Nov 30, 2015

Dr. Jones: The costs of medications in general are increasing. But what's the reason for that and what can we do about it? I'm Dr. Kyle Braford Jones, a family physician at the University Of Utah School Of Medicine and we're talking about that on The Scope.

Announcer: These are the conversations happening inside health care that are going to transform health care. The Health Care Insider is on The Scope.

Dr. Jones: I'm here with Erin Fox who's a PharmD at University of Utah, and Director of Drug Information Services. Now Dr. Fox, a recent Kaiser Family Foundation poll found that increasing drug prices are the number one health care concern of the public. What's going on right now? Why is this becoming such a big issue?

Dr. Fox: Well, I think we've seen a lot media issues around this, particularly around medications that are used for very rare diseases. And we're seeing those increase in price really opportunistically. I think one of the things to think about is drug companies are business, first and foremost. They are responsible to make money. And many companies are taking opportunities these days that are good business opportunities but really are impacting patients.

Dr. Jones: Pharmaceutical companies will say, "Hey, we spend a lot on research and development." Do we have a sense of what is an appropriate amount to spend on that?

Dr. Fox: Some companies do spend a lot of money on research and development. And they do have a great pipeline and they're working on bringing new cures and better medicines for patients. But there are also some companies that are opportunistically raising prices. These are companies that don't actually manufacture the medicines. They buy them from someone else and just put their sticker on. And those companies really aren't reinvesting in health care.

Dr. Jones: What are some examples of some of the medications that have increased dramatically in prices recently?

Dr. Fox: So a couple of years ago we saw really big increases in very common antibiotics like doxycycline and minocycline. Part of that dealt from a drug shortage, but when the products came back to market they came back at very, very high prices. There are also medicines that we're using in the hospital and those have raised prices by 500% to 1000% in some cases.

Dr. Jones: And you mentioned this a little bit, is a lot of that driven by the shortages that we've seen in the last few years that have become fairly prevalent?

Dr. Fox: Some of these are related to drug shortages, but many really are just companies taking a look at the market, finding an old drug that has a very unique use with only one manufacturer, and then raising the price. It makes perfect business sense. But it's really not good for health care.

Dr. Jones: Absolutely. Now in the last few years, especially since the pass of the Affordable Care Act, the insurance environment is shifting a little bit in terms of what's covered, how much you pay for that. Does that have any bearing on why patients might be more acutely aware of these increasing prices?

Dr. Fox: I think overall, consumers and patients are thinking more about what their overall health care cost is. And we've also seen changes related to prescription coverage. You know, it really does change according to your prescription plan. And so when people go to the pharmacy, on one month it's one price, and then the next month it's maybe 5 or 10 times that price. That's really difficult. People can't plan for that in their budgets.

Dr. Jones: Now a lot of people have thrown out different ideas on how to address this, whether it's increasing the use of generic medications, or allowing Medicare to negotiate more with pharmaceutical companies among others. What can we do about them?

Dr. Fox: It's going to take a lot of different actions on different parts. I don't think there's any one thing that will fix this problem. I know the Senate Committee on Aging is going to hold some hearings on December 9th about these high prices. You know, in some cases it can be public shaming. We've seen some drug companies back off of their drug prices after the media reports on those high prices. But negotiating fair prices for medications is really important. And I think Medicare that is a potential solution.

Dr. Jones: Now some of the other things thrown out would be like direct to consumer advertising, considering more the cost effectiveness in terms of what outcomes we get. Are those things that are feasible, especially politically in this current environment?

Dr. Fox: I think they're feasible. Politically it might be very challenging. But we know that other countries have scoring cards and really do take a good look at a medicine's value versus the benefit that it's bringing before they decide to use it. Our government, we don't have that at all. FDA takes no consideration into price when they consider a drug.

Dr. Jones: Is part of the problem, and I say this as a clinician, are patients on too many medications? Could that be part of the issue?

Dr. Fox: That's a good question. I think there's always room to take a look at what medicines you're taking to see if you really do need all of those medicines. You know, avoid duplication. As a pharmacist that's really something I focus on every day. But some medicines . . . Some patients might only be on a few medicines that cost a very, very lot of money.

Dr. Jones: Are patients on too many medications?

Dr. Fox: As a pharmacist that's something we look at all the time. It's always good to look at your medication list, review it, make sure you're not on too many medicines, duplications of medicines. But for some patients, they might take only a single drug, but that drug might be unaffordable.

Dr. Jones: Now as you've mentioned, this is a complex problem. There's lots of facets to it. And a lot of it is political in terms of changing some of the structure of maybe patent laws, or different areas. And even many of the presidential candidates right now are talking about this issue. What do you think is most likely to occur to address this issue?

Dr. Fox: I think the most likely thing to occur will be hearings and lots of talk. But because the problem is so large, and so complicated, I don't actually foresee any actual action. The new Trans-Pacific Agreement that might be going in to place is probably the one thing that really might drive some change, because that would change the patent terms.

Dr. Jones: And with that Trans-Pacific Agreement, what exactly does that mean? What does it entail?

Dr. Fox: You know, I haven't really read the full agreement in detail. But some of the patents would be decreased so drug companies wouldn't have as long of a patent on their medicines which would allow generics and biosimilars on the market sooner.

Dr. Jones: A lot of people also talk about re-importation of medications from Canada or other places. And the argument against that is always, "Well, you know, we can't be sure of the safety of it." Do you think that's a legitimate concern? Or is that again, more talk to protect business interests?

Dr. Fox: Safety is a concern. But I think the bigger issue with re-importation is actually supply. Canada has a very, very bad drug shortage problem, similar to the United States. And Canada's whole market is really about the size of California. So if you think of the entire United States going to purchase all their medicines from California, there's not enough to go around. And re-importation discussions always make Canada very, very nervous because on top of a drug shortage problem, they don't want that worsened by American's basically buying up all of their medicine.

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