Who Can Afford American Drug Prices

Who Can Afford American Drug Prices?

Last night I watched 60 Minutes with my daughter, who manages the Critical Care Unit of a large hospital. The topic was prices pharmaceutical companies are charging for their products. Some cancer drugs now cost more than eight thousand dollars a month (and must be taken for months or years.)

How did this ever get started? Somehow, Congress enacted a law that forbade the VA, Medicare, etc. from negotiating prices, leaving the drug companies free to charge as much as they liked. In other nations the drugs cost about one tenth the price, even though they come from USA. And it doesn't affect only cancer drugs. I get the same story many times from with former patients (I am retired.)

A chapter from my 2008 book Access to Medical Care seems worth repeating here:

Chapter Four: The Medicine She Never Took

"My doctor gave me a new medicine for my stomach pain," a friend answered when I expressed hope that she was feeling well. "It works fine, but I can't take it."
"I'm sorry to hear that," I said. "Too many side effects?"
"No, the free samples he gave me helped a lot. But when I took his prescription to the pharmacy, a month's supply was four hundred dollars. That's almost half my Social Security check! How am I going to pay my utility bills and buy my groceries? So I'll just keep on with the antacids."
"Did you tell your doctor you couldn't pay that kind of price?"
"I phoned him, and he said he had no idea it was that high."
"Did you ask him about any of the over-the-counter medicines? Some of them are about one-tenth that price, or less."
"No, I didn't know anything about that. He had his nurse make me an appointment for two weeks from now for follow-up. But I never had the prescription filled when I found out the cost."
If you think that's an isolated example, another patient had had at least six back surgeries over the years (laminectomy) and no surgeon would now touch his scarred back. His local doctor was trying to manage the pain with various pills and patches, some of which eased his steady pain, but not the "lightning spasms" that struck when he moved wrong. Additonally, over the years, he had developed unacceptable reactions to some of the medicines, and the doctor was trying a new one. His medical insurance refused to pay for it. The doctor's office clerk said she would try and straighten the matter out, and would call him back. She never did, nor even to let him know the problem. He finally called his pharmacist to see if he could afford to pay for it himself, and found to his horror that a month's supply was $525.00, half his entire monthy income. Presumably, the doctor's clerk could have found that out, but if she did, she never let him know.

These illustrate a basic flaw in the American way of marketing medicines. The manufacturers have well-paid "detail persons" who make regular calls at each and every doctor's office to inform him/her about their company's latest and most advanced product. They sometimes used to appear around noon, with enough pizza for the whole office staff. Friendly people, well trained and informed in their field, they are a principle source of information for busy doctors who don't spend as much time as they might with medical journals and Internet search. The pharmaceutical rep has free samples to leave with the doctor, along with note pads or pens bearing the product's name.
Sometimes the reps really do have valuable updates for the doctor, but they rarely mention the price of their product, or that the older remedies still work as well as they always did. And the doctor will try the samples on his patients because (a) he doesn't want them to buy a whole month's supply of any medicine unless he knows it works for them, and/or (b) he may want to help a patient he knows is having difficulty affording care.

Most doctors don't keep up with the present-day price of what they prescribe. But they could. Every doctor gets an annual free update of Physician's Desk Reference listing all prescription medicines with their uses, side effects, and precautions (about 4,000+ pages—old copies make good doorstops), and a supplement with all the non-prescription medicines is available as well. Plus an annual update of Redbook (not the women's fashions one, but current drug retail prices) with the option of subscribing to monthly updates.
So - here's what a patient can do. Don't be afraid to ask what a new prescription will cost, and if necessary, ask if there is a less expensive generic that will be adequate. Sometimes there will be, sometimes not.
And Doctors, here's what you can do. Be aware that the latest drug is pushed by the drug rep because that's what he/she is hired to do. It's good to keep that product in mind, but ask yourself, "Is this what this patient sitting here in front of me really needs, or will an older, less expensive drug be effective?" And stay away from reps who want to buy you meals or pay for a vacation trip. Your patients have to pay for that in the cost of their medicine.
And all you readers in the general public, pressure your reps in Congress to reasonably regulate the charges for medicines. Why should a drug that has been on the market fifteen years now cost thirty dollars per pill when the company was raking in high profits at the original price of ten dollars per pill? Why should an injection aimed at mass use be selling for thirty-five dollars, when it originally wholesaled forty years ago at one dollar? Or why should a drug, manufactured in USA, sell for less in Canada or Europe than it does here where it was made?
Even in a free market economy, the customer should get as much consideration as the company's stock holders get.

Returning to the Sixty Minutes report, I asked my daughter how her hospital handles these exorbitant costs. "Often we talk with the doctor, especially in cases where the drug is likely to prolong life only a month or two. More and more, hospitals are buying out the doctor's practice [that is, it's the same doctor, but now employed by the hospital.] Medicare can't negotiate the price, but we can, and we can buy in bulk, getting a much lower price."

Granted, new medicines sometimes do cost a lot to develop, but that ill-advised law forbidding federal agencies to negotiate the price should be repealed. Or perhaps USA should go to a single payer system like most other countries have. As things stand now, even insured patients are going bankrupt.