Sticker Shock: The high cost of prescription medications

[David Baxter PhD]

Doctor wants to stop 'sticker shock' for patients picking up prescriptions
By Marcy Cuttler, CBC News
December 19, 2017

Patients often don't know how much their drugs will cost, nor do the doctors prescribing them

A Toronto family doctor thinks she has a prescription for the nasty surprise many patients experience when they go to the pharmacy and learn just how much their medications will cost.

Dr. Iris Gorfinkel says drug prices should be easily searchable in existing electronic records systems so doctors ? most of whom don't know the prices off the top of their head ? can discuss cost with patients and check if there are cheaper alternatives. "Providing cost-effective care is simply not possible in the absence of accurate knowledge of drug costs," Gorfinkel says in a commentary published Monday in the Canadian Medical Association Journal (CMAJ).

It's a problem Sharon Dennis knows all too well.

Dennis, now 62, spent more than a decade receiving treatment for leukemia at the Juravinski Cancer Centre in Hamilton, Ont. But in 2015, when her doctor prescribed a better medication she could take at home, he didn't tell her the price or if it was covered under her plan. So when Dennis spoke to the pharmacist, she was in for a surprise. "They came over and said it was $5,100 for one month's supply. And I was like, 'Wow. Don't bother filling it because I can't afford it.'"

Dennis went almost four months without taking the medication, Bosulif. Her insurance company originally agreed to pay but only if she shelled out the money first and submitted a claim afterward. Dennis was terrified the lag in waiting for the reimbursement would ruin her financially. After months of arguing and pleading, she finally convinced her insurer to pay the cost of the medication directly to the pharmacist.

While Dennis doesn't fault her doctor for prescribing the medication, she wishes he had been able to tell her the price upfront. "I would have liked to have known all of the options ahead of time, before I got this sticker shock at the drugstore."

According to the most recent national survey conducted by the Angus Reid Institute in July 2015, more than one in five Canadians said they or someone in their household didn't take their meds as prescribed, if at all, because of the cost.

Canada has among the highest prescription drug prices in the world. On a per capita basis, only patients in the U.S. and Switzerland spend more than Canadians on pharmaceuticals, according to the Organization for Economic Co-operation and Development (OECD).

Gorfinkel says most doctors are too busy to research how much every drug costs. So she's pushing for an electronic fix that would allow doctors to see the price of medications on their computer screens as they discuss treatment options with their patients.

"So the idea is the cost comes up in real time when the prescription is being provided. And that opens the dialogue."

Gorfinkel believes that dialogue could also help reduce overall spending on medications because doctors and patients would be able to see whether cheaper options are available.

'Swallowed my pride'
Heidi Bauer would have liked to have had that type of conversation when she was diagnosed with breast cancer five years ago. The 43-year-old registered massage therapist in Ottawa was the breadwinner while her husband stayed at home to care for their 18-month-old son.

"I swallowed my pride and asked family and friends for money and donations. Those are things that I never expected to have to do, or that I would be comfortable doing," Bauer said. "But definitely that's what I had to do in order to keep going forward with the treatment plan that was given to me."

Patients suffer when cost isn't factored into the discussion with their doctor, said Toronto pharmacist Mina Tadrous, who often has to break the news. "It often goes a little bit like, 'Oh, that's how much it's going to cost? OK, well, let me think about it.' And the moment they walk out that door, I know I'm probably not going to see them again for that specific prescription."

He fears the situation is likely going to get worse as drug prices continue to rise.

He says Gorfinkel's idea of having prescription prices readily available electronically could bring clarity to the conversation. "I think there's a huge gap here and an opportunity to develop tools and look at ways to make it easier to fit [price-checking] into the doctor's schedule," Tadrous said. "At the same time, it will help patients walk out with the right prescription."

Gorfinkel started a petition urging the Ontario government to add drug price information to existing electronic records systems. The Ontario Medical Association officially endorsed her proposal back in November.

"I finally realized nobody's doing it unless I try to make it happen," Gorfinkel said. "I'm hoping there will be enough interest around this to make change in a real intransigent system."

 

[Daniel E.]

I still can't get over the prices. A cream for dermatitis would have been over $400 (USD) for just a single tube (since my insurance didn't cover it -- no wonder). And there's no guarantee it would have worked any better, anyway.

 

[David Baxter PhD]

I needed chemotherapy for cancer but I was too weak to tolerate IV chemo. I needed to take an oral chemotherapy drug. Fortunately, my oncologist was able to get approval for the cost to be paid by our national medical program. Had that been unsuccessful, I would not have been able to afford it (I forget the exact cost but it was thousands of dollars a month) and probably would not have survived.

 

[Daniel E.]

Oh, wow. They should at least have given you the dignified option of selling one of your/relatives kidneys first.

 

[David Baxter PhD]

Well, I don't think it would have come to that, but the point I was trying to make was that there was no way for me to afford a medication that expensive.

And there still are lags in getting very expensive medications covered, especially if there are cheaper alternatives even if they don't work for a particular individual.

I think our medical system is excellent, but the part that covers pharmaceuticals still lags far behind the part that covers medical services.

 

[GaryQ]

I think the problem isn't the coverage or not of specific medication but the extreme greed that is permitted by not legislating big pharma markups.
The only reason we (Canada) are the 3rd highest in med costs in the world is because we allow it. It's also very understandable why certain meds are not covered when a cheaper equivalent is available in order to avoid abuse and Doctors getting even more kickbacks for prescribing them etc.

Here in Manitoba we have the provincial Pharmacare program and the yearly deductible is based on total family income on a sliding scale (higher income higher percentage). Some meds that are not covered fall under the EDS (Exception Drug Status) program. The Doc has to call in the request and justify the reason for prescribing it in order for it to be approved and covered. For me it covered life saving Plavix for years before the generic came to market.

The sad part is it's a reality that's not getting any better any time soon and even sadder is that too many people wind up not being able to afford needed medication.

 

[Retired]

to avoid abuse and Doctors getting even more kickbacks for prescribing them etc.

I am not a defender of the pharmaceutical industry, but it should be clarified that doctors in Canada do not receive kickbacks for prescribing a specific medication. This practice may occur in other Countries, but not in Canada.

I have been away from the industry for a while now, and I know legislation has tightened since I had first hand experience.

There were subtle promotional strategies that acted as reminders in physicians' offices, like rulers, calendars and pens....though I doubt if a self respecting physician would be influenced to prescribe a med for a pen.

No, prices are set by the multinational pharmaceutical companies, and they do charge what the market will bear in each market (Country) in which they operate. If a certain market demands they give it away free, they will do that, and if another market can get away with thousands of dollars per dose, that's what they will charge.

Now that there has been significant consolidation in the pharmaceutical industry where a handful of giants have acquired all the smaller players, competition has been all but eliminated..therefore higher prices when they can get away with it.

I recently saw that with a product that has been around since 1941, bought and paid for decades ago and sold to patients for a few dollars throughout the sixties, seventies and eighties.....now that the baby boomer generation is aging, that product has been boosted in price.

 

[GaryQ]

Ontario is planning to force pharmaceutical companies to divulge their payments to doctors, a major step toward transparency in the otherwise murky world of medical marketing in Canada.


I like the word "murky"

"Bleed them but leave just enough blood to survive"

 

[Retired]

AS I said, I've been away from the industry for a long time, but the Globe article does not report precisely what kinds of payments have been made to physicians and medical associations in Canada. The article alludes to payments in the U.S. and implies the culture in both Countries is the same.

My first hand experience, albeit a bit dated, can attest to drastic and dramatic differences in pharmaceutical and medical professional culture between the Countries.

Pharmaceutical companies in Canada often help subsidize educational and professional meeting activities in Canada as well as help sponsor speaker fees for physicians engaging in continuing medical education.

I don't know what arrangements take place in the U.S. in this regard, nor do I have knowledge about today's business environment between the pharmaceutical industry in Canada and Canadian physicians.

It is now and has been a political football for decades.

Much of what is reported in the media does not seem to tell the whole story, and this article contains a lot of innuendo, but light on facts.