Drug Costs... Why?

[Rianne]

True story, happened the day before yesterday. I got a Meijer (Midwest discount grocery chain) coupon for $20 off my groceries if I transferred a prescription to their pharmacy. I thought wow, of course I will. I transferred a prescription for Gabapenton, a nerve and muscle med my dog takes because he's old and Vet prescribed it for him. People take this med too.

I go to pick up the prescription at Meijer and it's $97.46 for a 30 day supply. I thought that's a lot, but could not remember what the Vet charged me, so I bought it, without insurance or discount. I went home and looked at the receipt from the Vet, same medicine, same dosage, for 1 month...Vet charged $25.67. I was incensed. So I call the local CVS and asked what they charge for Gabapenton, 30 day supply, same dosage with no insurance or discount, they charge $50.23. A very bright light went on in my head.

I have health insurance, my dog does not, but where we buy our meds makes a huge difference. I realize health insurance covers a lot of the cost so we don't pay too much attention as long as the drug is affordable through insurance. This is outrageous! I called Meijer and told them they were charging $75.00 more for a med than the local Veterinarian
The response, "sorry" it's where you buy the meds that makes the difference. They have no control what they charge the customer. Can anyone explain that?

 

[samclem]

The response, "sorry" it's where you buy the meds that makes the difference. They have no control what they charge the customer. Can anyone explain that?

I think you've already explained why there's a difference in the price of the drug:

I have health insurance, my dog does not, but where we buy our meds makes a huge difference. I realize health insurance covers a lot of the cost so we don't pay too much attention as long as the drug is affordable through insurance.

I'm sure there's also some additional overhead for drugs intended for humans (gotta pay for that pharmacist's degree, for all those brick an mortar pharmacies on every street corner, etc). But still. When my pooch has needed an X-ray (happens frequently--the dog eats anything), they do it right in the vet's office and I pay out of pocket. I grumble about the price, but I'll bet it's much less than the insurance company would pay to have a picture taken of my gut. And if I paid the cash, walk-up price, it would be higher still.

 

[euro]

True story, happened the day before yesterday. I got a Meijer (Midwest discount grocery chain) coupon for $20 off my groceries if I transferred a prescription to their pharmacy. I thought wow, of course I will. I transferred a prescription for Gabapenton, a nerve and muscle med my dog takes because he's old and Vet prescribed it for him. People take this med too.

I go to pick up the prescription at Meijer and it's $97.46 for a 30 day supply. I thought that's a lot, but could not remember what the Vet charged me, so I bought it, without insurance or discount. I went home and looked at the receipt from the Vet, same medicine, same dosage, for 1 month...Vet charged $25.67. I was incensed. So I call the local CVS and asked what they charge for Gabapenton, 30 day supply, same dosage with no insurance or discount, they charge $50.23. A very bright light went on in my head.

I have health insurance, my dog does not, but where we buy our meds makes a huge difference. I realize health insurance covers a lot of the cost so we don't pay too much attention as long as the drug is affordable through insurance. This is outrageous! I called Meijer and told them they were charging $75.00 more for a med than the local Veterinarian
The response, "sorry" it's where you buy the meds that makes the difference. They have no control what they charge the customer. Can anyone explain that?

I understand that you are upset about it (I would be too) but this is no different from any other item that you buy at that local grocery. Say, a gallon of milk may cost $3.80 at Meijer. It may cost $2:20 at Costco, or $2:50 at the Walmart Supercenter, and it may cost $4.75 at the convenience store around the corner. You compare prices and shop the best deal. Same goes for drugs (prescription or otherwise). You make a very good point in your post:"because people tend to have drug coverage", they tend not to KNOW (and often not to CARE) about the pricing situation, but that doesn't mean it doesn't exist.

 

[bmcgonig]

I have just spent three hours trying to understand the What? and Why? of drug costs, starting with a personal situation.

A year ago, I, along with 2.6 million other Americans, have been diagnosed with Atrial Fibrillation (AFIB). The most commonly prescribed drug to lower risk of heart attack, or stroke, is Xarelto. Until today, the cost of thirty 20mg pills has been $36.00 with my Medicare D Supplement plan. Without the plan, the cost full U.S. retail price would have been $102.

Today, when renewing my 30 day supply, the Plan D price is $115, and the full retail price is $420...

Simplifying... my cost for a year now $1398.00 up from $432.00
w/o a drug plan, Full price 1 year $5100.00
.
This change for me occurred between August 15 and July15, this year.
........................................................................................

Because my risk factor is low on the CHAD2 Score, I'll go back to .81mg aspirin, or no drugs at all. (risk factor goes from 11% to 7% w/Xarelto).

I'm not concerned but I wonder how many of the other nearly 3 million AFIB patients will die because they can't afford the expense. The drug companies usually offer lower costs for those who can't afford the drug, but when going to the sites to check, find that the "affordability factors" don't qualify for that lower price.

It's easy to pass this off as "They do, because they can" but consider that this is just one drug, out of thousands of patent drugs which have protection against competition, but no limitations on price. Egregious because Pharmaceuticals often spend more money protecting their patents than they do in developing the new drug.

Wikipedia has what I consider to be a particularly good and well researched article about the subject here:
https://en.wikipedia.org/wiki/Generic_drug

it's about generics, but explains patent drugs in detail.

Don't know much about the price but I've read this a lot. Aspirin a bad idea for AFib. Why risk the worst possible outcome even if your CHADS VASc is low?

http://www.medicalnewstoday.com/articles/317459.php



"In both the general and medical communities, aspirin therapy is perceived to reduce risks, it's easy to prescribe, and it's available worldwide over-the-counter. There's always been little evidence to support its use for stroke prevention in AF patients. This study continues to show that aspirin has little to no benefit for stroke prevention in AF patients and when used in low-risk patients it significantly increases a patient's bleeding risk."

 

[imoldernu]

Don't know much about the price but I've read this a lot. Aspirin a bad idea for AFib. Why risk the worst possible outcome even if your CHADS VASc is low?

Aspirin not an effective treatment for atrial fibrillation, study suggests



"In both the general and medical communities, aspirin therapy is perceived to reduce risks, it's easy to prescribe, and it's available worldwide over-the-counter. There's always been little evidence to support its use for stroke prevention in AF patients. This study continues to show that aspirin has little to no benefit for stroke prevention in AF patients and when used in low-risk patients it significantly increases a patient's bleeding risk."

Yeah.... agreed, but... this brings up what could be the subject of another thread.... "Medication... Who do you believe?"

For we poor mortals, and the internet, it's possible to find information to back every fact, opinion, and theory. for every study that produces "Proof A", there is another study that proves "Proof B". Even on NIH, you'll find studies that are antithetical or nuanced.

Here's a site devoted to AFIB, that suggests aspirin for a 1 score.

http://www.stopafib.org/newsitem.cfm/NEWSID/220?REFCODE=GooglePPC&Q=chad2%20score

can't change being over age 75...

 

[iloveyoga]

[-]You[/-] They have to pay for all that CONTANT TV Advertising somehow.... Most other countries do not allow drug advertising and thus their drug prices are lot more reasonable.

The drug ads are terrible and they run so many times during the day!

 

[6miths]

Just finished 'An American Sickness' by Dr Elisabeth Rosenthal. Gives many explanations for why costs are inflated in the system including drugs. I was a skeptic and a cynic prior to reading this and now I am pretty much just depressed.

 

[bmcgonig]

Yeah.... agreed, but... this brings up what could be the subject of another thread.... "Medication... Who do you believe?"

For we poor mortals, and the internet, it's possible to find information to back every fact, opinion, and theory. for every study that produces "Proof A", there is another study that proves "Proof B". Even on NIH, you'll find studies that are antithetical or nuanced.

Here's a site devoted to AFIB, that suggests aspirin for a 1 score.

http://www.stopafib.org/newsitem.cfm/NEWSID/220?REFCODE=GooglePPC&Q=chad2 score

can't change being over age 75...

I agree with you. But that article was written in 2009. And the aspirin studies we from 1991 I believe. The studies since then have negated that advice from what I've read. I have AFib as well but CHADS of 0 so I'm just monitoring the research.

Same website, later date

"I want to emphasize that that’s not just my opinion — the Japanese have taken it out of their guidelines, the European Society of Cardiology is about to remove it from their guidelines, the recent American College of Chest Physicians Guidelines have demoted aspirin so that even with a CHADS2*[score of] 1 they don’t recommend aspirin, and the same with the Canadians"


http://www.stopafib.org/newsitem.cf...ive-for-atrial-fibrillation-stroke-prevention

 

[imoldernu]

I agree with you. But that article was written in 2009. And the aspirin studies we from 1991 I believe. The studies since then have negated that advice from what I've read. I have AFib as well but CHADS of 0 so I'm just monitoring the research.

Same website, later date

"I want to emphasize that that’s not just my opinion — the Japanese have taken it out of their guidelines, the European Society of Cardiology is about to remove it from their guidelines, the recent American College of Chest Physicians Guidelines have demoted aspirin so that even with a CHADS2*[score of] 1 they don’t recommend aspirin, and the same with the Canadians"


Why Aspirin Should Not Be Used for Atrial Fibrillation Stroke Prevention — Video Interview with Dr. Albert Waldo

And... not to disagree, but to go back to the premise that much of medicine is in a state of flux..with older theories being reviewed and changed, in the part of science that continually digs deeper to the point where larger and larger studies actually confirm or refute what has been inferred. Almost all of the studies concerning the role of aspirin in AFIB end with the statement that the "results suggest" on theory or another. A current search of the two words "afib" and "aspirin" will bring up as many as fifty websites... many with very recent studies that are underway... and at least ten, since August 2017... that outline new or ongoing studies that will not be completed for years. Also... that the AFIB being discussed is for patients who have had ablation, or have already had a stroke.

I am replying, not to defend a point of view, but to suggest that the many breakthroughs in disease treatment, which are usually accompanied by the launch of new drugs (Patent Guarantees for the Pharmaceutical Companies),
are often based on data that has been approved arbitrarily. Thus the almost infinite list of "side effects" that consume the majority of time in the promotion of new drugs.

The recent quantum leap in lawsuits over failed drugs, or those with unexpected side effects, has erected a high wall of warnings and disclaimers to protect the purveyors of new "breakthroughs" from lawsuits. Unfortunately, the patient with no other options has to accept the risks with no recourse. "Fast Track" drug research provides high profits for drug companies, with ever decreasing government requirements for extended studies.

"Use at your own risk" may eventually replace the disclaimer warnings that print out at your local pharmacy.

Definitely a work in progress.

 

[Scuba]

I'm working on ramping up my spending! My heirs will get plenty either way. I bought my first Dyson vacuum recently, definitely not a particularly frugal purchase, but it hardly put a dent in my excess. Got to work harder at this (fairly enjoyable!) task. Any suggestion not related to travel or vehicles are quite welcome.

More frequent dining out? I love the food in New Orleans!

 

[Fermion]

More frequent dining out? I love the food in New Orleans!

Indeed.

 

[W2R]

More frequent dining out? I love the food in New Orleans!

I do, too! We eat lunch out every day. I guess we could go to the more expensive tourist type restaurants, but we each pay for our own lunch, and F wants to keep his costs down right now. Besides, the great New Orleans food in our neighborhood mom-n-pop restaurants is surprisingly cheap and nutritious. Sometimes I *do* order the most expensive thing on the menu, if it is not too fattening, just because I can. But more often we share.

Indeed.

I love beignets and café au lait! But my waistline doesn't.... Haven't had any in a long time, even though we live very close to Morning Call. But in honor of your suggestion, I changed my avatar.

 

[Alan]

Yeah.... agreed, but... this brings up what could be the subject of another thread.... "Medication... Who do you believe?"

For we poor mortals, and the internet, it's possible to find information to back every fact, opinion, and theory. for every study that produces "Proof A", there is another study that proves "Proof B". Even on NIH, you'll find studies that are antithetical or nuanced.

Here's a site devoted to AFIB, that suggests aspirin for a 1 score.

Study finds new predictors of stroke risk in those with atrial fibrillation (AF)

can't change being over age 75...

My cardiologist in Texas had no problem in me taking an aspirin a day for stroke risk (I have A-Fib as well) but the cardiologist here told me that the bleeding risk wasn't worth it. The NHS follows the N.I.C.E. recommendations so you pays your money and takes your choice.

https://www.nice.org.uk/guidance/cg180/chapter/1-Recommendations#diagnosis-and-assessment

Antiplatelets

1.5.15 Do not offer aspirin monotherapy solely for stroke prevention to people with atrial fibrillation. [new 2014]

 

[Walt34]

My cardiologist in Texas had no problem in me taking an aspirin a day for stroke risk (I have A-Fib as well) but the cardiologist here told me that the bleeding risk wasn't worth it. The NHS follows the N.I.C.E. recommendations so you pays your money and takes your choice.

I've also been following this topic with interest. While I no longer have A-Fib (the cardiac ablation seems to have worked) I'm still taking an 81mg aspirin daily because I have two overlapping stents in a heart artery.

Sigh. Decisions, decisions....

 

[Rianne]

NSAIDS, which include aspirin are bad for the kidneys if used often. Kidney.org states 30M people have kidney disease and do not know it. There are no symptoms, you can only tell with blood test.

 

[bmcgonig]

I've also been following this topic with interest. While I no longer have A-Fib (the cardiac ablation seems to have worked) I'm still taking an 81mg aspirin daily because I have two overlapping stents in a heart artery.

Sigh. Decisions, decisions....

And even making the decision not to take anticoagulants after a "successful" ablation is controversial. Some wonder that you might still have AFib but that it is unnoticed or that it happens at night when you wouldn't notice it anyway.

When it comes time for me to decide, I think I'll have to err on the side of taking anticoagulants. As one cardiologist I read said: most patients that have bleeding problems leave the hospital the same day. No stroke patients do...

 

[Alan]

I've also been following this topic with interest. While I no longer have A-Fib (the cardiac ablation seems to have worked) I'm still taking an 81mg aspirin daily because I have two overlapping stents in a heart artery.

Sigh. Decisions, decisions....

As the NICE guidelines say, and my doctor, taking aspirin for other reasons such as your other heart condition is almost certainly worth the risk of intestinal bleeding. I think these risk factors can be pretty marginal decisions. In my case my Chad2 score is 0 so no anti coagulants are being prescribed at present. I'm sure that issue will be re-visited when I pass age 65 or develop other conditions.

I had another 24hr heart monitor test a week ago and, unlike the 48hr one I had in Texas in 2015, it was not normal so I'm going in for another echocardiogram in 4 days time. ( the Echo in 2015 was also clear but things change).

So pleased we managed 6 years of extensive traveling when we retired. Our future looks more like lots of shorter vacations that can fit in or be easily canceled when health issues arise.

 

[samclem]

So pleased we managed 6 years of extensive traveling when we retired. Our future looks more like lots of shorter vacations that can fit in or be easily canceled when health issues arise.

A great way of looking at things. I hope you get good news on the echocardiogram.

 

[Alan]

A great way of looking at things. I hope you get good news on the echocardiogram.

Thanks, hopefully this will be just a few bumps in the road. Time for bed now in a time zone far, far away.

 

[sengsational]

You're lucky your doctor prescribed Xarelto. What if your prescription was for Angiomax? It's a quarter million for a 30 day supply.

 

[Scuba]

I do, too! We eat lunch out every day. I guess we could go to the more expensive tourist type restaurants, but we each pay for our own lunch, and F wants to keep his costs down right now. Besides, the great New Orleans food in our neighborhood mom-n-pop restaurants is surprisingly cheap and nutritious. Sometimes I *do* order the most expensive thing on the menu, if it is not too fattening, just because I can. But more often we share.
I love beignets and café au lait! But my waistline doesn't.... Haven't had any in a long time, even though we live very close to Morning Call. But in honor of your suggestion, I changed my avatar.

Love your new avatar! Have you been to Upperline? That and Commander's Palace are my two favorite splurges in N'Awlins. Would you mind sharing your favorite local places? We go there every few years and would love to learn more about local places.

 

[bmcgonig]

As the NICE guidelines say, and my doctor, taking aspirin for other reasons such as your other heart condition is almost certainly worth the risk of intestinal bleeding. I think these risk factors can be pretty marginal decisions. In my case my Chad2 score is 0 so no anti coagulants are being prescribed at present. I'm sure that issue will be re-visited when I pass age 65 or develop other conditions.

I had another 24hr heart monitor test a week ago and, unlike the 48hr one I had in Texas in 2015, it was not normal so I'm going in for another echocardiogram in 4 days time. ( the Echo in 2015 was also clear but things change).

So pleased we managed 6 years of extensive traveling when we retired. Our future looks more like lots of shorter vacations that can fit in or be easily canceled when health issues arise.

Good luck Alan.

 

[GTFan]

Indeed.

Mmm... beignets at Cafe du Monde, a must-do for any visit to NOLA. You're going to be down in the Quarter anyway.

 

[Alan]

Good luck Alan.

Cheers, I'm expecting/hoping for a good result.