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Why Do Patients Pay the Price they Pay For Prescription Drugs? It’s not why you think.

April 11, 2018
Posted by: Gerald “Pharmacist Jerry” Finken, RPh, MS; Contributor: Martha Morton

Why Do Patients Pay the Price they Pay For Prescription Drugs?

Recently there has been a buzz over social media and the news about the rising prices of prescription drugs. The blame has been mostly placed on the drug manufacturers. The spikes in medication prices are notable, for it has been documented that prices have increased, what feels like overnight, by the thousands per pill. I find it very interesting and short sighted, that so much focus has been placed on the micro – the price of drugs – rather than the big picture issue of the overall price of healthcare. Prescription drugs only make up approximately 10% of the overall health care costs. Though I too don’t like to have to pay more for the same and understand the grievance with rising drug costs, I think we all need to look at the situation with a wider lens.

A recent New York Times article detailed the personal stories of a few patients who have been directly impacted by elevated prices of prescription medications. The stories listed the patients’ conditions, the prices of each in their extensive medication lists, and noted how most are not eligible for additional assistance past insurance. Many of the patients who were interviewed for this article had some form of chronic illness that involved expensive medication therapy as well as time in the hospital.

The price of prescription drugs was identified as the key problem causing all the trouble for each of the patients. The article cited an imbalance in the health eco system: drug companies raise prices, but medical insurance companies are not willing to cover the price hikes. Instead, the insurance companies are passing the bill onto the patients who often cannot afford it.  What caught my attention here, is not what was included but was not. The article neglected to really mention the expenses of the ‘other’ medical services that these patients were using as part of their treatment. There was no mention of how much the patients paid for their doctor visits, their hospital visits/stays, their lab tests, etc. – all which involve the whopping 90% of healthcare costs? What we had here is a micro rather than macro perspective.

Let’s ask:

  1. Were these expenses omitted from the article because they were substantially paid for by the patient’s insurance?
  2. If so, what is the insurance company’s rationale NOT to cover the medications that ensure the patient would not return to the hospital? AND,
  3. Isn’t it much less costly to provide a successful preventative care upon diagnosis than provide costly corrective action?

One of the patients mentioned in the article had to discontinue some of her medications until she was able to pay for them. Specifically, she stopped taking one of her shorter acting diabetic medications so that she could afford her other “more important” prescriptions. As expected, she had to spend a three-week stint in the hospital for high blood sugar as well as fluid retention. A one-week visit to the hospital costs an average of $10,000. Did she have to pay this fee on top of her prescription medications or was this covered by Medicare? Whoever had to pay the hospital bill ended up with an unneeded and comparatively greater additional expense that could have been avoided.  Something is wrong with this picture – viewed through any lens.

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