What is going on with prescription drug costs?

[harllee]

DH is on several drugs that he must take long term. He is on Medicare with Part D drug coverage. In the last few months the cost of some of his medications have increased drastically. For example, he take generic Methotrexate for his psoriatic arthritis. Last year the cost for a 90 day supply at Walmart was reasonable--$14. Recently he went to get his prescription filled at Walmart and the cost (even with his Part D) had increased from $14 to $175!!! We have called around, found a few places cheaper, around $150. Tried using Good Rx, most places don't take it, even with it still very expensive. Finally he tried a local independent pharmacy, and they said with his part D or Good RX the cost was over $100. I told the pharmacist I didn't understand why the price had gone up so much and then he offered a "cash" price of $40, so we got DH's refill for $40 for 3 months, more than we had paid last year but a lot better than $170. We are now looking into Canadian pharmacies recommended by his doctor for the next time he needs a refill.

Anyone else see drug costs skyrocket in the last few months? What is going on?

 

[cbo111]

In a word....Greed!

 

[ExFlyBoy5]

DH is on several drugs that he must take long term. He is on Medicare with Part D drug coverage. In the last few months the cost of some of his medications have increased drastically. For example, he take generic Methotrexate for his psoriatic arthritis. Last year the cost for a 90 day supply at Walmart was reasonable--$14. Recently he went to get his prescription filled at Walmart and the cost (even with his Part D) had increased from $14 to $175!!! We have called around, found a few places cheaper, around $150. Tried using Good Rx, most places don't take it, even with it still very expensive. Finally he tried a local independent pharmacy, and they said with his part D or Good RX the cost was over $100. I told the pharmacist I didn't understand why the price had gone up so much and then he offered a "cash" price of $40, so we got DH's refill for $40 for 3 months, more than we had paid last year but a lot better than $170. We are now looking into Canadian pharmacies recommended by his doctor for the next time he needs a refill.

Anyone else see drug costs skyrocket in the last few months? What is going on?

Is this available thorough a mail pharmacy? I know I can get my meds through the mail and they are a lot cheaper that way. Also, while my Dad was still around, I helped him with his Medicare stuff, including his Part D supplement through Humana and the mail order was significantly cheaper than getting them at any retail location.

 

[aja8888]

DH is on several drugs that he must take long term. He is on Medicare with Part D drug coverage. In the last few months the cost of some of his medications have increased drastically. For example, he take generic Methotrexate for his psoriatic arthritis. Last year the cost for a 90 day supply at Walmart was reasonable--$14. Recently he went to get his prescription filled at Walmart and the cost (even with his Part D) had increased from $14 to $175!!! We have called around, found a few places cheaper, around $150. Tried using Good Rx, most places don't take it, even with it still very expensive. Finally he tried a local independent pharmacy, and they said with his part D or Good RX the cost was over $100. I told the pharmacist I didn't understand why the price had gone up so much and then he offered a "cash" price of $40, so we got DH's refill for $40 for 3 months, more than we had paid last year but a lot better than $170. We are now looking into Canadian pharmacies recommended by his doctor for the next time he needs a refill.

Anyone else see drug costs skyrocket in the last few months? What is going on?

Did he hit the "donut hole"? When DW's prescriptions get to that level, we pay a bunch more until she gets to the other side. BTW, DW takes 13 prescriptions, some of which are several hundred dollars a month.

 

[harllee]

No DH has not yet hit the donut hole. We will look into mail order, but if we are going the mail order route we will probably go with the Canadian pharmacy suggested by his doctor, it is significantly cheaper.

 

[OldShooter]

... What is going on?

I think we are in the early maneuvering for a complex game.

The politicians are beginning to believe that their constituents are so upset about drug costs that the politicians' paymasters, the drug companies, are seeing their power being diminished.

The result of this will probably be some level of price regulation and/or negotiation -- things that don't happen now in the USA although it happens almost everywhere else in the world.

So, the drug companies would like to start negotiations from a higher base price, hence are trying to increase prices. But its a balancing act because the act of increasing prices further infuriates the politicians' constituents and thus makes it harder for the politicians to do their paymasters' bidding.

Eventually, at least some prices will be forced down. Which drugs, by how much? That's the battleground.

 

[Walt34]

The politicians are beginning to believe that their constituents are so upset about drug costs that the politicians' paymasters, the drug companies, are seeing their power being diminished.

The result of this will probably be some level of price regulation and/or negotiation -- things that don't happen now in the USA although it happens almost everywhere else in the world.

I suspect you're right. On TV today at the gym (the only place I watch TV anymore) there was an ad playing from some ostensibly "consumer" organization opposed to the importation into the U.S. of "inferior" and "unregulated" prescription drugs from that well-known hotbed of deadly and fake drugs, Canada. (Note to Canadians: If it isn't clear, I'm being sarcastic here.)

Okay, if they were opposed to importing drugs from say, Bangladesh, I could maybe buy it. But Canada? Last time I was there Canada seemed pretty civilized, and that was in the late 1960's. By all accounts that I've read they've managed to keep up with the rest of the world fairly well, and excelling in some cases. Like, for example, regulating the retail prices of prescription medicines.

Why would the drug companies band together to pay for expensive TV ads like that? The only reason I can think of is that they see their gravy train being threatened.

 

[harllee]

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?

 

[Walt34]

<snip>...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?

Greed, pure and simple.

To the best of my information, knowledge, and belief, nothing (except perhaps prescription drugs) has increased in price that much in one year.

 

[omni550]

Heard this on NPR the other day.

In Florida, Gov. Ron DeSantis signed a bill last week that, if federal authorities give it their go-ahead — still a very big if — would allow his state to import prescription drugs from Canada. That makes Florida the third state to pass such a law, joining Vermont and Colorado. More such legislative attempts are in the works.

https://www.npr.org/sections/health...-medicine-from-canada-but-how-would-that-work

omni

 

[Chuckanut]

We are now looking into Canadian pharmacies recommended by his doctor for the next time he needs a refill.

Anyone else see drug costs skyrocket in the last few months? What is going on?

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.

 

[CardsFan]

OP,
Not to let the drug companies off the hook, but if this is the first time this year you have refilled, is it possible that your Part D insurance company change it's coverage at the beginning of the year?

 

[zinger1457]

60 Minutes did a story recently about the collusion that is going on among many of the different generic drug manufacturers. They each control a specific area and agree among each other to raise the price on a specific drug to a certain level, there were emails and phone records showing what was going on. Quite the racket.

 

[Amethyst]

Echo, echo: Greeeeed

BCBS Basic coverage requires us to use generic drugs if they exist. Otherwise, we pay hundreds of dollars for a course of medication. And "exist" means just that. If local pharmacies are sold out of the generic - which actually happened last fall, when I needed a scopolamine patch for small-plane travel - BCBS will charge the higher price for the available non-generic drug. There wasn't time to seek out Canadian alternatives before leaving on our trip, so I paid the going rate ($150 for 3 patches). And got a nastygram from BCBS about "always use generics," into the bargain.

Now, imagine that was a drug one of us would have died if we couldn't get it in time.

 

[omni550]

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.

from the NPR article I posted above:

"Canada negotiates drug prices just like many other countries around the world," explains Rachel Sachs, a law professor at Washington University in St. Louis who studies prescription drug pricing. "In the U.S., we've constructed a system where pharmaceutical companies are able to charge far higher prices because there's no mechanism to push back — there's no way to say, 'We're not going to pay for that drug unless we get it at a better price.' "

And it's sort of unbelievable that Medicare and other large US institutions who spend big-bucks on prescriptions don't negotiate much lower prices.

omni

 

[Walt34]

And it's sort of unbelievable that Medicare and other large US institutions who spend big-bucks on prescriptions don't negotiate much lower prices.

omni

Would you believe that there is a federal law forbidding Medicare from negotiating prices on the drugs it pays for? Gee, wonder how that happened.

 

[Chuckanut]

Would you believe that there is a federal law forbidding Medicare from negotiating prices on the drugs it pays for? Gee, wonder how that happened.

I can't imagine how that would happen. What could possibly go wrong?

 

[brett]

We are moving toward Pharmacare in Canada. Similar to universal health insurance. The medical profession has been recommending this for years.

The pharma companies, patent and generics, are pulling their collective hair out and knashing their teeth over this. As are the insurance companies and pharmacies.T

Their PR campaigns will do doubt be filled with fear, uncertainty and doubt however there is too much public support for this. No use having medical coverage and not being able to afford the necessary prescription drugs.

 

[Breedlove]

Are there any Generics for Methotrexate ? Or a copy cat drug . I went through this on BP medicine. I sat down with my doctor and explained , he gave me another one and with my part D I pay zero. he explained they are taking drugs off the market and they want you to use a common drug ( high Production )
Also my DW was taking something called Eva Mist Once she retires over the counter it will be 90.00 a month . One of my doctors suggested we try the compounding pharmacy that sells me my Cialis . Here in Houston Compounding seems to be big and is accepted by the Doctors . Her Eva Mist without Insurance over the counter ( with doctor RX ) 12.00 monthly .

 

[harllee]

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.

 

[Souschef]

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.

 

[ownyourfuture]

Would you believe that there is a federal law forbidding Medicare from negotiating prices on the drugs it pays for? Gee, wonder how that happened.

I think I remember when that law went into effect. Was it sometime between 2000 & 2008 ?
I'd like to say more, & I'm guessing you would as well, but God forbid, that might involve politics, & we know how taboo that subject is here.

 

[Breedlove]

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 ??

 

[6miths]

Would you believe that there is a federal law forbidding Medicare from negotiating prices on the drugs it pays for? Gee, wonder how that happened.

It is pretty unbelievable. I read 'An American Sickness' by Dr. Elisabeth Rosenthal a couple of years ago so I did know this - and many other incredible things regarding how healthcare and drug reforms are stymied in America.

I've been thinking of starting a mail order drug service as a retirement side gig! And for the record, I'm glad you clarified regarding your statement on Canada.

 

[ziggy29]

We are moving toward Pharmacare in Canada. Similar to universal health insurance. The medical profession has been recommending this for years.

The pharma companies, patent and generics, are pulling their collective hair out and knashing their teeth over this. As are the insurance companies and pharmacies..

And here is the thing -- the more Canada and other countries do this, the more they will jack up the prices on US consumers, insurers and Medicare -- because they can, and that is the only way they can satisfy their investors.

When the USA joins the rest of the world in saying "enough is enough" about prescription drug prices, it will be interesting to see what happens. It will certainly help US consumers with existing medications, but a small part of me wonders if this will discourage R&D for some future potential blockbusters that are very expensive to develop.