Why are the costs of prescription drugs so high? While I have prescribed thousands of them, I
can’t offer an intelligent answer to this inquiry. Of course, all the players in this game – the
pharmaceutical companies, Pharmacy Benefit Managers, insurance companies,
consumer activists and the government- offer their respective bromides, where
does the truth lie?
While I don’t fully understand it, and I don’t know how to
fix it, we all know that the system is broken.
More than ever before in my career, I am seeing patients who cannot
afford the medicines I prescribe for them.
In the last few weeks of this writing, 3 patients with colitis, a
condition where the large bowel is inflamed, called me to complain about the
cost of their new medicine. The annual
cost was in the $2,500 - $3,000 range, which is way out of range for normal
folks. While I was only focused on the
colitis drug, many of these patients face prohibitive costs over multiple
medicines. All of these patients had
medical insurance, thought it didn’t feel like it to them.
Medicine or Retirement?
Should sick patients be given the added burden of price gouging?
I'm not an attack dog against PhRMA. I've expressed sympathy on this blog and elsewhere that it costs pharmaceutical companies a fortune to design, test and market new medicine. R & D is not cheap. If we want this industry to take risks developing tomorrow's drugs, then they deserve a profit high enough to justify the investment. Nevertheless, from the prescribers and the consumers points of view, the system is out of balance and needs to be recalibrated.
I reviewed my colitis patients' formularies, which is the list of medicines
that patients' insurance companies cover.
If a drug is labeled as a ‘Tier 1’ drug, then the cost to the patient is
the lowest. The higher the Tier #, the
more the patient will pay. This is how
the insurance company ‘guides’ physicians to prescribe cheap drugs. Of course, the insurance company will never
say that the patient can’t receive an expensive drug. That’s a decision, they claim with a straight
face, that’s between a patient and the doctor.
Give me a break. Ordinary folks,
especially retired people on fixed incomes, are confined to lower Tier
medicines.
I have no issue with the Tier system as long as there is at
least one Tier 1 drug that can do the job.
If there are half a dozen heartburn medicines that are equally
effective, I understand if an insurance company makes one of them Tier 1, their
preferred choice. This happens when the
insurance company gets a special discount on this particular medicine.
With regard to my 3 colitis patients, the only Tier 1 drug
was one that came on the scene decades before I was born. The standard colitis medicines that every
gastroenterologist would have prescribed were all upper Tier. My patients had no choice but to accept an
inferior drug.
If any reader can explain why our drug prices are the
highest in the world, can you also explain why insurance companies are not
practicing medicine?