THE DOCTOR IS IN-There are two things that are clear about the cost of medications in our nation: First, the cost of prescription medications are zooming skyward in a trajectory that threatens both the health and economy of our nation.
Second, there is a lack of empowered political or medical leaders willing to tackle this issue on behalf the ordinary American citizen, and everyone and everything you thought were on your side ... isn't.
My life as a physician, father, husband and citizen activist (like so many of the rest of us) is a series of compromises and balances that respect the needs of both businesses and consumers, of both health plans and of patients, and of the need to allow for new, innovative medications while encouraging cheap access to older and time-tested treatments.
New medications require hundreds of millions to billions to develop, monitor and study, and are understandably expensive--but there are limitations, of course. Cost-benefit ratios are regularly confronted by health plans that (without being an apologist for them) are not going to embrace mega-expensive medications unless medical necessity and cost-effectiveness can be proven with literature support and scientific evidence.
However, the GREATEST threat to the cost of medications is not the new and innovative, but the older and what should be cheaper medications that have been around longer than many of you reading this now.
PROBLEM #1: Generic doxycycline, topical steroids and topical antibiotics for acne, eczema and psoriasis (in existence for decades) zooming up to $200 for a month's supply? Unless the generic manufacturers are sprinkling gold dust in their products, this is prima facie ridiculous--so don't be surprised when the medications that once cost $15-25 are no longer affordable...and your health plan will force you onto another medication.
(Not trying to be an apologist for the health plans, but do you really want your premiums to go up? Do you want your health plans to confront overcharging manufacturers or not?)
PROBLEM #2: Why are generics so expensive? Well, lots of reasons--not the least being that a generic can sell for 85-90% of a brand name medication, when the law should be rewritten to lower that cost to 50% or even less. Furthermore, if legal or other contrived issues create a manipulated shortage of supply of a given generic medication, then the costs go inappropriately up.
PROBLEM #3: Why don't health plans fight and advocate for lower medication costs, and articulate their case better? In the past, they managed to get expensive Claritin and Allegra and other nonsedating antihistamines over the counter, but they've dropped the ball. Perhaps they should be allowed to buy out certain industrial plants and flood the market with cheap medications ... or perhaps the U.S. should start implementing price controls like we see in Canada and Europe.
(And if price controls make you accuse me of being a socialist, then fine. I always thought I leaned conservative, politically and economically, but artificial price manipulation at the expense of Americans' health and quality of life is untenable and violently immoral.)
PROBLEM #4: Your neighborhood pharmacist is NOT always your friend. Many of the big name pharmacy chains have inherent conflicts of interest with respect to generic substitutions (which, as aforementioned, aren't always cheap), and their personnel get graded and paid differently based on their profile of generic to brand prescribing.
(So here's a hint: more often than not, if you want a true story on coverage of any prescription which is brand-name and not generic, go to Costco. Wal-Mart is another location to consider--but make sure that any special coupon or rebate offer that has a confirmatory phone number for the pharmacist to call is, in fact, called before your pharmacist or pharmacy tech throws out an ungodly figure that has nothing to do with reality, and everything to do with intimidating you from getting what your doctor prescribed you.)
PROBLEM #5: Your doctor and other medical provider isn't always your friend. In all fairness, I need to tell you that my medical group also grades my performance with respect to cost-effective (generic vs. brand) medication, and my own score is as pleasing to them as it gets--top-notch, so I clearly write a lot of generics.
That said, I am both appalled at the cost of some of these generics, and know that some generics aren't as good as branded medications in certain cases--so I will fight for my patients whenever it's medically necessary and appropriate to do so.
Hence my greatest critique when I brought up the costs of certain medications that weren't so cost-effective at the annual meeting of the American Academy of Dermatology (for which I sadly had to leave early to provide coverage for my patients while my colleagues attend the rest of the meeting):
I was told that market forces are what they are, and that we can't do much about it.
That generic answer is as inappropriate as the medical profession's past avoidance of the subject of rising health care costs, and which led to an Affordable Care Act that is anything BUT affordable. Right now, the medical community is screaming about fixing the "doc fix" in how Medicare and other plans reimburse doctors for their services...but says nothing when sky-high medication and other costs plague individual consumers.
(And perhaps the medical community isn't connecting the dots between the rising costs of medications and the lowering reimbursement rates for their services in a Medicare budget that is trying to remain balanced?)
The medical community DOES have the ability to decry the high costs of generics, and DOES have the ability to demand innovative ways to reduce medication and other costs of health care that are eating up the wallets and both physical and mental health of Americans. Certain health care costs are unavoidable and are even cost-effective...but some are just plain predatory.
And, as so many of us pointed out years ago, if the medical community doesn't advocate for the access, affordability and cost-effectiveness of health care for Americans ... someone else will. And the medical community along with the American People might not like what they end up with...again.
(Ken Alpern is a Westside Village Zone Director and Board member of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He is co-chair of the CD11Transportation Advisory Committee and chairs the nonprofit Transit Coalition, and can be reached at Alpern@MarVista.org He also does regular commentary on the MarkIsler Radio Show on AM 870, and co-chairs the grassroots Friends of the Green Line at www.fogl.us. He is also a Board-Certified Dermatologist with past experience working with patients of all socioeconomic levels, and of all insurance backgrounds, in LA, Orange and Riverside Counties. (The views expressed in this article are solely those of Mr. Alpern.)
Vol 13 Issue 25
Pub: Mar 24, 2015