AUDIE CORNISH, HOST:
From Capitol Hill to the campaign trail, politicians of all stripes say they want to lower prescription drug prices. And it's an issue we see reflected in the medical bills you send us for our Bill of the Month segment. We're joined now by Dr. Elisabeth Rosenthal. She's editor-in-chief of Kaiser Health News. Welcome to the studio, Elisabeth.
ELISABETH ROSENTHAL: Thanks for having me.
CORNISH: So introduce us to the family that sent in April's Bill of the Month.
ROSENTHAL: Well, this month, we're meeting the Yoder-Perry family. They live in the college town of Bloomington, Ind., where both parents work for Indiana University. And they encountered a super-high drug price for a drug that literally saved the life of their 10-year-old daughter.
CORNISH: Now, Jake Harper with member station WFYI in Indianapolis actually visited them. He's going to pick up the story from here.
JAKE HARPER, BYLINE: Something's making noise on the trail near Oakley Yoder's house.
OAKLEY YODER: Probably either a snake or a frog. Hope it's a frog. Hopefully it's not a snake.
HARPER: Oakley loves being outside, but snakes are not her favorite animal. She was away last summer on a climbing trip in southern Illinois. And at dusk, her group headed back to camp.
OAKLEY: I felt something, like, grab onto my foot. So I think it went into this side of the toe. That's where the dent right here is. And I thought it was just thorns or glass or something like that.
HARPER: But the pain started to move up her leg. It was a snake bite, probably a copperhead. She told the counselors, and to keep the venom from spreading, they put a tourniquet around her ankle. One of them gave her a piggyback ride out of the woods.
OAKLEY: And I felt his sweat. I could feel how worried he was. I thought I was going to get paralyzed or die or get my foot cut off. I had so many things that - in my mind that could have happened.
HARPER: While they waited for help, the counselors got Oakley to relax with Gushers candy and Taylor Swift.
Do you remember what song?
OAKLEY: "You Belong With Me."
HARPER: How's it go?
OAKLEY: You wear high heels, I wear sneakers. You're cheer captain, and I'm on the bleachers.
(SOUNDBITE OF SONG, "YOU BELONG WITH ME")
TAYLOR SWIFT: (Singing) Dreaming about the day when you wake up and find...
HARPER: Did it calm you down?
OAKLEY: Yeah. Like, we listened to it, like, at least 20 times.
HARPER: Oakley eventually got in a helicopter and was taken to St. Vincent Hospital in southern Indiana. She got four vials of antivenom before they sent her north to a children's hospital in Indianapolis.
JOSH PERRY: It was around 5 or 5:30 in the morning when the ambulance from St. Vincent arrived.
HARPER: Oakley's parents, Josh Perry and Shelli Yoder, met her at the second hospital. Shelli says Oakley's leg was swollen and dark.
SHELLI YODER: It was pretty far up her leg, let alone her toe. I mean, I was pretty worried about where this was going.
HARPER: But the specialists said the antivenom was working. Oakley was out of the hospital in a day. She couldn't play outside for a while, which was frustrating. And she says her foot is still kind of numb from the bite. But she could walk and run in about a month. And she even got some presents out of the whole thing. That period was a little more stressful for her parents. They both teach at Indiana University. And Perry actually researches health care ethics. They knew enough to worry about the bills.
PERRY: I was holding my breath walking to the mailbox to see, what's the next step in this saga?
HARPER: St. Vincent gave Oakley four vials of antivenom called CroFab. The list price - $3,200 per vial. And the hospital charged way more, more than five times that amount. After all the bills came, Perry added them up. The charges for treating Oakley's snakebite totaled $143,000.
PERRY: It just seems unconscionable that you would inflate prices by such an extraordinary amount. It took my breath away.
CORNISH: That's Josh Perry telling his daughter's story to reporter Jake Harper in Bloomington, Ind. Elisabeth Rosenthal is here to talk more. And how did this bill grow to over $140,000?
ROSENTHAL: Well, a big chunk of that - about $55,000 - was the air ambulance, which this little girl clearly needed. I mean, this is a big emergency. And we've talked about high air ambulance prices before on Bill of the Month. But the other big chunk, which we want to talk about today, is for those four tiny vials of antivenom that she got. That was more than $60,000.
CORNISH: Why? Why are those four vials so expensive?
ROSENTHAL: Well, when your kid gets a poisonous snake bite, they'll die without rapid treatment. So you're vulnerable to financial extortion. Look. Even with the antivenom, she ended up with signs of early gangrene in her leg.
CORNISH: But $60,000?
ROSENTHAL: There's two reasons why it gets so high. The first is the drug maker in this case had a monopoly on the product. Only one company had the license to sell this antivenom when Oakley got bitten. And the U.S. doesn't regulate drug prices. It's not a particularly high-tech drug, but in our country, the wholesale price was $3,200 per vial at the time. The same or similar drug in Mexico is $100 or $200. The second thing is there's a big hospital market. Like booths at a restaurant, the hospital has a captive audience here and can markup with abandon. And in this case, they did five times the wholesale costs.
CORNISH: That ended up being $143,000 that the Oakley family was charged. How much of that did they pay in the end?
ROSENTHAL: They're extremely lucky. They didn't pay anything. You could call it a miracle. They had zero dollars out of pocket. The camp came in to pay what their insurance didn't. But I would add the bigger problem is when your insurer and your company jumps in to save you from these extortionate bills, well, the next year, the prices for premiums in your company are likely to go up.
CORNISH: Is there any movement to bring down prices for this particular antivenom, especially for people who don't have insurance miracles?
ROSENTHAL: Yeah, these guys were lucky. There is a second company that now makes antivenom in the U.S. The problem is only two drugs doesn't make competition. In studies, we've seen that you need really four or five competitors in a market to really bring down prices.
CORNISH: Is there any way that politicians could level the playing field, anything the Trump administration could do or lawmakers?
ROSENTHAL: Well, this kind of case is exactly why other countries do regulate drug prices. We don't seem to be going in that direction. So I'm looking for the next year to see what Nancy Pelosi and Donald Trump can come up with.
CORNISH: Elisabeth Rosenthal's editor-in-chief of Kaiser Health News. And if you have a medical bill you want us to investigate, head on over to NPR's Shots blog.
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