HOUSTON – Courtney Segura was in the middle of training for a marathon when a podiatrist told her she had plantar fasciitis, a common injury for runners.
The doctor prescribed Segura with a topical cream that she was told would numb the pain. But instead of asking where she would like the prescription filled, the doctor’s office said the prescription would come from a mail-away pharmacy based in Dallas.
“She didn't give me any options. She just said, 'This is the pharmacy that we use,'” Segura said.
Several tubes of an ointment arrived later that week, and according to Segura, the pharmacy then refilled the prescription without her permission.
Her husband, David, noticed that the pharmacy billed the couple’s insurance around $7,000 for the ointments.
“It didn’t even work. I barely used it,” Segura said.
The prescription lidocaine cream arrived in the mail from a compounding pharmacy, where special combinations of medications can be compounded together to come up with unique treatment options.
The pharmacy will often bill for each ingredient mixed into the compound as well as a compounding fee, according to the Texas State Board of Pharmacy. As a result, a compounded prescription can be a lot more costly than a regular prescription.
“In the past, these pharmacies have been charging upward to $10,000 for these particular products,” Gay Dodson, executive director for the Texas State Board of Pharmacy, said.
However, the prescription label for what Segura was shipped did not indicate anything was compounded reading, “Lidocaine 5 percent.”
A podiatrist who oversees standard of care for the Texas podiatry board confirmed that a prescription for lidocaine cream should cost a fraction of what the Seguras were billed.
The high cost of prescriptions being billed to both private and public insurance has caught the attention of the federal government’s Centers for Medicare and Medicaid Services.
“Where we see issues, we are able to get these pharmacies out of the program,” said Dr. Shantanu Argawal, who is known as Medicare’s top fraud fighter.
The Texas State Board of Pharmacy also recently pushed to get the power to look at pharmacy financial records to see if doctors sending their patients to specific pharmacies are getting kickbacks from the pharmacies.
“It seems to be a collusion between the pharmacy and the doctor to make a bigger profit,” Dodson said.
She said patients have the right to have a prescription sent to a pharmacy of their choosing, that they know will be covered by their insurance plan and recommends to raise concerns if a doctor is trying to direct a prescription to a specific pharmacy.
The State Board of Pharmacy is looking for complaints of potential collusion between doctors and pharmacies. Those complaints can be filed online.