about cost savings in medical care. People are constantly concerned about how much is it costing, both national discussions but personal pocket book discussions as well. I know in the counseling business when people come in to see me the question they would have what’s it going to cost and is it worth it? I once saw a couple for marriage counseling for a year and they ultimately decided to get a divorce. At one session the woman turned to the man and said you know what, I’m done, I’m going to get a divorce, I’m not going to do this anymore, and she got up and left. And he looked at me for about 30 seconds and he said “where is the refund window?”

KM: Yeah counseling.

BN: Because they had been paying all along. And so part of cost calculation is what does it cost? But part of the cost calculation is what does it save? And so today we’re going to talk about cost expense ratios for people that are aging and going through the cascade of deterioration that starts with the loss of hormones, particularly women, but men as well, we’ll include costs for men, vs. the cost of Kathy’s treatment, bioidentical pellets at BioBalance Health here in St. Louis and talk about what they cost, what they save just in terms of dollars, and then we’re going to talk about long term benefits in terms of long term care issues as people get older and older, the average cost that exists today vs. the savings that can occur if the treatment that you provide is successful and continued. So when we talk about cost, if a woman comes to you, she’s post menopausal, and she’s complaining of depression, anxiety, weight gain, general malaise, discomfort, her current doctor doesn’t seem to be able to find anything to do, loss of libido, her husband’s complaining, her kids are complaining, everybody’s saying, what’s wrong with mom. And she’s saying I don’t know but it feels bad and the doctors says you’re just getting old, you’re just getting old.

KM: You just have to live with it.

BN: You just have to live with it. There are some things we can do, we can put you on an antidepressant we can put you on an anticholesterol, we can put you on and antihypertensive, we can put you on an antianxiety, and we’ll do the chemistry set rations and we’ll do the best we can.

KM: Most people come to me on 4 or 5 drugs because they’ve not had their hormones replaced and they’ve not gotten back to young healthy levels and young healthy body mass.

BN: Phosomax.

KM: Phosomax for osteoporosis. Many of these drugs are expensive even if you’re just paying co-pays. By the way the insurance companies have shifted all the cost to you. So it doesn’t matter even if you have great insurance, they’ve increased year by year that little drip of water you’ve gotten, more and more you have to pay for each prescription. If your deductible is $5,000 you have to pay yourself for everything you do, you have to pay yourself for the first $5,000. So if it’s a matter of coming to somebody who doesn’t take insurance you can still send it in to your insurance for reimbursement but that $5,000 is going to be yours whether you get good treatment or not.

BN: Speaking of good treatment it is important to say that what we’re not saying is that if you come to Kathy and get these treatments, you will be able to come off of your antidepressants. Because there are other factors in people’s lives that cause this. We’re talking about the physiologically caused issues that can be repaired or restored by bio-identical hormone replacement.

KM: It’s over time. We never stop antidepressants right away. But in general, some people feel so good, their depression was from loss of hormones, then they can come off antidepressants down the line maybe after 2 pellet insertions.

BN: So the individuals who come to you and receive treatment report anecdotally that they are able to get off these medicines. So you’re not saying if you come and get it, it will wipe this out.

KM: Yes, they come in and start telling me. Or [I am not saying] you can stop taking your medicines the minute you show up. It’s a matter of time it takes a year or so for you to get back to normal. And then we re-evaluate. Is you blood pressure down, is your cholesterol down, usually those things get better by replacing your hormones, you kind of go back to 35.

BN: So in a worst case, with all those compounded issues, we’ve calculated some average costs, average monthly and yearly costs for people who are on hypertensives, antidepressants, sleeping pills, antianxiety, and phosomax which is a pretty clear cluster that a lot of the people that come to see you are already on.

KM: They’ve gotten these from multiple doctors. They’ve been to multiple doctors, multiple co-pays,

BN: And not counting any over the counter stuff that they’ve decided because they’ve seen the ad, that I should try that, it could help. So the average cost per year is $3,948 for men or women who are on these things. Except that men won’t be on the phosomax, that’s a $720 a year subtraction out of that. So $3,200 to $3,900 a year is what they’re putting out for these meds.

KM: For just those medications.

BN: Trying to make themselves feel like they have energy and life and capacity to function.

KM: That still doesn’t necessarily work, but with pellets we usually get people off some or all of their medication over the first two years.

BN: And those medications block for these issues roughly $3,500 a year that someone’s paying, a combination them and co-pay or the insurance company or the deductible.

KM: And those are average costs that I have accumulated from the internet and average co-pays mostly based on Midwest numbers because things on the coast go up a bit. But those are Midwest costs and Midwest averages for 2012. I mean it changes all the time. But the first thing patients come in and tell me is “I don’t care what this costs, I’m paying it.” And they act like they’re buying a car. For women after the initial of visit of $250 for a 45 minute or more visit with me,

BN: The initial consult is a flat rate.

KN: then the pellets are about $500 three time year. If you’re on maintenance of three times a year which is typical, then women are going to be paying $1,500 a year. Now if they get off some of those medicine that’s going to more than make up that cost.

BN: Right because some of those medicines are twice that already so whatever combination they can come off. And that’s not counting the women who present with these issues who’ve already started taking hormones of one kind of another that you’re going to offset by the hormone replacement that you provide because those cost another 100 dollars a month or $1,200 a year.

KM: That’s right. So you’re replacing one hormone, the pellets, for your hormones that you buy at the pharmacy. So when they’re thinking about coming into a doctor’s office they’re not really thinking about oh, this is 4 months worth.

BN: Because it’s a one stop shop. It’s not like going here and going there.

KM: Right. So we’re doing the medicine and we’re providing the care at the same time. So that’s a lot less just in the short term immediate savings, they’re going to save that.

BN: So part of the message here is this is not an additional outlay of monies you’re already spending. It’s an outlay that can replace and reduce monies that you’re already spending. So, for the average cost of say a Starbuck’s a day. If a woman was to go to Starbucks and get a cup of coffee every day of the year, it costs her about $4 a day. And that’s what this would cost, $4 a day.

KM: You can even replace it. If you’re taking estrogen and progesterone, you’re going to be spending $1,200 a year. The pellets are $1,500 so you’re really looking at.

BN: Just for the coffee.

KM: Less than coffee. Even if you’re just replacing your hormones we’re replacing your cost, your co-pays, your cost for the hormones you’re paying for at the pharmacy. It’s just that it’s 4 months at a time.

BN: So what happens often, you’ll have to say if it’s typical or not. A woman finds you because her friends tell her, she’s surfing the web, her doctor’s saying this or that, and other doctors refer especially ones that can’t cure migraine problems.

KN: Well more and more doctors refer to me now because they’re sending their wives, and their sisters, and themselves.

BN: Actually my physician went to her recently, and she was talking about you and that she gets your treatments and she told me “I have to tell you it’s the only reason my teenage kids are still alive”. I don’t know what she was on before that she’s come off of, but her kids are still alive. And what’s that worth? Priceless?

KM: Priceless. So we’ll talk about those types of things you get out of this treatment afterward. But just the monetary immediate costs are what people are looking at. And they feel like that’s a lot of money, and it is a lot of money but it’s a lot money you’re already spending. And we try to save them money in any way we can. If you have osteoporosis and you’re spending $700 a year in Fosomax. And that’s with insurance because it’s the highest co-pay. But you are improving your bone strength, but very slowly. Your bones are going to be back to normal in 2-3 years. If you have normal osteopenia or perosis they come back to normal with estrogen and testosterone much faster than they do with Fosomax without the side effects.

BN: And that’s included in the cost of what you do verses an outlay of $100 a month.

KM: Yes, another drug another doctor, another test and then you have to go to the radiology department or to your doctor and get a bone density and there’s a co-pay for that. So you’re paying that co-pay. If you really look through it you’re saving money by doing this immediately.

BN: Saving money and feeling better.

KM: Feeling better and you don’t have to spend your time at the pharmacy. One of the other things in the immediate savings is that you don’t have to go to the pharmacy and wait in line and have to have these other prescriptions filled. That’s huge. I mean I hate standing at the pharmacy and it‘s never ready when they say it will be because of course you’re supposed to walk around and be bored and buy things.

BN: Right, it’s a marketing strategy.

KM: It is and many of the drug stores, not all of them of course, Pharmacists are some of my best friends. So I don’t want to make any them mad.

BN: Yes but would you want your daughter to marry one?

KM: Yes of course, they’re great guys. They have better hours than we do.

BN: That’s another discussion for another time.

KM: One of the other things, we’ll talk about men now. Men need a lot more testosterone.

BN: That’s what I was going to say. Typically a woman finds you and she gets the treatments and she gets better and then her husband starts to get a little antsy because her libido has come back and even though he’s been complaining for years about her, he may not have recognized that his is declining as well, because it’s so easy to put the responsibility for that on the wife.

KM: And if you’re not using it you don’t notice it.

BN: Yes that’s what people tell me. So we did some research and looked on Google. You can Google it.

KM: This is his favorite part of it, of course.

BN: The average number of times that people have sex is a question that I’m always asked in counseling. You know, what’s normal? Is my husband abnormal because he’s always thinking about and talking about or wants it, when ever? Am I abnormal because with all the distractions and responsibilities I have I’m not really interested? What’s the average? The average according to Google, the website that we checked, for couples living together, not married, average 148 times a year. For couples who are married, average 96 times a year. So the secret is divorce your wife and just live with her and your sexual experiences will go up by a third.

KM: So sad. Maybe it means that the people living together are younger it may be that as well. It’s just like anything else. You want something, you want that car, you want to posses something, you’re going after it harder than if you have it. And it’s sitting next to you watching TV every night, that’s a whole different experience and I think that has something to do with attraction and the neuro chemicals that cause attraction. However.

BN: But where we were taking this conversation is that the man begins to get concerned and he also by comparison begins to recognize the resurgence of her energy, her alertness, her awareness compared to his own and she will steer him to you.

KM: Yes he wants what she’s having.

BN: He wants what she’s having. So he comes in. And let’s talk about the number of cost savings for men. If you’re a 60 year old male 55, 70 year old male, you also may have all of these issues, and we didn’t talk about obesity as an issue, but the hypertension, the anticholesterol, the antianxiety, the antidepression. So If you’re taking the same average meds that someone would come in, the same 39, 48, then you’re looking at male costs, just uniquely male costs. If a man is already starting to use androgel or androderm or something like that as a way to restore his libido, that’s like $720 a year you’re shelling out.

KM: That’s your highest co-pay. That’s like 60 bucks a month and if you’re paying for it, it’s more.

BN: And then if you’re taking ED drugs, if you’re taking something like Cialis or Viagra to enhance or qualify your performance, those things run $20 a pill and the insurance limits you to 30 pills a month.

KM: No 6. 6 pills a month.

BN: 6? 6 pills a month?
KM: Well that’s the average.

BN: Blows those averages all to hell.

KM: They must have looked at the averages too.

BN: But $20 a pill, where did we figure that out?

KM: Insurance doesn’t usually cover Viagra, I have to say that. Viagra and Cialis and Levitra are usually out of pocket expenses. In general they won’t cover it. You’re talking 20 bucks a pill. That’s expensive. So if you do that, what did you say, 6, so $120 a month? That’s $120 a month. That’s a lot for having sex 6 times. Actually I had a patient, I’ve told this story but I’ll tell it again. I haven’t told it on camera. I had a patient in Kansas City, we go to Kansas City and I have an office there and we take care of women and men there, and when I first got there, there were patients of the doctor I bought the practice from because he was doing pellets there. A gentleman and woman came in, she’s still my patient. They sat down very meekly and he said “this is the best deal I have ever heard of.” And I said why? Because, usually that’s not what I hear. And he said, I guess he had figured it out. He said for $400 my wife and I can have sex every night for four months. He said, but if I go down to Main and 2nd Street, $400 only buys me an hour. And I thought how does he know that? And if I were her I would have smacked him. And she just sat there smiling. So it didn’t bother her. But that’s kind of how their math worked. Everybody’s math works differently. And the number of times you have sex is going to matter if you’re taking Viagra or Levitra.

BN: Well if your relationship is good and you love your partner and want to have sex with your partner, if your body feels better and is more responsive, obviously that number should increase. And so you get out of performance sex for checking the box; we did that this month, or obligatory, it’s our anniversary, we have to have sex.

KM: We’re trying to wipe that out.

BN: So the combined costs, for this couple, the woman came in first and then the man, and they both get the treatments, the cost of the men of the BioBalance Health treatments is more.

KM: Is more for the men; they have more pellets. Their average is 10 pellets. If we’re looking at 10 pellets and they come in every 6 months and their insertion is a little different. They have two insertions sites, so it’s a little more expensive. After the initial consult it’s $3,800 a year on average.

BN: So it’s a about twice as much, a little more than twice as much.

KM: Because it’s a lot more pellets, and the charge is by the pellets because what you need.

BN: Although there is a factor a lot of times men’s costs are reimbursed by the insurance, a significant portion of i,t where women’s are not at all.

KM: About 2/3 of men have their costs reimbursed by insurance but the women is this area in the Midwest don’t get it reimbursed in fact I don’t think they get it reimbursed anywhere.

BN: The women?

KM: The women. Because they don’t think we need testosterone of course. Even though it’s going to save them all this money, the insurance companies for all these drugs, they haven’t really put that together yet. But any cost shift that they can do, they will. That’s just kind of how they operate; it’s a business to them, it’s not warm and fuzzy, it’s a business. How can they not pay more money? They don’t really realize that if you’re on this you’re going to decrease your cost for all these other drugs. Or you’re going to go see other doctors less. So they haven’t really put that together, I’m hoping that someday they will.

BN: Maybe they’ll watch the show and see that and say oh that makes sense.

KM: Yes it would be so nice if that would happen.

BN: So we’re looking at an average cost for men of $8,500 a year if they’re taking ED drugs and have already started some anti drugs.

KM: If they’re not taking pellets.

BN: If they’re not taking pellets. And an average cost for women of $4,200 a year, so we’re talking about $12,000 a year for a family that they’re already paying in different kinds of costs.

KM: And we’re not talking about the kids yet we’re just talking about the parents. And so we’re saving them we’re going down to the $1,500 plus $3,800, did you do the math on that?

BN: I did we’re saving $7,500 a year out of money they’ve already been spending, if they are the typical example who has these issues and can come off of them. For every individual person that’s going to vary. You may not maximize those savings, you may increase them, you may just get some of them.

KM: You may not be on them but you may not have to go on them, because your lean body mass is improved. It’s not a weight loss program but it is a lean body mass program. Lose fat, gain muscle; muscle is so important for us as we age. And it burns calories while we sleep. So if we have the muscle and less fat, we’re healthier. So being lean, not being skinny, but being lean is the key to being healthy all the way through and staying independent as you go.

BN: So the bottom line of a discussion about costs, we think needs to include costs that can be saved out of expenditures that are already being made by some portion of the system whether it’s insurance companies or individual client payers compared to the proactive cost of this treatment. That is what we have been discussing today. I know throwing numbers around and listening to statistics is sometimes difficult to conceptualize what the message was. We’ll put some slides up to show you these things as the show goes but basically what we want you to consider is generally the health benefits, the quality of life that’s available if you receive these treatments. And secondary, do a cost benefit analysis and look at the expenses that you already have of the things that you’re already taking and the side effects that those things cause. Versus the benefit for doing this with Kathy for the cost that it costs for you to go there. And we think the outcome is pretty obvious.

KM: And we’re going to go over some of the long term savings.

BN: We’ll do that in the next podcast.

KM: In the next podcast, we’ll go over the long term savings that you can get by taking pellets, which doesn’t even count the short term which is what we just talked about. But the long term savings both in monetarily and in continuing your productivity and independence.

BN: So, check Kathy’s website or contact us directly if you want, we’ll tell you how in just a minute, but check Kathy’s website for testimonials from people who come in and say “hey this is what happened in my life”. These are real people. They’re not paid people who come in and just say this stuff. So think seriously about this stuff. So if they have questions or comments how do they get in touch with you?

KM: They can reach me at the website and podcast@biobalacehealth.com or they can go to the website at BioBalanceHealth.com or they can call my office at 314-993-0963.

BN: And you can always reach me at BrettNewcomb.com.