Cutting Drug Costs, Part 1: Start with your doctor
Part one of a three-part series on ways to manage drug costs.
Some facts just throw me. Here’s one: The U.S. makes up less than 5 percent of the world population, but buys more than 50 percent of its prescription drugs. Are we that sick? Wealthy? Pill-happy?
Yet, according to a 2015 Centers for Disease Control and Prevention report, almost 1 in 10 Americans don’t take their medications as prescribed because they can’t afford to. As a veteran internist, I consider myself well-schooled and informed on this issue.
Last Friday morning, I was juggling two rooms and running an hour behind, when I got a call. It was about an antibiotic I’d ordered earlier that morning. Because of the patient’s drug allergies, I’d opted for an old timer: nitrofurantoin. This little beauty has been around since the 1950s—the days of jukeboxes and poodle skirts. Just right for the job.
“For a few days,” I’d said to my patient, “it won’t break the bank.”
Well I was wrong.
The pharmacist informed me, ever so politely, that this drug would’ve cost my patient $150 for a 7-day treatment.
Was I surprised? Not hit-by-a-falling-piano surprised, but more like step-on-an-unknown-brownish-yellow-semi-solid surprised.
According to a 2016 Consumer Reports poll, while 6 percent of people were informed of a new drug’s cost during a doctor’s visit, “63 percent didn’t learn the price of the drug until they were standing at the pharmacy counter.” I’ve always instructed my patients that if the drug I prescribe is too expensive, don’t touch it; have the pharmacy call me first.
And here’s what I do – order generic (the same drug as its brand-name counterpart, without the fancy kiwi flavor). For example, Lipitor, Pfizer’s $100-billion-dollar prize bull in the fight against cholesterol, costs $353.44 a month; the generic (atorvastatin) costs $17.72.
No cheap generic available? I look for sister drugs in the same class (drugs that share similar efficacy but differ in minor side effects). Nexium, a drug for reflux and stomach ulcers, costs $220 a month; omeprazole costs $15.99 for 42 tablets.
Another thing I do often and easily is separating combination pills. The diabetic drug Actoplus Met XR 15/1000 (pioglitazone and metformin) costs $373.77 a month. But if I write a prescription for each drug separately, I can get the price down to about $30.
Ideally, the cost conversation should start at the doctor’s office. But if you’re caught at the pharmacy counter, call. There are too many reasons for unpleasant surprises: a generic drug’s sudden price hike, insurance’s ever-changing coverage, Big Pharma’s unchecked profit motive … or maybe there’s an off off-chance that your confident and “well-schooled” physician just didn’t know what she was talking about.
On Friday, working with the ever-so-patient pharmacist, I ended up switching the antibiotic. Not my first choice. But the alternative cost a few bucks and would do the job nicely.
Later that day, I looked up the wholesale price of my little 60-year-old beauty: $0.005 to $0.46 per pill. Sigh.