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Val Davis, 67, is healthy. Really healthy.
She’s a powerlifter who holds the Oregon record in her weight class for Raw Full Power, a combination of squats, bench press and deadlift.
But she has no illusions about how aging changes one’s medical needs. When a friend recommended that she find a primary care physician before Medicare kicked in, she started a search. Three years ago, she landed with a doctor at Oregon Health & Science University.
She was pleased with her choice until Nov. 12, when she got a bill in the mail for a September visit, where she had gotten a PCV20 pneumococcal pneumonia vaccine (brand name: Prevnar 20) recommended because of her age.
The bill showed that the shot cost $937.49. Worse, there was a $55 fee for administering it.
“I blew a cork,” Davis says. “What’s this made from? Ground unicorn horn?”
Medicare paid $615.07, leaving her with a balance of $377.42. That took some of the personal sting out, but the idea of taxpayers paying so much enraged her further.
OSHU spokeswoman Tamara Hargens-Bradley defended the charge, saying in an email to WW that the “wholesale acquisition cost” for Prevnar 20, an “estimate of the manufacturer’s list price,” was $923.49—the “correct charge” for this fiscal year, which is up 9% from fiscal 2023.
But a quick search of the internet shows that Prevnar 20 is cheaper elsewhere, though how much cheaper varies. GoodRX.com lists it for $270 at various pharmacies. A list maintained by the U.S. Centers for Disease Control and Prevention shows Prevnar 20 has a private sector cost of $253.21. And the Walgreens on Northeast 33rd Avenue in Portland offers it for $307.99, with no charge for the jab.
Davis’s shot is just one of thousands given at OHSU, but her bill raises questions about a health care provider that will become the largest in the state—and the biggest employer in the Portland metro area—if regulators allow it to buy crosstown rival Legacy Health.
OHSU signed a letter of intent to buy Legacy in August, saying that the deal would “create a high-impact health care system driven by a mission of public service.”
Nowhere in the 704-word press release did OHSU mention prices or costs. Health care mergers rarely lower either. A January study by Harvard University faculty and the National Bureau of Economic Research showed that large health systems delivered “marginally better” care than independent practices or hospitals but that prices and spending were “substantially higher.”
And OHSU is a cost laggard already. Oregon’s Sustainable Health Care Cost Growth Target Program (a mouthful) sets an annual target to slow increases in health care spending. For 2021 to 2025, the target is 3.4% or less. For OHSU patients with private insurance, costs rose 21.1% from 2020 to 2021, compared with 10.2% for Kaiser Permanente and 9% for Providence Health & Services.
OHSU patients with Medicare Advantage saw their costs go up 8.3% during the same period, compared with 3.4% for Kaiser and 6.8% for Providence.
Davis experienced the price inflation firsthand with her pneumonia vaccine. She remembers getting a flu vaccine at OHSU some years ago; the cost seemed high, so she made a mental note to go elsewhere for those. But when she went in for a free Medicare wellness exam in September, the doctor recommended a booster for the pneumonia shot she got in 2019.
Make no mistake: PCV20, or Prevnar 20, is good medicine. PCV20 stands for “20-valent pneumococcal conjugate vaccine,” which means it helps protect against 20 types of pneumococcal bacteria that can cause serious infections in adults.
“I said fine, let’s boost it,” Davis says. “Nobody said anything about the cost.”
She didn’t think much of it until she got the bill in November, and her jaw dropped. There was a charge of $937.49 for “drugs requiring specific identification.” Davis called OHSU and learned that the charge was for the pneumonia booster. She pressed the representative, named Scott.
“He basically mansplained, and then he hung up on me,” Davis says.
She called back and got someone nicer who offered to cut her share of the shot’s cost to $288.81—the amount she paid in 2019—from $377.42. Great, she said. Including an older bill for other work, she would owe OHSU $405.96.
For Davis, the ordeal didn’t bring financial ruin. She had worked in marketing at Hewlett-Packard and has plenty saved for retirement.
But when the stock market slumped in 2022, she took a job as a cashier at New Seasons, fearing that her money might run out. There, she met people who were living paycheck to paycheck. They would have been crushed by a $377.42 bill for a vaccine, she says.
“I’m really lucky,” Davis says. “I had the dough. If this hit other people, it could have been life-changing. You shouldn’t have to go into debt trying to protect yourself from pneumonia.”
From now on, Davis says, she’ll be wary of anything OHSU prescribes.
“This was supposed to be a free Medicare wellness exam,” Davis says. “I never thought I would walk out with a $400 bill. Are they still trying to pay off the tram?”