Drug costs are important. Patients increasingly do not get their prescriptions filled due to costs. And insurance does not necessarily make prescription drugs affordable. Increasing copayments required by the insurance industry makes needed medications unaffordable for many families. Patients who cannot afford prescribed medications or who do not purchase them due to other financial priorities may not tell that to their health care providers, resulting in alternative, more toxic, or even more expensive medications being prescribed. Costs of prescription drugs was a frequently cited concern by candidates form all political perspectives in the recent U.S. presidential campaign.
On October 27, the Washington Post reported on a Kaiser Family Foundation finding that Americans perceived drug prices to be the most important health care issue on which the new president and Congress should focus—even more than the Affordable Care Act (ACA). That same week, U.S. News and World Report noted that voters were more worried about Congress and the next president controlling the price of prescription drugs than about the ACA. And these opinions cut across party lines; both Republicans and Democrats place priority on their political leaders addressing drug prices. Late in 2016, a HealthDay/Harris poll showed that 81% of consumers supported drug price caps or controls. Consumers advocating drug price controls has increased from 64% in 2014 to 73% in 2015 to 81% in 2016!
The pharmaceutical industry is understandably concerned. But their reaction has been increased, not decreased, drug costs in many cases. Some segments of the industry have dramatically increased drug prices—perhaps in anticipation of governmental price controls. The media are replete with reports of seemingly egregious price increases. The massive EpiPen cost increase to over $600 has been well reported. It seems ironic that the manufacturer of that product has now introduced a “generic” form at half the price. And it is also ironic that the chief executive officer (CEO) of the manufacturer, Mylan Pharmaceuticals, is the daughter of a prominent U.S. senator. Another example of unjustified pricing that may directly impact migraine headache patients is Treximent (sumatriptan/naproxen sodium). This relatively new combination drug product costs $728.67 for a box of nine tablets, whereas the price for nine tablets of its constituents, sumatriptan and naproxen, is $19 according to an October 30 Wall Street Journal report. Far too often clinicians are unaware of how much drugs they prescribe actually cost their patients. And too often, neither prescribers nor patients are aware of far less expensive alternative medications.
The Wall Street Journal published a front-page report on October 28 stating that price moderation for prescription drugs could be coming. The report indicates that some analysts and investors believe the prospect of price moderation on prescription drugs could occur due to structural changes in the marketplace caused by increased competition, government intervention, and backlash from pharmacy benefit managers. However, the marketplace is not implementing in price corrections because Pharma hesitates to reduce drug costs when their stock is negatively impacted by public perception.
On November 4, Bloomberg News reported on a federal Department of Justice investigation of “suspected price collusion” by generic pharmaceutical companies that began 2 years ago and “now spans more than a dozen companies and about two dozen drugs, according to people familiar with the matter.” Charges could be imminent. Reuters reported on November 3 that several pharmaceutical companies, including Mylan, Allergan, Endo, and Taro Pharmaceutical Industries Ltd, had already received subpoenas in connection with the investigation.
Congress has addressed the issue, but this had not led to reduced drug prices. The Associated Press (AP) reported on November 16 that Congress' “routine of publicly shaming drug company executives over high prices…may make some people feel better, but it doesn't treat the problem.” Both the House and Senate “have issued over a dozen subpoenas to pharmaceutical companies that have increased drug prices notably. The AP reported that the list prices “of nearly 30 brand-name medications and generic versions targeted by Congressional investigators shows most haven't budged since coming under federal scrutiny, according to figures from Truven Health Analytics.”
On December 6, a report from Quintiles/IMS Institute for Healthcare Informatics suggested that Congressional pressure may have “helped cool the rate of cost growth for prescription medications…” In 2016, drug costs increased by 6% to 7%. That is less than the 12% increase seen in the previous year, but it is still markedly greater than the overall cost of living increase for the year.
Patients are seldom in a strong position to impact drug costs by any means other than not getting their prescriptions filled, and that can have obvious deleterious results. It is incumbent upon clinicians to become knowledgeable about true out-of-pocket drug costs for their patients. Average wholesale cost data are relatively worthless unless that information is accompanied by the actual copayments that patients must meet for the drugs. Consultation with pharmacists by prescribers can provide useful information and may well result in far more cost-effective prescribing.
This issue is far too important to leave up to the marketplace alone or politicians. Actual drug prices vary widely due to drug benefit manager restrictions and insurance plan copayment requirements. We urge clinicians to become more aware of drug prices and their patients' out-of-pocket costs.