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Apparently, it’s up to us

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By Stuart P. Rosenthal
Posted on February 21, 2018

My column last month, about my experience with an outrageously and unnecessarily overpriced prescription, generated a good deal of reader comment.

In case you missed it, in brief: I was repeatedly encouraged by a doctor, despite my protests, to try out a “new” medication that combined two readily available over-the-counter drugs into a single prescribed pill. The doctor said he would call in the prescription, and assured me I would owe no co-pay for the new drug if I decided to fill it.

I took some samples home to try it out, and was shocked a few days later to find a bottle of 60 pills in my mailbox, sent to me by a pharmacy I was not familiar with.

I was even more shocked when I noticed (in very fine print) that the bottle had been billed to my insurance company for more than $2,000.

I called the pharmacy and insisted they take it back and credit my insurance company. Then I called the head of the medical practice and informed him about the experience. He expressed amazement at the cost, and indicated he would tell his staff to think twice before prescribing it in the future.

While a number of readers responded with various suggestions, questions and their own similar experiences, one caller, who gave no phone number or email address, left the following voicemail message on our office line as soon as she read the column.

“I just read your editorial. And what I don’t see in the article is what you did about it after you talked with your doctor. Did you call Medicare? Send a copy to every member of the Maryland delegation in Congress? Did you contact AARP? As a matter of fact, if I were you, I’d send a copy to “60 Minutes.”

“Let’s do something about it! It’s a great article, but if all you do is call your doctor, it’s certainly not going to stop.”

I found her message striking, not because she seemed to feel the issue was of such great importance that I should forward my story to all the powers that be. But rather because it seems to me that she may have missed a crucial point of my column.

In case other readers may have had the same misunderstanding, I have decided to devote this month’s column to a clarification.

In no way did I see my experience as unique, or worthy of a congressional hearing or television expose. In fact, I think it’s fair to say that “overpriced prescription drugs” is one of the most common topics discussed today.

The White House has called it a high priority to address, Congress has held heavily publicized hearings in the last few months. Television and newspaper reporters highlight it frequently.

On the contrary, what was most concerning to me was the dawning awareness that — despite all this public attention and discussion of the issue — rampant overprescribing of unnecessary medications apparently continues to happen every day in doctors’ offices across the country.

This raises two questions for me. First, why are our doctors apparently unaware of the costs of new drugs (and so willing to promote the latest brand of the drug manufacturers who send reps to their offices bearing gifts)?

And second, why are we patients so cowed by our doctors, or blinded by claims of “zero co-pays,” that we accept medications that we may (or should) know, are probably unnecessary, overpriced or both?

Of course, no patient asks their doctor “are there other medications that will cost my insurance company less?” Especially if those other options may actually end up costing us more in terms of our co-pay.

You see, it turns out that the manufacturers of these overpriced combo drugs purposely absorb the co-pay of the patient’s insurance company so that consumers don’t complain, and so that doctors feel they are doing “the right thing” by saving their patients from paying anything out of pocket.

One thing doctors do know is that many of their patients never fill their prescriptions, in part because of the cost to them. The clever trick of the drug companies in absorbing the co-pay avoids that obstacle.

And so the reason I wrote my column was to encourage as many individual consumers as I possibly could (that is, the nearly 400,000 readers of the Baltimore, Howard County and Greater Washington Beacons, as well as FiftyPlus, the paper we publish in Richmond), to be alert to these kinds of schemes, and to challenge their doctors (and pharmacies) on it.

Let’s face it: What the drug manufacturers are doing is not illegal. They work carefully within patent law to develop new combinations of drugs that they can then price however they choose.

Medicare and insurance companies can only do so much. There may well be some patients out there who truly benefit tremendously from these new drugs, so Medicare feels obliged to cover them and insurance companies follow suit. (And listen to how loudly consumers complain when Medicare hesitates to cover a new drug or treatment.) But that doesn’t mean these drugs aren’t hugely overprescribed by doctors.

“60 Minutes” can bring moral pressure to bear, but there’s nothing they can really do to stop this other than by shaming the occasional company, lobbyist or doctor.

Congress is not going to get into the business of pricing individual medications (certainly not when so many members accept significant campaign contributions from drug manufacturers and face nearly 1,500 lobbyists from the industry).

Simply put, the problem is systemic. The system allows it, and there’s no easy way to disallow it.

And that means the only way I know of to really put some brakes on it is from the bottom up: through actions by consumers. By you and me.

And so I think the person who called us actually hit the nail on the head without realizing it: It’s precisely us calling our doctors that has the best chance of changing things. As she so rightly said, “Let’s do something about it!”

Please share your thoughts with us about this and other issues of importance by emailing, calling or responding via our website, www.TheBeaconNewspapers.com

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