How high-cost medications affect patients

The skyrocketing price of prescription medications has been a huge topic from the presidential campaign trail to social media, thanks in part to former Turing Pharmaceutical CEO and real-life villain Martin Shkreli. Shkreli made headlines in late 2015 when he jacked up the price of Daraprim (pyrimethamine), used to treat toxoplasmosis and malaria, to $750 per pill from $13.50.

Shkreli was arrested on December 17 for his Ponzi-scheme business practices. He resigned from Turing the next day.

While Shkreli got what many would agree was coming to him, his company’s move sparked a loud debate across the country about how to address the problem of high medication costs. Presidential candidates on bothsides of the aisle have offered their takes on both the causes and solutions to high drug prices. 

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Optometry Times' sister publication Drug Topics writes that the U.S. Senate Special Committee on Aging recently met to discuss possible solutions to the problem (you can watch that hearing HERE). Four pharma companies-Turing, Valeant, Retrophin, and Rodelis Therapeutics-all faced harsh criticism from the investigation for the practice of acquiring off-patent drugs and rising the price by 20 to 40 times.

Senator Susan Collins (R-Maine), chair of the Senate Special Committee on Aging, told Drug Topics that federal policy has attempted to strike a balance between maintaining incentives for drug development and keeping medicines affordable.

“That balance we have struck never anticipated companies acquiring off-patent drugs and then jacking up their prices to enormous heights, and doing so, as one executive essentially put it, ‘because I can,’” says Collins.

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One of the proposed solutions was fast-tracking the U.S. Food and Drug Administration (FDA) approval of generics. Mark Merritt, president and CEO of the Pharmaceutical Care Management Association, told the committee there is a three-year backlog of 4,000 drugs. Expedited review of drugs that don’t have competition could change the business picture entirely, Merritt told Drug Topics.

While those at the top debate the issue ad nauseum, high drug prices continue to affect patients-and thereby their treatment plans and doctors-every single day.

Next: How high costs affect patients

How high costs affect patients

You can prescribe the right medications all you’d like, but what happens if a patient can’t pay the bill when she gets to the pharmacy counter?

“From R&D to marketing to sales to acquisitions, developing medications requires significant investments,” says Optometry Times Editorial Advisory Board member Walt Whitley, OD, MBA, FAAO. “Most patients may not realize this-nor do they care. All that matters is they need the medication, and it needs to be affordable.”

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Optometry Times Editorial Advisory Board member Mohammad Rafieetary, OD, FAAO, shares one recent case that illustrates the problem at hand:

“Recently, I prescribed a brand steroidal and a brand non-steroidal drop for a patient with inflammatory macular edema,” he says. “She returned for follow-up with no improvement in her OCT findings. When I asked her if she was using her eye drops, she indicated that the steroid drop was expensive-even in the substitution that the pharmacist had suggested-so she was only using the nonsteroidal substitution that the pharmacist had told her is as good as the one prescribed for her. She was baffled by the fact that she had no improvement-even more puzzled when I told her she could have been using tap water to get almost the same of her less expensive option.”

Next: How ODs handle it 

How ODs handle it

It has often been said that some optometrists struggle to prescribe this brand medication or that premium lens because they’re concerned about cost instead of focusing on what’s best for a patient’s vision or health.

“Our practice is a high-volume surgical office-patients do get frustrated at the high cost of their postoperative drops,” says Marta Fabrykowski, OD, FAAO, in New York City. 

She says that patient counseling about the need for medication and potential challenges in getting it is important.

“It can be a disheartening conversation when patients admit to having difficulty paying for the medications, and we want the best for them-both financially and medically,” Dr. Fabrykowski says.

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While choosing a cheaper drug may help your patient’s wallet, it may not help his condition, so it’s not always the best choice.

“It is a shame that medications cost a lot of money and are putting a burden on our patients (and ourselves as patients) and the entire medical bill,” says Dr. Rafieetary. “However, using ineffective substitutes will only add to the cost.”

Dr. Whitley says he always prescribes the medication he thinks will provide the best clinical efficacy based on evidence-based medicine, but patient education is key. He educates patients on their conditions, why he has chosen a specific medication, and the potential side effects.

“I also let them know that these should be covered by their insurance; however, if it isn’t covered or if the cost is too high, I want patients to contact me so I can decide on alternate therapy vs. the pharmacy choosing the medication based on only what the insurance covers,” he says. “We have all seen some of the substitutions that are made which aren’t necessarily effective for their conditions.”

Next: Where do we go from here?

Where do we go from here?

Some argue that the federal government should be negotiating prices instead of insurers to help bring down costs. Others say the cause of high costs is just greed and far exceed what’s needed to cover R&D. Some politicians blame overzealous government regulation, others say there isn’t enough regulation. 

“We all have been fully exposed to the debate of brand vs. generic in regard to efficacy and cost,” says Dr. Rafieetary. “The points I like to make as far the argument of the active ingredient debate is that just because I have a copy of my grandmother’s recipe for a given dish doesn’t mean I can cook it as well as her.

“Secondly, we have to recognize that pharmaceutical R&D comes at an exorbitant cost that has to be recouped somehow,” he says. “Otherwise, we may not see any future advances in that arena.”

Dr. Whitley says that while most doctors utilize e-prescribing and apps like GoodRx to research the cost of various medications, he’d like to be able to access all of this information in one place to help practitioners discuss medications and costs with patients.

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