Prescription Musical Chairs Part II

In part one of this two-part series, I was explaining why the high cost of prescription drugs sometimes seems like a game of musical chairs. The Journal of the American Medical Association (JAMA) conducted a review and published their findings on why prescription drug costs are often higher than costs in other countries. Their findings revealed as the most important factor being, Pharma is allowed to set their own prices in the United States under copyright protection laws which are unique to this country.

Other Factors

• Government-protected monopolies for certain drugs prevent generic versions that could potentially be cheaper
• FDA backlogs often stall the application process for new drugs
• Sometimes Federal and State laws place emphasis on patient authorized generic substitutes which create a more complex pricing structure and drives up the price of prescription medication
• The cost of research and development although often cited by pharma as the main cause isn’t the most significant but the failure rate and mismanagement of funding, in my opinion, is more prevalent.

These factors are just part of why the drug pricing game seems just that, a game. Pharma has a large contingency of lobbyists and spends millions of dollars each year supporting political candidates that will protect their interests legislatively and financially. Also, there is legislation that does not allow state and federal agencies like Medicare or Medicaid to negotiate prescription drug prices. When private insurance is involved, a middleman called a pharmacy benefits manager who is paid by pharma often shifts market share in its favor. This has been the industry norm for years and some members of Congress are beginning to listen to their constituents and filing legislation to change the process but pharma is still a huge lobby locally and federally, spending nearly $20 trillion in 2016 for its interests.

What can we do?

• Establish a good working relationship with your pharmacist. Often they will listen and explain the process and recommend what will benefit you. This may involve your patience and work with your doctor or Physician’s Assistant. If you find that they refuse to take time to listen, maybe you should consider changing pharmacies.
• Take advantage of manufacturer assistance programs. These are often available when you can’t afford your medication and are found on the pharma’s website. Be aware not all drug manufacturers provide assistance.
• Ask your doctor for available samples.
• Enlist the help of a social worker. Often they will have resources or can help with the application process.
• Ask your doctor’s receptionist if there are available prescription drug discount cards or programs available.
• In the case of a drug not being covered by your particular insurance plan, ask if an exemption can be made. This may happen especially if your drug is unique and a generic or substitute isn’t available.

The pharmaceutical industry isn’t unlike any other business. Their goal is to make money but balanced with patient-centric care, they achieve a win-win. I think you would agree that major reform needs to happen to reign in the high cost of prescription medication. Legislation needs to change as well as the mindset of those that we elect to public office. If we sit on the sidelines complaining about the costs and lack of coverage by insurance then we are more than likely to end up out of the game for lack of a chair when the music stops. I encourage you to advocate for changes. Make your voices heard. Call or write your members of Congress and give your opinion. Cast your ballot in the electoral process and make a difference. I want to hear from all of you. So, leave your comments below and share your experiences and remember to keep battling my friends!