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Outrage about Outrageous drug prices – and what to do about it

The outrage is building. Drug prices are nothing less than astounding. The American Academy of Family Physicians is just the latest group to join The Campaign for Sustainable Rx Pricing, a non-partisan coalition aiming lower drug prices in the U.S. From AARP to professional societies to insurance companies to Wal-Mart, the coalition is attempting, through legislative support, to slow the rapid growth of drug costs.

It’s Not Just Epi-Pen

Everyone has heard about the Epi-Pen and Narcan pricing scandals. How about these? New drug for eczema? $37,000/year. New formulation of 50-year-old doxycycline? $16 per dose vs $0.75. Colchicine, which has been used for over 100 years to treat acute gout, increased in price from $0.10 to $5.00 per tablet overnight.

On average, every man, woman, and child in the U.S. pays an average $858 per year on medications. It is not unusual – in fact, it’s the rule – for drug prices to rise at twice the rate of inflation.

It’s not enough to reassure ourselves that “insurance will cover it.” Some patients have a co-pay that varies based on the cost of the medicine. Others pay 100% of drug prices until they reach the yearly out-of-pocket limit, which is $7,150 in 2017.

Why the increase? It’s simple; manufacturers can charge whatever they want. The drug industry is unlike any other.

What can Clinicians do?

There’s more to prescribing than simply knowing indications and side effects. For most illnesses there are several options. An easy way to decide on the best medication is to think STEPS:

  • Safety: Is one choice less likely to cause major adverse effects?

  • Tolerability: Which one causes fewer non-threatening but still bothersome problems?

  • Effectiveness: Is there a clear benefit advantage of one treatment over another?

  • Price: What is the cost, both in terms of out-of-pocket and monitoring costs?

  • Simplicity: Is one choice easier to take or use?

Here are some practical ways to keep drug prices low:

  • Know the options that exist for common illnesses. Cholesterol can be lowered at a yearly cost of $40 generic lovastatin or $3,000 Livalo (or, truly outrageous, $14,600 for Praluent).

  • Know the cost of your common scripts. GoodRx is a cost web site.

  • Take a walk through a pharmacy and familiarize yourself with nonprescription items. My optometrist prescribed Patanol ophthalmic (an eye-watering $195 a bottle) for my seasonal allergy; I used OTC ketotifen ($8) instead. Patients can feel the burn with Qutenza patches ($900 each) or OTC capsaicin cream ($10).

  • Start with low-cost generics. Local pharmacies typically have generic pricing programs as low as $4 for a month of chronic therapy or a full course of acute treatment.

  • Avoid samples, which are “gateway” drugs to expensive treatments.

  • Resist the lure of the fashionable and the new. These will always be more expensive though frequently without additional benefit.

  • Clean out the trinkets. Pens, pads, tchotchkes and other reminders, which usually litter a typical office, slip drug names under your mind’s radar and unconsciously remind you to prescribe them. Buy your own pens.

What Patients Can Do

We know from studies that patient requests drive clinician prescribing. You can help your doctor by asking:

  • Do I really need to take this medication?

  • Can I do something else, instead of taking a medication?

  • Is there a less expensive option?

  • Is there a generic version available?

  • Can I take a non-prescription product instead?

You can also shop around. Drug prices vary by pharmacy (see Physicians sometimes vary in their price sensitivity. RxAssist and NeedyMeds are two organizations that can assist with finding ways to afford must-have expensive medications.

Drug Prices Should not be Harmful to Health

Drug prices have risen to be such a factor in providing health care that patients frequently must decide whether to buy the medicines they need to live or paying for their daily needs. That’s not a choice they should have to make. While groups try to take on pharma through legislation, clinicians and their patients can also work together to control the punishing costs of medication.

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