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Sticker Shock At Your Pharmacy

It makes little difference if you’re a Democrat or Republican. Every year Big Pharma buys off Washington to the tune of $310 million plus change. Moreover, virtually each Big Pharma company separately makes its own smaller but still significant PAC (political action committee) contribution.

Your sticker shock at Walgreen’s or CVS starts with these political contributions, which literally reimburse those in Washington for voting against regulations that might make drugs more affordable.

President Bush accepted Big Pharma’s self-interested wisdom when he blocked discount drug purchasing from Canada. During his eight years, President Obama, having received Big Pharma support when he was trying to get the Affordable Care Act passed, simply ignored drug price issues and left the Canada ban in place. And during the recent presidential election, Hillary Clinton made all sorts of pre-election promises about reining in prices, but as the single largest individual recipient of Big Pharma’s contributions, I personally didn’t expect much.

I was actually hopeful that Trump might do something positive in this regard after his election. Referring to drug pricing, he’d boomed “Big Pharma is getting away with murder,” but by the end of January he totally caved to them, backing off any price regulation and agreeing to lower their corporate taxes as well.

The worst of the worst of Big Pharma-owned politicians is former congressman Billy Tauzin, who, depending on the need of the moment, was sometimes a Democrat and sometimes a Republican. He was the major architect of the prescription benefit program of Medicare (Part D). Despite protests from both the AMA and AARP that Medicare D was a total sellout to Big Pharma, he got it through.

Tauzin received $11.6 million in 2010 from Big Pharma to shepherd Medicare D into law, which included a rule actually forbidding the government from negotiating any drug pricing with Big Pharma.

For this plum, Congressman Tauzin resigned from congress in 2004 and in 2005 became head of Big Pharma’s lobbying group, salaried at $2 million a year.

Always keep in mind that sticker shock is the product of your federal government at work.

The hard drug facts
For the rest of this Health Tip, I’m going to give you some examples of this mess. Next week, I’ll walk through some steps to reduce your drug costs and give you some ideas on how to get access to drugs your insurance company has denied.

  1. New drugs are astonishingly overpriced.

As new drugs hit the market, their price tags cause us to shake our heads in disbelief. Seven recently approved drugs cost more than $100,000 per year and while Big Pharma maintains these prices are necessary to support research and development, many drugs are actually developed at medical schools and small drug companies overseas.

The primary purchaser for many of these drugs is Medicare D, which, you may remember, cannot be negotiated.

As an example of the new trend in pricing, a eight-week treatment for hepatitis C with the drug Epclusa (by Gilead Science) is $75,000. Most people with hep C have no symptoms and will die of an unrelated disease, but the drug rep from Gilead I saw last week told me I should test everyone over 40, implying that every Baby Boomer spent her wild and frivolous youth sharing an infected needle with every other Baby Boomer. To see who’s actually at risk, click through to the CDC statistics.

  1. New drugs are often not new at all.

Two approaches make it much cheaper to market and price “new” drugs. Either market old generics that have been renamed or pass off as a new drug two cheap generics that have been combined into one tablet.

You may have heard the term orphan drug. These were drugs developed for diseases so obscure there simply weren’t enough patients to make the drug worthwhile to market. But companies have been playing fast and loose with the FDA about orphan drugs, identifying as “orphan” some inexpensive generics that doctors don’t prescribe anymore (simply because better drugs have replaced it). Investigators looking into this have been shocked to discover that hundreds of low-priced generics have slid through as orphan drugs, rebranded and insanely priced. This is a very disturbing trend. Patients discover that a generic med they’ve been taking for years, one that’s covered by their insurance, is now carrying a new name and an utterly unaffordable 300% price increase, which their insurer quickly denies.

  1. Big Pharma companies are allowed to increase prices at will, free of any regulation.

The most famous of these, Daraprim, a 62-year-old generic anti-parasite drug, went from $13.50 to $750 a pill (I wrote a Health Tip about it here). Others include an old tuberculosis drug, from $500 to $13,500 for 30 capsules.

Understand that any and every drug, branded or generic, is susceptible to a random price increase depending on the whim of the manufacturer. The only ones to stop this nonsense are the prescribing physicians (who are virtually never told of a price increase unless you tell them), who can refuse to prescribe it, or an insurer who denies coverage.

  1. When they control a brand-name drug about to go generic, Big Pharma companies are allowed to pay whoever’s producing the generic to hold off and delay manufacturing it.

This is called pay to delay. Let’s say a drug is about to go generic. Seeing its profits go into a tailspin, the Big Pharma manufacturer of this drug is allowed to pay off the companies that applied to the FDA for generic rights to hold off releasing the generic for an agreed period of time. In addition, pharma companies will go to any length to keep a profitable drug from going generic. For example, Oxycontin, Premarin, and Adderall XR have patented release systems that can never go generic.

What this means is that even with health insurance, you might suddenly experience chest pain and palpitations when your pharmacist tells you how much your prescription will cost. If you don’t have good coverage, you might just leave the drugstore empty-handed altogether, wondering if you really needed the meds in the first place.

Naturally, if you’re at a Walgreen’s (“at the corner of happy and healthy”) you could become so frustrated that you ponder buying a pack of Marlboro Lights, thinking, “Well, if I can’t get my meds, I might as well smoke.”

Don’t do it!

Next week, I’ll share some ways to beat this disgusting travesty and get just about everything you need without emptying your wallet or lighting up that cigarette.

Be well,
David Edelberg, MD

Leave a Comment

  1. John Cox says:

    Readable, funny, informative, and generally irresistible. Thanks!

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