This one is on us
My column last month, about my experience with an outrageously and unnecessarily overpriced prescription, generated a great 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” anti-inflammatory (which turned out to simply combine two readily available over-the-counter drugs into a single prescribed pill).
The doctor said he would call in the prescription to a pharmacy that would not charge me a co-pay, and that I simply needed to let them know if I wanted it.
I took some samples home to try it out, and was shocked a few days later to find a month’s supply of Vimovo sitting in my mailbox, mailed to me by the pharmacy without my saying a word.
I was even more shocked when I noticed (in very fine print) that the prescription had been billed to my insurance company for $2,236! The generic OTC pills I usually take cost less than $10 a month.
I called the pharmacy and insisted they take the prescription back and credit my insurance company. Then I called the head of the medical practice and informed him about my experience. He expressed amazement at the cost, and indicated he would tell his staff to think twice before prescribing it in the future.
I think I’ve received more comments and letters concerning that column than any other I’ve written in the past 30 years. Readers responded with kudos, with questions, shared their own similar experiences or, in a few cases, threw out challenges like this one I found on my answering machine:
“What did you do after you talked with your doctor? Did you call Medicare? Send a copy to every member of the your 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! If all you do is call your doctor, it’s certainly not going to stop.”
Actually, I think facing up to our doctors on this kind of thing is the only way such behavior is going to stop, or at least lessen. Let me explain why.
My complaint is about a particular type of price gouging: where a pharmaceutical manufacturer combines cheap OTC drugs into a single pill, and charges a huge premium for the convenience.
In my column, I was not objecting to new breakthrough drugs that, with one shot or a brief course of treatment, completely cure a potentially fatal condition (such as is the case with several new cures for hepatitis C, an otherwise chronic condition that can, left untreated, lead to liver failure and death).
One can make the argument that if such a treatment obviates a lifetime of expensive medications and saves and improves lives, it could legitimately be priced at a significant premium.
On the other hand, when these hepatitis C treatments came out a few years ago, I wrote a column giving reasons for NOT charging such a premium, based on the fact that the underlying discoveries that led to the breakthrough were paid for by taxpayer-funded research. This is a different problem calling for a different solution.
I was also not speaking last month about “personalized medicine,” where doctors individually design treatments to correct a particular person’s genetic condition or halt a rare, fatal cancer.
We have just begun to have successes in this type of medicine, so I can understand why — at least at the moment — the huge costs that go into crafting these treatments should be passed along to the patient or their insurance company. We can hope that prices will come down as we learn more, and perhaps develop new efficiencies in these techniques.
I also wasn’t speaking in my column about the situation where a drug company acquires an old patent and, having a monopoly, jacks the price up several hundred-fold.
That is a heinous practice in my view, but at least it reflects the reality of monopoly pricing, and should give other companies an incentive to develop their own versions at a far lower cost. This is a problem that our economic system often can address, and that our regulators and legislatures have power to change if they choose.
My specific complaint was about something else: the practice of combining two or more OTC medications into one pill and charging hundreds of times more than their ingredients warrant. Even if we customers aren’t personally paying for these drug at the counter, we all end up paying their exorbitant prices through higher insurance premiums overall, and through the drain on Medicare.
And I want to be clear: I am not saying there is no value for any patient in the new meds. There are no doubt individuals for whom Vimovo is a godsend.
Patients with severe arthritis, for example, may need high doses of anti-inflammatories all day, every day to function. And they will likely need a second medication to protect them from the internal bleeding such a dosage can cause.
Not only do many patients, especially older ones, face huge logistical problems trying to juggle multiple doses a day of multiple medications, some of which may interfere with other meds or with one’s diet. There is also the fact that having to buy large amounts of such pills for the rest of one’s life can be a burden.
If a drug manufacturer can make a once- or twice-a-day pill that patients (or their caregivers) can easily remember to take, and the company is willing to absorb patients’ co-pays for such drugs, that can have real value for some.
It just happens to have had no real value for me. I wanted a generic pain pill for a few weeks until my shoulder got better. My doctor knew that, and should have known better than to push me to try Vimovo instead.
For this particular problem, it seems to me, Congress, Medicare and “60 Minutes” are not the solution. The drug companies are exploiting legal patents and our established economic system. Bringing moral pressure to bear through bad publicity is of limited effectiveness.
And Congress and Medicare are unlikely to start capping prices of particular drugs as used by particular patients, which is the problem we have here.
So in this situation, I think it’s up to us as consumers to educate ourselves, and to say no to our doctors, when warranted.
When a doctor prescribes us a drug, we need to ask: Why do I need it? What does it actually cost? Are there less expensive alternatives? Less expensive not only to me, but to my insurance company and to the healthcare system as a whole. Because, as I said before, we all end up footing the bill.
And if our doctors can’t answer those questions, we need to push them to find out. They should be held responsible for knowing the economic consequences of their prescribing habits.
And so, I think the person who challenged me about last month’s column actually hit the nail on the head without realizing it. In these situations, it’s consumers who have the greatest power to change things. As she so rightly said, “Let’s do something about it!”
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