Jesse Posey, 83, drove to Boise with his daughter in December for surgery.
The retired Kimberly resident ended up staying two nights at St. Luke's Regional Medical Center.
"I was shocked, to say the least, when I got the bill for the medication that I normally take at home," he said in a letter to the Idaho Statesman.
His hospital bill included charges for eight pills that totaled $178.16, or $22.27 each.
Normally, 120 pills of an anti-seizure medication cost him $1.50 after insurance at a grocery store pharmacy in Twin Falls. Without insurance, Posey said his prescription would cost him $1.21 per pill.
For a recent Time magazine story, journalist Steven Brill spent seven months looking at hundreds of medical bills. He found that health care pricing is opaque and unpredictable, with Medicare offering the most protection.
That's true in the Treasure Valley. Posey's pill is a case study in the wide range of health care costs.
Why did Posey's pill cost 18 times more than he'd pay without insurance?
When it comes to anti-seizure medication, St. Luke's does not use generics, said spokesman Ken Dey. It uses only brand name versions because St. Luke's doctors say they are more effective.
The hospital also doesn't allow patients to bring their own medications from home, unless they take a drug that St. Luke's doesn't have in its pharmacy.
That's also true at Saint Alphonsus in Boise. But that hospital gives the generic version of Posey's drug for about $7 a pill.
The price of a pill varies throughout the marketplace.
For someone paying out of pocket, the generic version of Posey's medicine costs $20 for 120 pills at Ladd Family Pharmacy in Boise.
With a middle-of-the-road Aetna health insurance plan, a person would pay about $11 out of pocket for that same prescription at a retail pharmacy.
Why so many price differences? There is no single answer.
Both of Idaho's largest health systems have strict rules on how drugs are given. They must be ordered by a doctor, approved for distribution by the pharmacist and administered by a nurse. Those rules are one reason for the markup.
Hospitals also need to make money and don't receive the kind of bulk discounts that regular pharmacies do, Dey said.
Posey was so alarmed at what his hospital-stay medication would have cost without Medicare that he sent a letter to the hospital. He thought there must be a mistake.
"I just couldn't see how any hospital could charge $22 for a single pill, where they could be bought for a dollar," he said.
Audrey Dutton: 377-6448, Twitter: @IDS_Audrey