Obsessed Journalist says Drug Prices Aren’t Based in Reality
/“Health care is not a market. We don’t get to choose. There’s very little competition.”
That was the message that Brian Howard, features editor of Philadelphia magazine, brought to the more than 500 people attending the 2019 Sunflower Fair in September.
Journalist Brian Howard of the Philadelphia magazine speaks at the 2019 Sunflower Fair (staff photo)
His focus on the topic of the pricing system for prescription drugs is deeply personal. In 2003, after suffering headaches, double vision, dizziness and blind spots, he was diagnosed with optic neuritis, small lesions on his optic nerve, caused by an over-active immune system attacking the central nervous system. Howard said that patients with his condition have a 50% chance of developing multiple sclerosis, a disease the works via the same mechanisms.
So for 15 years, Howard took his medications regularly. Although he knew his drugs’ price tag was between $75,000 and $99,000 a year, he took comfort in his employer’s health plan, and his costs had been limited to $100 to $150 per month.
In December 2018, the company’s health plan told him he would now have to start paying full price up to the deductible--and then 20 percent afterward--until hitting his annual maximum of $6,650 a year. “It was the first time I really had to think about that price tag,” Howard said.
“And it all got me wondering just why prices for drugs are so freaking high. It just can’t be real, right? That can’t be how much it costs to make that medication.” Howard became “obsessed with finding the method behind all of this,” an obsession that resulted in an article published in the May 2019 Philadelphia magazine: “Ouch! The Outrageous Cost of Prescription Drugs.”
Howard’s conclusions? Drug prices aren’t based in reality, our healthcare system is the most expensive and complicated in the world, there is too much bureaucracy around healthcare, and pricing is a black box where few are in a position to comparison shop.
Among his sources, Howard interviewed Steven Joffee, Chief of Medical Ethics at the University of Pennsylvania. Joffee told him that the system’s flaws include monopoly sellers and buyers who can’t negotiate. “It’s not unethical to put a dollar value on well-being. However, without transparency, it’s impossible to make real decisions” said Joffee.
Drug companies offer rebates to entities called Pharmacy Benefit Managers, or “PMBs”, as an incentive to be listed in the formularies – the lists that decide which drugs an insurer will cover and at what price levels. One reason list prices start out so high is to allow the rebates to be larger. PBMs can also earn revenue by reimbursing pharmacies less than what they receive from insurance--a practice called “spread pricing.” There is no guarantee these savings are being passed on to patients.
A Sunflower Fair participant asked Howard why drug companies advertise on TV: “It’s a big business to sell medication, and they are allowed to. It must be working for them,” he said.
Another participant asked what could be done to fix the system: “My personal opinion is that something more fundamental needs to happen--beyond just tinkering around the edges. Let your elected officials hear from you.”
Practical Ways to Save Pharmacy Costs
Brian Howard provided these practical tips for consumers to control their prescription bills:
Ask your doctor if you really need the drug. Howard referred to that found that 70% of patients who asked their doctors if they could cut down on drugs were advised they could ditch at least one of them.
Ask your doctor how much the drug will cost. Some physicians aren’t really aware of the costs and don’t always consider alternatives.
For those medications that you must take, consumers should consider generics and compare pharmacy prices before filling prescriptions.
Sometimes, it’s actually cheaper to pay cash than rely on insurance.
Some medications can be purchased with 90-day supplies at less cost.
Talk to your doctor about “pill splitting”--where the prescribed dosage is doubled and the patient then cuts each pill in half using a pill splitter.
Call the manufacturer direct to ask about discounts and should look into coupon cards and other assistance programs.
Check out resources from non-profit organizations like Needy Meds and the National Patient Advocate Foundation. The website RXAssist.org is an easy way to search for programs.
This excerpt is from a feature article that appeared in the October-November-December 2019 edition of Keynotes. Source material for the original article included Philadelphia magazine. If you would like your own subscription to Keynotes, please contact us.
