Drug Costs: The Hit That Sinks the Ship

We have talked about the cost of medications in the past. Currently they make up about 10 percent of health care expenditures and threaten to represent even more as time goes by. New biological agents are being developed. Genetic solutions to such things as cancer, by the targeting of specific DNA sequences, are on the horizon.

But as the number of options increase, insurance companies are hard at work playing various brands of medication against each other, trying to bring down the cost of these medications through competition. But what happens when you find that one medication from a certain group of medications makes you sick and that’s the only one covered by your insurance? Are you out of luck. Maybe. There are usually mechanisms to appeal the denial for a certain medication. But even if it gets approved, there is no guarantee that you won’t be saddled with a higher co-pay.

And while generic medications must contain the same active ingredient as the brand name, sometimes the inactive ingredients are not; and can consequently cause intolerances that their brand name cousins do not. And even if your physician writes for a brand name medication, if he fails to make it clear that a generic can’t be substituted, many states mandate that a generic must be given.

Of course, costs continue to rise. And the lobbying interests for the pharmaceutical industry ensure that Congress won’t negotiate prices for the Medicare population making it nearly impossible to curb those costs. One need only go to another industrialized nation to find drug costs significantly cheaper for the same medications. In fact, many in this country send away to Canada to get their medications for significantly cheaper prices, even though doing so is illegal.

But this isn’t the only problem. Many insurance companies prefer to give a 3 month supply of medications rather than one month, keeping the co-pay for each the same. So when you go to your physician you will likely insist that you be given a three month supply. But for a new medication, what happens when you have a bad reaction to that medication after the first dose? It’s likely that the rest of that expensive medication gets flushed down the toilet. Moreover, this may happen several times before a satisfactory medication can be identified.

And if this is an opioid/narcotic, given for short term pain control after an operation, this leaves a three month supply available to fuel the drug crisis in this country.

But this is not likely the biggest complaint that patients have about their prescriptions. They often find it incomprehensible that if they have been on the same medications for years, why, when they go to a new doctor, these prescriptions aren’t renewed as a routine matter.

The answer is simple. Some medications are made obsolete with the advent of newer medications. Some medications’ safety profiles are adjusted as new information becomes available. Thalidomide was thought to be a wonderful drug to control nausea during pregnancy until it was found to be responsible for severe birth defects among mothers using it. And sometimes diagnoses which were made in the past are subsequently found to be incorrect. Or found to have resolved themselves over time.

And with the expense of the medications, to say nothing of their interactions with each other, there is a significant argument for regular reassessment. Where this is particularly true is in the elderly population. Within the nursing home industry, it is not uncommon to find patients taking in excess of 10 medications a day. And if the over-the-counter supplements are included, the number can exceed 20. And the more medications a person takes, the more likely that they will be subject to deteriorations in memory and balance among other things. Which can result in falls and institutionalization. Which results in further expense to the health care system.

So if you find yourself at odds with your doctor about your medications, some of this may be financially driven. But in most cases, it is more likely being driven by the need to improve your care.

But what do you do if your physician is too busy to address your concerns about your medications. Or about your physical ailments? What are your options? That will be our topic next time.