What is going on with prescription drug costs?

[Bamaman]

I'd be talking to that pharmacist to see if there are any alternative drug or drugs to replace the meds that prices have gone out of sight on.

We went to my wife's Pain Clinic today, and she was informed that her main pain medicine (taken for 15+ years) is going to be changed in an effort to reduce her opioid intake by 30%. The order came from The State who has been auditing their patients' medical records. (This is not even the state we live in.) The anesthesiologist with a fellowship in pain management has no say so in the state's decision, and a bunch of bureaucrats are essentially making some of his medical decisions in patient care.

We chased around to 4 major pharmacies trying to find the drug, and no one even stocks the stuff. We eventually found it at a small, independent pharmacy and Medicare with a Supplement paid for it. If a drug is going to be prescribed, especially if it's so time sensitive, at least the pharmacies should be notified to begin stocking it.

Politics is such a number's game, and The State wants to say prescriptions of controlled substances are down "X"%, even if it causes pain and suffering by the chronically ill.

 

[Momcpa]

The ugliest part of the doughnut hole is you do not know when you hit it until it is too late.It is based on the total cost of the prescriptions, not your OOP.
It kicks in at $3820 and ends at $5100.
here is the ugly part:
Total drug cost- $3820, your OOP may only be $1000
You will have to pay another $4100 to get out of the doughnut hole.

Is this how it works? I've never quite understood the 'doughnut hole' calculation. If this is correct, the explanation is quite clear......although the reality of the OOP is scary !! Thanks for your help.

 

[Go-NoGo]

Why should Canadians pay so much less? That is the question I want answered. Along with why our elected representatives at all levels seem oblivious to this difference in price.

We get adulterated blood pressure medicines approved by the FDA from overseas sources, yet we are warned about the dangers of buying drugs from the Canadians. Go figure.

The drug company has to make a ROI on its investment in getting that molecule from the lab to the market and generate profits to return to the shareholders - think of this entire cost as the air in a long skinny balloon.

With me so far?.. Good now visualize Canada grabbing one end of balloon and squeezing it and saying "We are only paying so much for this drug", and the NHS of UK squeezes the balloon and so does every other country in the world.

Now the air in the balloon forms an enormous bulb at the other end and THAT represents the cost the US consumer has to pay because we did not negotiate with the drug company (you know "free markets" and all).

So we have allowed ourselves to get screwed (If you were able to form a mental image of the aforesaid balloon, which now looks like a d* - how appropriate) by the Pharma companies because we have gutless politicians and have bought into the idea that new drug development will stop unless we allow unconstrained price growth.

Time to squeeze back and get other developed countries to pay their fair share for drug development.

 

[6miths]

Time to squeeze back and get other developed countries to pay their fair share for drug development.

Fair share? A drug like methotrexate costs much less than a penny a pill to manufacture and was developed in the 1940s. That people who need it are being charged $175 for a 3 month supply is ridiculous. I am definitely not going to be extorted by drug companies and their shareholders if I can avoid it.

 

[jimandthom]

I take a drug called Welchol, which is normally used for people with high Cholesterol.

I take it as a binding agent---- due to mold exposure issues that have occurred in our house reno.

Until May, the charge paid by Aetna/Caremark under my previous FEHB retiree policy was around $700 for the 3 months. With a $2 copay and $10 shipping.

In May we switched to a different FEHB retiree policy. The charge paid by Aetna/Caremark when to over $1400 for a 3 month supply. With a $2.50 copay and $0 shipping.

Hard to understand how 2 policies administered by the same company, getting the refill from the same RX filler can have such a different price.

 

[Breedlove]

Talked to my Compounding Guy . If you have a good script for the Methotrexate and call him he can help . He does not have the buying power of Walmart but it won't be outrageous . ( Pure Pharmacuticals Houston Texas ) he could not understand the high price .


He can buy the chemicals and make the tablet . He said the injections are more expensive because of the machines required. On the Welchol he said only one company makes the chemical. Can't help.

 

[youbet]

......... but a small part of me wonders if this will discourage R&D for some future potential blockbusters that are very expensive to develop.

Yes, I wonder that too.

Having our Fed Gov't dictate prices for drugs (another way of saying what "negotiated" prices will be.....) will insert politics into the resource allocation process. And that could be a good thing, or perhaps more like a good thing with potential unintended consequences.

An obvious positive would be some assurance that non-USA, gov't insurance customers would be paying a so-called "fair share." Since I doubt that the USA gov't agencies would want to explain why the price they negotiated is higher than that paid by other countries, I'd expect some price equalization.

An obvious downside is that there would likely be less incentive and resources for drug R and D. With over population being an oncoming problem here on planet earth, maybe this wouldn't be such a bad thing?

 

[harllee]

Talked to my Compounding Guy . If you have a good script for the Methotrexate and call him he can help . He does not have the buying power of Walmart but it won't be outrageous . ( Pure Pharmacuticals Houston Texas ) he could not understand the high price .


He can buy the chemicals and make the tablet . He said the injections are more expensive because of the machines required. On the Welchol he said only one company makes the chemical. Can't help.

Thanks Breedlove. DH was able to find the Methotrexate tablets for $40 for 3 months ("cash price") at a local independent pharmacy which is close to what the Canadian pharmacy charges and we can live with that cost. We have a compounding pharmacy we have used the past, we can look into also in the future. Thanks for your offer.

We could certainly afford $170 for this drug that DH desperately needs but my issue is the huge price increase from one quarter to the next--$14 to $175 and neither the pharmacist or the Part D insurance company could explain the increase.

 

[ShokWaveRider]

Yet another Tick in the box for Universal Healthcare, all the other countries mentioned have it, that is why their costs are so much cheaper. One stop shopping so to speak. If Medicare did the negotiating for it's members then it would achieve a similar goal. But it is farmed out to Part D Insurance companies, so there are no rules.

 

[harllee]

The ugliest part of the doughnut hole is you do not know when you hit it until it is too late.It is based on the total cost of the prescriptions, not your OOP.
It kicks in at $3820 and ends at $5100.
here is the ugly part:
Total drug cost- $3820, your OOP may only be $1000
You will have to pay another $4100 to get out of the doughnut hole.

OP here--We checked with DH's part D insurance company to see if he had gone in the donut hole and they said no. We asked why the huge increase in the cost of the Methotrexate and they could not explain it.

 

[Breedlove]

Harllee. Compounding seems to be helping us and I am glad you have found it cheaper . My guy explained that Metho is a trade name . For example my DW takes a Hormone ( Evamist ) . Now the company that makes Evamist does not own the chemicals . So he can sell her the same product Estradol for 12.00 a month from 90.00 a month. Just like buying from Canada .

 

[grasshopper]

Heck the nearest drug store for me is half a mile from Mexico. I have Aetna 'D" and it is still cheaper or free so I use CVS.

 

[Walt34]

...but a small part of me wonders if this will discourage R&D for some future potential blockbusters that are very expensive to develop.

I used to buy into that but given that drug companies spend on marketing over twice what they spend on drug development I don't think so anymore.

 

[Koolau]

I know it will be unpopular, but let me suggest the following: Buy drug stocks! IF (yeah, really, IF) the drug companies have the power I sense our members think they have to inflate prices as much as they want (at will), then why would you NOT buy their stock?

By the way, I've been hit hard by price increases and I have been just as angry about it. BUT, I think it's a bit more complicated than raising prices because they can. Oh, and I only buy drug stocks in my large-cross-section stock mutual funds.

Remember when the oil companies were "gauging"? Did you buy their stocks? If so, I hope it wasn't in the early 80's, mid 90's or just before 2008. Again, I am NOT defending ANYONE. Just sayin' - it may be a bit more complicated than it sounds. As always, YMMV.

 

[Running_Man]

OldShooter, very interesting thoughts. Prescription drugs are not like most consumer products. Supply and demand theories don't really apply. For someone like my DH, you can't just say I won't buy this drug, it costs too much. If he did not have Methotrexate (and Humira, that is a whole different story) DH's knees would swell so much he would not be able to walk. We are grateful for the drugs that help DH and we are willing to pay for them, I just can't understand the huge price increase. If the drug could be sold for $14 in 2018 why is the cost in 2019 $175 for the exact same thing?

Because in the meantime lawsuits have been allowed to proceed against Methotrexate and if you have potential for several thousand people receiving 2 million each for being prescribed without adequately being told risks and being able to prove you informed patients of the risk, it doesn't make much sense to sell it for $14.

 

[6miths]

Because in the meantime lawsuits have been allowed to proceed against Methotrexate and if you have potential for several thousand people receiving 2 million each for being prescribed without adequately being told risks and being able to prove you informed patients of the risk, it doesn't make much sense to sell it for $14.

Which lawsuits are you referring to? If a drug has a known side effect that is not disclosed to the patient by the treating physician then I imagine that the physician is going to be on the hook. It seems unlikely that a drug that has been in use since the 1940s has many 'unknown' side effects. If it were true that lawsuits were driving up the price then this would be an argument for consumers in the US bearing these costs as these suits are not very frequent in other countries.

 

[ckelly78z]

I was smart enough to ask my cardiologist about any possible price breaks/rebates/samples on my Eliquis prescription. He told me about a discount card that would limit the co-pay to $10 a month (rather than the $65 a month I was paying). I sure don't mind saving $55 a month with this card.

https://www.eliquis.bmscustomerconn...siteid=801&CopayGroupID=50776822&CopaycardID=

 

[DougJohnson]

Okay, if they were opposed to importing drugs from say, Bangladesh...

We are importing drugs from Bangladesh. https://en.wikipedia.org/wiki/Pharmaceutical_industry_in_Bangladesh

-- Doug

 

[Potstickers]

I was smart enough to ask my cardiologist about any possible price breaks/rebates/samples on my Eliquis prescription. He told me about a discount card that would limit the co-pay to $10 a month (rather than the $65 a month I was paying). I sure don't mind saving $55 a month with this card.

https://www.eliquis.bmscustomerconn...siteid=801&CopayGroupID=50776822&CopaycardID=

I use discount cards for two drugs -- but both cards (and all the others I've seen) warn that they can not be used once the patient is on Medicare, even if the Medicare drug plan won't be paying for the prescription. I suspect it has something to do with the Medicare fraud and abuse regulations, but it is definitely going to cause me a problem since one of the drugs is not approved on any Part D formulary.

 

[candrew]

A few days ago, DW & I made our quarterly run to Algodones, MX (3 hour drive). She has to take the Armor brand of Synthroid (generic stuff has nasty side effects for her). In network cost in our area for a 3 month supply $140.00. Identical Armor brand and dosage in Algodones, $40. She also needs a prescription topical for rosacea that she buys in Algodones (again, identical to the stuff she gets here) that saves her another $60. We do our best to make it a nice day trip, having a brunch of chilaquiles at La Parilla and a pit stop on the way home in Dateland for date shakes.

 

[Ronnieboy]

We get adulterated blood pressure medicines approved by the FDA from overseas sources, yet we are warned about the dangers of buying drugs from the Canadians. Go figure.

Exactly, we can't even guarantee that we are getting good medications from our own FDA. If you believed in a conspiracy, maybe the Chinese were intentionally contaminating the active ingredient to kill off the US population

OP here, Methotrexate is a generic drug. That is why DH was getting it for $4 per month from Walmart last year. For some reason the price has gone way up on the generic.

Walmart's $4 list was and is a loss leader, just to get you in the store. They were selling quite a few medications under cost and they have revamped their list a number of times moving some of the loss leaders off and jacked up their prices to make up the loss of other $4 generics.

$40 for a 90 day supply sounds reasonable. Not $175 though. A quick Costco search shows $97 for #100 tabs so stock up at $40.

I was taking Teveten for BP it went from 30.00 month to 158.00 . The pharmacy was absolutely NO help . I went my doctor and explained the jump . He said the Pharma . were trying to force me into a more common drug . Something about these drugs if they have been around a long time the patent expires and everyone and their brother will be making it . So the name brand mfg. wants to make their last buck. He changed my RX . Now I pay nothing. a common drug . Have you ever heard of compounding ??

A compounding pharmacy cannot legally make a drug that has a trade name and patent. The poster that says their compounding pharmacy is making Evamist is not technically making Evamist, they might be making a transdermal gel that is 0.1mg difference is strength than the Evamist (which is a spray) and that is how they get away with it.

Which lawsuits are you referring to? If a drug has a known side effect that is not disclosed to the patient by the treating physician then I imagine that the physician is going to be on the hook. It seems unlikely that a drug that has been in use since the 1940s has many 'unknown' side effects. If it were true that lawsuits were driving up the price then this would be an argument for consumers in the US bearing these costs as these suits are not very frequent in other countries.

A lawsuit is easy to start. A possible side effect of methotrexate is cancer, since it is a immuno-suppressant. Get a few people who have been taking it for a few years that have developed cancer and boom you have a lawsuit because they don't remember ever being told that it could cause cancer or they didn't read the warning that came with the prescription. So since I never thought I would get cancer and I did, I must sue the manufacturer.

 

[Quantum Sufficit]

In a word... Lawyers

 

[MarieIG]

I'd be talking to that pharmacist to see if there are any alternative drug or drugs to replace the meds that prices have gone out of sight on.

We went to my wife's Pain Clinic today, and she was informed that her main pain medicine (taken for 15+ years) is going to be changed in an effort to reduce her opioid intake by 30%. The order came from The State who has been auditing their patients' medical records. (This is not even the state we live in.) The anesthesiologist with a fellowship in pain management has no say so in the state's decision, and a bunch of bureaucrats are essentially making some of his medical decisions in patient care.

We chased around to 4 major pharmacies trying to find the drug, and no one even stocks the stuff. We eventually found it at a small, independent pharmacy and Medicare with a Supplement paid for it. If a drug is going to be prescribed, especially if it's so time sensitive, at least the pharmacies should be notified to begin stocking it.

Politics is such a number's game, and The State wants to say prescriptions of controlled substances are down "X"%, even if it causes pain and suffering by the chronically ill.

This is very sad. The abuse has negatively impacted patients who really need the pain relief.

 

[MarieIG]

Yes, I wonder that too.

Having our Fed Gov't dictate prices for drugs (another way of saying what "negotiated" prices will be.....) will insert politics into the resource allocation process. And that could be a good thing, or perhaps more like a good thing with potential unintended consequences.

An obvious positive would be some assurance that non-USA, gov't insurance customers would be paying a so-called "fair share." Since I doubt that the USA gov't agencies would want to explain why the price they negotiated is higher than that paid by other countries, I'd expect some price equalization.

An obvious downside is that there would likely be less incentive and resources for drug R and D. With over population being an oncoming problem here on planet earth, maybe this wouldn't be such a bad thing?

Until it's a child . . Until it's your loved one . . .

Seem to me it's a balancing act.

And the government is starting to look very hard at drug pricing. Hopefully there will be a positive outcome for patients.

 

[MRG]

This is very sad. The abuse has negatively impacted patients who really need the pain relief.

+1000

I'm currently experiencing the new guidelines to save help me from a demon I don't have. This is my 5th rodeo with a pinched nerve root and I know from experience what it's going to do. However some risk management director is going to decide how much medication I need, how cute.

I can't imagine we are going through this again. After 60 years a new "war on drugs". Who knew that making innocent people criminals would be a problem? Guess there will continue to be a very profitable street trade in unsafe drugs.