In the United States, where most of us think we have the best medicine available, prescription drug prices are the highest in the world. I spent a year in Colombia, receiving treatment for cancer, as I was an uninsurable patient at the time. My eyes were opened almost daily about what excellent treatment options were available in other countries at a very low cost. Prescription drugs were cheaper in Colombia than in the U.S. in almost every case.
Most of us have health-care insurance that includes prescription drug coverage, so we don’t think very much about what that 30- or 90-day supply of life-saving medicine our doctor prescribed for us really costs. To counteract the rising cost of prescription drugs what many health plans are doing is to devise a “formulary.” This is a list of the drugs that are covered under your plan. Maybe a drug not on this list is what will give you relief from your illness, but you would have to pay out of pocket for it. And, don’t forget that the cost of prescription drugs is one of the key drivers in rising insurance premiums. So we do pay for the highest cost of drugs in the world.
Use consumer buying clout to lower prices
If the buying power of the American public were used to negotiate drug prices with the manufacturers, as it is in most other developed countries, we would not have to be beholden to insurance companies to tell us what drugs we can get. Even Medicare, covering some 49 million Americans, does not use its bargaining power to get the best prices for our citizens. Congress barred Medicare from negotiating drug prices with manufacturers when prescription drugs were first covered under Part D in 2006. It would be a simple legislative change to allow such negotiations (although it would be challenging to implement). The Veterans Administration and Medicaid (health care for the lowest income citizens) are allowed to do this, and it saves the taxpayers millions of dollars. Allowing Medicare to negotiate prices would save billions of dollars.
But let’s not stop there. How about the rest of us, under 65, and insured by the crazy quilt of hundreds of different insurers? Each insurance provider now is on its own to negotiate with drug providers. If we could use the buying power of everyone in the U.S. it is hard to imagine what the savings could be. Just because you don’t pay any more than $4, $10, or $25 for a prescription doesn’t mean it costs that flat price. Your insurance company has to provide the rest of the cost, and your premiums reflect the increasing prices.
Recently, a hepatitis-C drug named Sovaldi came on the market, from the drug manufacturer Gilead Sciences. Its price? An eye-popping average of $1,200 per pill. Taken once a day for 12 weeks. You do the math. Who could afford this? In countries where the government is allowed to negotiate drug prices, the cost for the same name-brand drug, from the same manufacturer, is far less. Drug manufacturers would not be negotiating and selling their drugs in countries like the U.K, Australia, Japan, and all of Europe, if they were not making money on them. Even in Colombia, where such negotiations do not take place, name-brand drugs are much less. Simple economics dictate that the Colombian public cannot afford the same prices that Americans are paying.
Keeping generics off the market
Another way we are being ripped off on drug prices is the cozy relationship of the manufacturers, through the powerful drug lobby, with our Congress. Collusion to allow older drugs to remain on the brand-name-only list, and not allow generic equivalents to come on the market, exists at every level. One example is the widely used arthritis drug Celebrex. I bought the generic equivalent of Celebrex, celecoxib, in Colombia last year for about $6 for 20 tablets, in sealed blister-packs from the multinational pharmaceutical firm McKesson. Here, in the U.S., it is not available as a generic, and the least expensive price for the same dosage and number of pills of Celebrex is about $120. Legal challenges and an appeals court ruling Dec. 16 paved the way for several generics to be marketed soon.
Re-patenting old drugs
But why should we have to wait for lawsuits to get cheaper alternatives? The most egregious swindles involve re-patenting of drugs that have lived out their name-brand life. The New York Times pulled the curtain back on this practice in an article that appeared one year ago, Oct. 12, 2013, “The Soaring Cost of a Simple Breath,” by Elizabeth Rosenthal. The article gives an example of one older asthma medication, necessary for sufferers to be able to breathe, that is being re-packaged and re-patented by simply changing the delivery mechanism of the drug with a new inhaler. The cost difference? In the U.K, which does not allow these shenanigans, the medicine is $20. In the U.S. the cost for the same inhaler medicine is $175.
Direct-to-consumer TV ads
Also, today you can’t turn on your TV without getting a barrage of confusing ads for prescription drugs. Drug makers spend some $5 billion a year on TV advertising to get you to ask your doctor for one drug or another. The feel-good images of the ads have little to do with the reality of what the drug actually treats. We see energetic athletes rowing a racing skiff on a pristine mountain lake, a golf foursome on a breathtaking course, ideal families playing Frisbee with their well-behaved dog in a beautiful park. All designed to prey on our subconscious – who wouldn’t want such idyllic events in our own lives? Just ask for Lipitor, or Abilify, or Cialis, and your life will be better.
If the government did not allow TV ads for drugs, which was the case prior to 1997 in the U.S., the $5 billion advertising budget could be put to better use. How about taking that money and putting it into research and development for new drugs? Drug manufacturers often point to the high cost of R&D, along with the FDA approval process, as the reason for high drug prices, so re-allocating the ad budget to R&D makes too much sense to become a reality.
Once ads are off TV, our doctors would be free to dispense what drugs they thought would benefit the patient the most (gasp!) instead of being badgered by their patients for the drug du jour. Consumers could still use the Internet, the library, and other sources to keep up-to-date on their particular condition or illness, including what drugs may help them. Only two countries in the world now allow TV ads for prescription drugs: the United States and New Zealand.
What can be done?
What can we do about the soaring cost of pharmaceuticals in the U.S.? Of course, you could travel to another country and stock up on what you need, which is what I did when I was in Colombia. Closer to home, many Minnesotans are traveling across the border to Canada for prescription drugs. However, most of us prefer to stay here at home and buy from U.S. pharmacies. In order to be able to cost-effectively buy your drugs here at home we need legislation to:
- Allow drug price negotiation – initially, for Medicare, and eventually, for all Americans
- Block the re-patenting of older medicines
- Allow generic medicines to come to market when the patent runs out in every case
- Disallow direct-to-consumer ads, especially TV ads, of prescription drugs
Contact your representatives in Congress. Let them know how you feel about the soaring cost of getting well in America.
Debra Axness is recovering from treatment for breast cancer. She is writing a memoir of her experience of what is was like to undergo cancer treatment in another country.
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