For Part 3 in this series, click here.
I know you’re all tired of the word collusion and especially the notion of government collusion, but let’s face facts. If there’s any single part of our egregiously expensive healthcare system in which the US federal government has given carte blanche to a single industry to rob its citizens, it’s pharmaceuticals.
Ever wonder why Viagra is $70 a pill at Walgreens, but in Toronto it’s $10 for the brand-name version and $4 for the generic (which is not even available in the US)? Because the entire system is protected and encouraged by the Feds. From the very first research and development of a drug until you’re handed the bottle by your pharmacist, the pharmaceutical industry is designed to enrich everyone except you. This includes the Big Pharma manufacturer, your health insurer, the pharmacy benefit manager (Allscripts and Caremark), and the drugstore chains.
Does your physician make money in this system? Yes, when the physician is involved in administering the drug, like oncologists giving chemotherapy. The list of physician-administered drugs is pretty substantial. Does knowing that they’ll make money administering a medication affect doctors’ clinical decision making? You decide.
You can learn more about prescription prices in this very interesting wiki article on prescription drug pricing. For example, that when a pharmacy benefit manager says it negotiates drug prices with a Big Pharma company, the money saved goes to the insurer, not to you. Or that when Medicare D, covering prescription drugs, went into effect, it was actually written into law that the government, acting as a pharmacy benefit manager, was not permitted to negotiate better prices with a Big Pharma company.
This is the exact opposite of how prices are set in Canada and other single-payer countries, where the government negotiates with the Big Pharma companies to achieve the best price. If the government senses something unsavory about the price being offered, it simply doesn’t put the drug on its formulary.
For example, you could be prescribed the antidepressant Wellbutrin XL as Forfivo XL (bupropion 450 mg) and pay $430 for 30 tablets or you could ask for two separate generic prescriptions, bupropion XL 300 mg + bupropion XL 150 mg and pay $35. Forfivo is—quite sensibly–not on the Canadian formulary.
This is your challenge
The problem faced by you as patient-consumer is that most physicians use only two toolboxes when treating illness: a prescription pad and the operating room. I’ve already shared the fact that experts believe at least half of surgical procedures are unnecessary. My guesstimate is that at least 75% of prescription drugs are prescribed inappropriately.
I’ve written in previous Health Tips about the horrifying statistic that 15% of women over 60 are taking ten or more prescription drugs. One woman was on 13 medications from three different physicians, most prescribed to treat side effects induced by the other drugs.
Of course, you yourself have to take some responsibility here. If you look at any list of widely prescribed drugs, the majority treat either the results of unhealthy lifestyles and environments (diabetes, GERD, high cholesterol, asthma) or the reluctance on the part of both patient and physician to consider alternative therapies instead of reaching first for immune modulators like Humira (side effect: neuropathies) or pain meds like Lyrica (side effect weight gain).
If you remember, this series began with the title “The Best Piece of Financial Advice You’ll Ever Receive: Stay Healthy” and certainly that phrase applies when it comes to prescription drugs. When you reflect on the fact that correctly taken prescription drugs are the fourth leading cause of death you might, when you’re given a prescription, put up your hand and say, “Uh, just a second.” Don’t say no reflexively because you might really need the meds, but ask if your doctor might consider alternatives to a drug-based fix.
Ideas on proposing alternatives to medication:
- Let me get this weight off.
- Let me make some lifestyle changes.
- I’d like to see my chiropractor/acupuncturist/nutritionist first.
Saving money on drugs
If you really, seriously, need the medication, here are some steps you can take to save some dollars.
1–Ask, “Does this drug come in a generic form?” If it does, the price will be substantially lower.
2–If your doctor wants you to take a brand-name drug (almost always expensive), ask “Is this one really better than what’s available generically?” Most new drugs are knock-offs of generics and are not–repeat not–proven superior. In fact, Big Pharma is not required to test a new drug against an available generic to win FDA approval. Even if the test (called a head-to-head test) shows the old generic superior to the new model, the FDA can still okay it.
3–Whether generic or brand-name, check the actual price of the drug at www.goodrx.com. This is an
extraordinarily useful site where you’ll discover all sorts of fascinating things about drug pricing. For example, the same generic can cost up to five times more at one pharmacy chain than it does at another. Or your co-pay for a drug can be much higher than if you simply bypass insurance altogether and pay cash out of your pocket.
4–If there’s no generic available, make sure the brand-name drug is in your insurer’s formulary. Otherwise, you might get socked with a co-pay that could be 50% of the drug’s retail price. It’s not rude to ask your doctor or your pharmacist the following: Is there a similar drug that my insurance does cover? Remember, though, that they may not know and as always it’s best if you do your own homework.
5–If you’re simply stuck with an expensive brand-name drug that your insurance barely covers, check the price at a Canadian pharmacy. Every year more than ten million prescriptions arrive from outside Canada despite a US federal law (written with the help of Big Pharma) banning this. You can check the price here at Universal Drugstore and decide if you want a brand-name or a generic. You simply open an account and fax or mail your doctor’s prescription.
6–If you’re naive enough to say, “I know it’s an expensive drug but my insurance picks it up,” don’t be surprised when you get word that both your insurance premium and deductible have skyrocketed. Somebody has to pay Big Pharma, and in the end, it’s always you.
David Edelberg, MD