Why is aspirin so expensive in the hospital?

Q: I keep reading that aspirin is dangerous. But when I went to the emergency room thinking I might be having a heart attack, the first thing they did was give me four baby aspirin. I wasn’t having a heart attack after all, but they seemed to think it would be protective if I was.

The “retail” hospital price for those tablets was $44! Why is hospital aspirin so outrageously expensive?

I don’t take aspirin daily, but I do take it occasionally. It doesn’t seem to irritate my stomach, but I always make sure I’ve eaten before I take any.

A: Hospital prices are mysterious and frequently inflated. The “list” price for items like aspirin or bandages can be significantly higher than the actual cost. Aspirin, for example, should cost a few pennies. But hospitals may charge $10 or more per pill. Part of that covers labor and overhead expenses.

Hospitals and medical practices frequently charge a lot more than they expect to receive. That’s because insurers and government payers reimburse a fraction of the list price. If you have ever examined an Explanation of Benefits (EOB) insurance statement, you have some idea how extreme the markdown can be from what is charged to what is paid.

Your strategy to take aspirin with food is smart. You should also do that if you take another NSAID such as ibuprofen or naproxen.

Q: Ten years ago, I was on a statin and developed diabetes. I needed insulin to control my blood sugar, but nothing helped the terrible muscle cramps in my legs.

After years on various statins, I got off of them and the cramps went away. I took up bicycle riding seriously, and now ride 33 miles or more two or three times a week. My endocrinologist helped me lose nearly 50 pounds. I no longer eat potatoes, corn or french fries. Best of all, I’m no longer diabetic and need no diabetes meds whatsoever.

A: The first statin, Mevacor (lovastatin), was approved in 1987. It wasn’t until a study was published in the New England Journal of Medicine (Nov. 20, 2008) that physicians got an inkling that cholesterol-lowering drugs like rosuvastatin could raise blood sugar.

Many physicians believe that the benefits of statins far outweigh the risk of developing diabetes. But this metabolic disorder causes many serious complications. The evidence for a link with statins has become stronger over the years.

Exercise and weight loss, as you have demonstrated, are well-established methods for getting blood glucose under control. People who would like to learn about a variety of non-drug approaches may wish to consult our “eGuide to Preventing & Treating Diabetes.” This online resource is found under the Health eGuides tab at Peoples Pharmacy.com.

Q: My doctor prescribed the drug metoprolol for my stage fright. The benefits last several hours.

I am an author and had terrible nerves and an embarrassing shaky voice when doing a reading. I wanted to share my experience with others who may also suffer from stage fright.

A: The beta blocker metoprolol (Lopressor, Toprol XL) has approval from the Food and Drug Administration for treating high blood pressure, angina pectoris and heart failure. Doctors sometimes prescribe beta blockers off-label for performance anxiety. These medications slow down the heart rate, which can help calm an overactive cardiovascular reaction.

Not everyone can tolerate beta blockers, though. People with asthma or complicated heart problems may experience dangerous complications.

Scott Olson/Getty Images Aspirin usually costs a few pennies each when purchased at a retail store, but the price can jump significantly when patients get it in a hospital setting.