The Cost of Pharmaceuticals

[imoldernu]

The current thread on the cost of the drug Nexium struck a chord that leads to this more general thread. Aside from the politics, the high cost of medications is in large part under the rdar, unless you, yourself are affected. I think it would be interesting to hear about the experience of others... yourself, or acquaintances who are dealing with this problem.

Not looking for solutions, but simply to see what, and how much is involved.

To kick this off, two cases with which I am familiar. DW was prescribed Prolia, for bone density. It's a twice a year "shot" that costs $1300 each, and is not covered by our Plan "D" Medicare.

The second, is for the Drug Cholcrys... a treatment for gout. It's a replacement for the ancient drug Colchicine, which, until declared illegal by the FDA, had a cost of $.06 per pill, which went to about $5 for the same strength and dosage, since reduced to about $1.00. Since a bout with gout four years ago, I have had a small supply of Colchicine... Now I have asked my doctor for a written prescription for the new drug, that I will not fill, just in case of a recurrance.. (you don't want a gout attack!)

This is a "take" on the change, which took place a few years ago.
Price of ancient remedy Colchicine goes up 2,600% after FDA gives approval | Mail Online

I think it would be interesting to see what has happened to pharmaceutical costs, both ways... when older drugs have price increases, and when copyrights expire, and the drugs drop in price, ala Lipitor...

Anything to add?

[brett]

Interesting. We live in Canada and we do not like the costs either. Why.. because one of the latest studies shows that the prescription drugs we buy in Canada can be purchased in Europe...UK, France, etc. at varying amounts for up to 50 percent less than we pay. This really ticks us off. Ontario hospitals have found that a generic drug that they buy is being purchased by the New Zealand health authority for 1/10th of what Ontario hospitals are now paying.

The report indicated that US prices are on average 30 percent higher than Canadian prices. So much so that places like the City of Portand, Maine apparently now send all of their employee prescriptions to Canada in order to contain their drug plan costs. In some cases the actual cost of the prescription (exact same name brand drug) to the City is less than the co pay amount if filled in the US. Go figure.

This has apparently been met by much opposition from the drug companies etc. but the City has prevailed. They batch the prescriptions and send them out 80 or so at a time. And more private and public organizations are looking closely at this.

I would be happy to send our prescriptions to Europe if we could realize a 40 or 50 percent reduction. The world is getting smaller. The large drug firms can only get away with this by having tacit government approval in the form of roadblocks and barriers. Guess that is why they spend so much on lobbying.

[Meadbh]

Nitric oxide (NO) has been an industrial gas for decades. In the 1990s, it was found to be extremely useful in treating a dangerous condition called pulmonary hypertension, particularly in infants. It was, and is, inhaled in minuscule concentrations. The price of the gas and the plumbing equipment needed to administer it shot up 1000%. Many years later, after much negotiation and market competition, the price has moderated, but it is still significantly higher for medical than industrial use.

Supply and demand.......

[aja8888]

Being on Medicare and with Part D drug plans has been an experience. My drug cost is very minimal as I only take a med for elevated blood pressure that I can buy for $8/month under the plan.

My wife, however, has COPD and we are spending large amounts on inhalers and steroids, Lipitor, and a few others. She was in for a respiratory problem not related to her COPD last summer that the doctor prescribed an antibiotic. When I went to pick it up, the pharmacy wanted to charge me $150 for 5 pills! I couldn't believe this. Apparently, the drug was not on our plan's list of discounted ones so it was the full price.

Needless to say, it went back on the shelf and the doctor prescribed a med that was in our Part D plan.

I can't believe the antibiotic was $30/pill.

[brett]

And to add insult to injury....my Pfizer stock has not been doing that well!

DW just was just able to switch her blood pressure prescription from name brand to generic. Cost went from $110. for three month supply to just under $33.

[samclem]

Quote:

Originally Posted by Meadbh Supply and demand.......

But the real "demand" for pharmaceuticals is so distorted by the intermediate payment mechanisms, and the real "supply" is so distorted by artificial barriers erected to "protect" us, that the normal market forces are absent. If the people using the drugs were actually paying for them directly (or even a substantial part of the cost), things would probably straighten out right away. Shopping/price comparisons would be more thorough, people would question their doctors/PAs about alternatives, and they'd also put pressure on their elected reps to pull down the barriers that restrict supply. Instead, we have this.

As far as the $30 pill: It might be well worth it. If it keeps a person out of the hospital or allows them to be on the job, they'll be money ahead. $150 for a course of antibiotics that lets me avoid some nasty bug is a bargain. There could be lots of reasons valid market-driven a particular medication would cost that much. But a patient should have access to info about the alternatives.

[aja8888]

Quote:

Originally Posted by samclem As far as the $30 pill: It might be well worth it. If it keeps a person out of the hospital or allows them to be on the job, they'll be money ahead. $150 for a course of antibiotics that lets me avoid some nasty bug is a bargain. There could be lots of reasons valid market-driven a particular medication would cost that much. But a patient should have access to info about the alternatives.

I absolutely agree with you on the above, but:

1. The doctor did not say a word about HIS selection of the medication/benefits/alternatives/etc,

2. The pharmacy just hands prescriptions out and collects the money.

3. No thought was given by the doctor as to whether or not the pill was on the Part D drug plan and he knows she is on medicare.

In my opinion, the bottom line is the medical industry and their doctors really don't give a hoot as to what the customer has to pay to get the medications or treatments they need.

I'm not sure about this, but if I were a betting man, I would bet the doctors who prescribe certain meds are getting kickbacks from the drug companies.

(I suppose I could mention the inhaler that one doctor prescribed previously for her that had a cost of $500 and not on our Part D plan either - that never got bought and we just stuck with the usual Spivia one)

[brett]

That may all be true.

But what I do not accept is that a name brand prescription can cost $100. in the US, $70. in Canada, and perhaps $50. in Europe. Thanks to the internet and the availability of information to so many, selective geographic pricing is very much out in the open for those who want to find it.

Especially since the cost of doing business in Europe is typically higher than Canada, or the US for that matter.

[ERhoosier]

Quote:

Originally Posted by aja8888 In my opinion, the bottom line is the medical industry and their doctors really don't give a hoot as to what the customer has to pay to get the medications or treatments they need. I'm not sure about this, but if I were a betting man, I would bet the doctors who prescribe certain meds are getting kickbacks from the drug companies.

Most (not all) docs I know are very much aware of cost-containment issues these days, inc. patient costs. Many tell their less-well-off patients to come back between scheduled visits to get more drug-company supplied samples of their meds to save $$. My own doc has warned me several times over the years when a specific drug/test/vaccine was commonly not covered by HI.

FWIW- Kickbacks for prescribing specific drugs (or referring to specific labs/clinics/etc.) are illegal in the US, and it's not difficult to find many examples of prosecutions.

https://www.fbi.gov/detroit/press-re...ibution-scheme

Former Serono executives charged with conspiracy and offering kickbacks to doctors - Drugs.com MedNews

Doctor accused of taking kickbacks to prescribe anti-psychotic drug - Chicago Tribune

Drug Company Accused of Bribing Doctors - ABC News

[MBAustin]

Saw this article on my Twitter feed yesterday - what I read so far looks very interesting but I haven't finished it. Interesting that a top hospital refuses to prescribe a new drug with limited improvement and much higher cost than current drugs. Also that chemo does very little good with many cancers - would like to know more about that.

The Rising Costs of Cancer Drugs -- New York Magazine

[aja8888]

Quote:

Originally Posted by ERhoosier Most (not all) docs I know are very much aware of cost-containment issues these days, inc. patient costs. Many tell their less-well-off patients to come back between scheduled visits to get more drug-company supplied samples of their meds to save $$. My own doc has warned me several times over the years when a specific drug/test/vaccine was commonly not covered by HI.

I guess its different in other places. Around here (The Woodlands, TX), which is a high end Mecca of oil companies, corporate offices and biotech firms, etc., all with highly paid employees, most Doc's drive very expensive cars and live in big houses. Never once has a doctor offered any free samples or even mentioned cost control to us. We also live in the Mecca of great medical facilities (MD Anderson Cancer Center, Texas Medical center, etc) that charge outrageous amounts to get treated. Maybe we should move to the midwest where life is simpler? (Oh, we came from there )

Also, some of the biggest Medicare fraud cases have originated in the areas around Houston, and there are a lot of them that have not been caught yet.

[samclem]

Quote:

Originally Posted by MBAustin Saw this article on my Twitter feed yesterday - what I read so far looks very interesting but I haven't finished it. Interesting that a top hospital refuses to prescribe a new drug with limited improvement and much higher cost than current drugs. Also that chemo does very little good with many cancers - would like to know more about that. The Rising Costs of Cancer Drugs -- New York Magazine

Yes, of course it is much more complicated in real life than any article can describe. A 47 day average improved survival time is just that--an average. I wouldn't know if I (or my child) might be the one to live an extra 4 months by using the drug. And, since I wouldn't be paying for it myself (some faceless insurance company is), that would remove one barrier. And then there is quality of life during the remaining time: Some chemo really puts the patient through hell, and some types give the patient more days of pain-free/reduced pain life.
Doctors often want to be seen to be doing all they can do for the patient. The patients and the families frequently feel the same way. Sometimes "all they can do" is a terrible thing to watch--or endure.

[ERhoosier]

Quote:

Originally Posted by aja8888 Also, some of the biggest Medicare fraud cases have originated in the areas around Houston, and there are a lot of them that have not been caught yet.

Completely agree.
Medicare fraud is particularly cruel since it sucks $$$ away from folks who need it for treatment. BTW- Medicare accepts fraud reporting tips from public.

https://www.medicare.gov/forms-help-...and-abuse.html

[sengsational]

Quote:

Originally Posted by brett That may all be true. But what I do not accept is that a name brand prescription can cost $100. in the US, $70. in Canada, and perhaps $50. in Europe. Thanks to the internet and the availability of information to so many, selective geographic pricing is very much out in the open for those who want to find it. Especially since the cost of doing business in Europe is typically higher than Canada, or the US for that matter.

My experience does not align with the report. It's a larger discrepancy. I only have one solid data point, but it's a name brand in the US is $350/mo and same drug out of the same factory is $90/mo outside the US. Why do American's pay 389% more for the same thing?!?

I have never used this site, can't vouch for accuracy or if it really shows the lowest prices, but it's a data point: Compare prescription drug prices and online pharmacy ratings at PharmacyChecker.com

[Co2012]

I will almost be glad when I'm old enough to apply for medicare. I'm getting my first taste of what many people pay for their med and it's ridiculous.

Recently I had a change in my blood pressure meds. The pill I was taking suddenly quit working and my doctor had to change it. They had no generic for the drug subscribed, so I went from $5.00 to $139. But what upset me was that after paying $139, the meds did not work and my doctor took me off after three days and tried something else. This something else now cost $158. This time I refused to accept the whole order in case it did not work. The medicine did not work like she wanted it (pressure now at 140+ / 80 -85 and she wants it lower.), so she went from 10 mg to 20 mg, which doubled the price. I never realized that the higher the dosage, the higher the price. I guess this makes sense. I've always had employee benefits and no matter the dosage, it was never no more than $15.00. This is going to definitely give me added incentive to keep my blood pressure down. The higher it goes, thus, so will the cost.

A friends gets her meds from Canada and swears she has never had a problem. She suggested I do the same. I don't know.

But regardless of any cost to medication, I will never regret retiring.

[Meadbh]

Quote:

Originally Posted by Co2012 I will almost be glad when I'm old enough to apply for medicare. I'm getting my first taste of what many people pay for their med and it's ridiculous. Recently I had a change in my blood pressure meds. The pill I was taking suddenly quit working and my doctor had to change it. They had no generic for the drug subscribed, so I went from $5.00 to $139. But what upset me was that after paying $139, the meds did not work and my doctor took me off after three days and tried something else. This something else now cost $158. This time I refused to accept the whole order in case it did not work. The medicine did not work like she wanted it (pressure now at 140+ / 80 -85 and she wants it lower.), so she went from 10 mg to 20 mg, which doubled the price. I never realized that the higher the dosage, the higher the price. I guess this makes sense. I've always had employee benefits and no matter the dosage, it was never no more than $15.00. This is going to definitely give me added incentive to keep my blood pressure down. The higher it goes, thus, so will the cost. A friends gets her meds from Canada and swears she has never had a problem. She suggested I do the same. I don't know. But regardless of any cost to medication, I will never regret retiring.

If the cost of the medication is related to the cost of manufacturing the active ingredient (and it is) it is perfectly logical that the higher dose will reflect that cost. There is a lot of price variation between pharmacies. Check out the price of your medication locally at www.rxpricequotes.com. Using the Zip Code 90210 I looked up my BP medication and found a cost per pill ranging from $0.41 to $0.80. (Beverly Hills may have a high price point!). I live in Canada and recently renewed my prescription for a cost of $0.28 per pill for the proprietary version, and $0.24 per pill for the generic version. The dispensing fee is extra and if you calculate the price per pill including the dispensing fee, the proprietary version costs $0.41 per pill and the generic version, $0.35 per pill. The price has recently decreased. I checked a Canadian drug database Pacific Blue Cross | BC Life and found that the price I paid is pretty standard for my area. You might find it interesting to compare the cost of your medication at different pharmacies in these two databases.