Wednesday, October 22, 2008

Missing the point

A New York Times article about people picking and choosing which prescriptions to fill was interesting.

AHEM. I never give medical advice. I'm not that sort of doctor! If any of this sounds like medical advice, well, it ain't.

Obviously, it really stinks that someone would be forced to choose between needed medicines and groceries, but then I started looking at the specific drugs given as examples. Here's what's specifically listed.

Lipitor is a statin. It is on patent for several more years, and so it is expen$ive. (About $100/month, depending on dose.) But Lipitor is just one of many me-too drugs. A very thoroughly marketed me-too, but not necessarily anything special. There are other options on generic statins, and it isn't hard to find a pharmacy doing $10 for 3 months of generics. (Walmart, Target, others...) And statins are good candidates for pill-splitting, which could lower the cost even further. (Pill-splitting is where the doctor prescribes tablets at twice the strength and then you take half tablets, which means that "90 days" of pills actually lasts 180.)

Provigil is under patent under bizarre circumstances, but I can't reconcile the numbers in the NY Times article. ("costing $1,695 every three months") with what I'm seeing. It is usally taken once daily, and I show a 90 day supply (mail order) running about $750 for the higher of the two available doses. (That means that if it can be split, that $750 could actually buy a 180 day supply if she doesn't need the higher dose, but I'm not sure if this one is actually safely splittable.) $250/month or $125/month (if split) is still a mighty big number, but it doesn't rival $1695 per 3 months!

Unfortunately, all the other examples aren't specific about the drugs involved.

Do I have a point here? Yes, actually I do, and here it is:

Some of what makes prescription drugs ghastly expensive is crappy prescribing habits. Doctors have almost precisely zero motivation to prescribe the cheaper generic, since they don't pay for the prescription. Doctors get hounded by drug reps to prescribe what they're touting as the newest, latest, greatest drug, when often there's something equally good (and with far more safety data) already available off-patent.

Too bad the NY Times missed the opportunity to discuss what patients could actually do if they find themselves on unaffordable drugs, besides not filling prescriptions. The Consumer Reports health site has a bunch of information on cheaper alternatives.

While I'm ranting about the pharmaceutical industry, let me point out this article about sampling, and how it harms patients, and this one about kids and free samples. The basic gist is that free samples are only available for drugs on patent, which means that if your doctor "saves you some money" by giving you some samples today, you're going to be paying much more when you finally do fill the prescription for the drug you've started taking as samples.

I think we ought to have universal health care and real prescription drug benefits (with none of this doughnut hole cra-penguin), but any solution is going to have to address this disconnect where the person who decides what to prescribe has no incentive to keep costs down.

OK, now I'm done ranting. Time to grade some more papers.

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