Dr. Stephen Smith set up a listening booth last summer to gather people’s stories about the cost of prescriptions medications.
One story in particular stands out for the semi-retired physician.
One woman brought her 2017 United Health bill detailing the price for the prescription medication she had been taking. The cost of the medication, Soliris, totaled $1.476 million.
“Fortunately, she was on Medicare and able to pay for it. She said if she hadn’t been on Medicare, ‘I probably wouldn’t be alive. There’s no way I can afford this kind of cost.’ I think that’s testimony to where we are in this country,” Smith said.
A study by the American Academy of Actuaries’ Prescription Drug Work Group detailed some of the reasons for the high prices. The two main factors in pricing are changes in utilization, including the introduction of new drugs and increases in the unit cost or cost per dosage. Other issues affecting drug pricing are delays in introducing generics; higher cost inflation in the United States for pharmaceuticals compared to other countries; and the compensation to stakeholders across the pharmacy supply chain, according to the work group.
The study also revealed that U.S. retail prices for common prescription drugs were 5 to 117 percent higher than the prices paid in six other countries included in the study.
The cost of sky-rocketing prescription medications affects everyone, across the board, said Monte Wagner, an advanced practice registered nurse, who has worked at Community Health Center and now works for the Veteran’s Administration.
And the effects of the high-cost of prescriptions also impacts Latinos.
A recent survey by AARP found:
- 78% of Latinos take prescription drugs on a regular basis.
- 97% reported taking prescription drugs on a daily basis.
- 36% reported taking two to three prescriptions on a daily basis.
In an effort to rein in the rising cost of prescriptions drugs, the state introduced House Bill 7174 which contains several proposals to lower drug prices. These include allowing the state comptroller to set up a prescription drug purchasing program and requiring pharmaceutical companies to publicly disclose any agreements that would delay or prevent generic drugs from becoming available to consumers. These agreements, known as “pay-for-delay’ cost consumers an estimated $3.5 billion in higher prescription costs yearly.
Frances Padilla, president of Universal Health Care Foundation of Connecticut, said the bill introduces transparency.
Currently, a pharmaceutical company pays generic companies to hold off developing a generic version, Padilla said.
“It all happens behind the curtain. It’s very difficult to know exactly when these deals happen, how much is involved in terms of money,” she said. “A 10-year patent can sometimes extend to 15, 20, 25 years keeping a generic form of the brand name medication from hitting the market.”
Smith has seen firsthand the effects of pharmaceutical companies manipulating costs for prescription drugs.
He recalled a patient, a new immigrant from Sudan, who was suffering from frequent and high fevers and abdominal pain. Familiar with the symptoms, Smith diagnosed him with familial Mediterranean fever. Smith prescribed Colchicine, which at the time, cost pennies per dose.
“It has been around forever. Benjamin Franklin used it to treat his gout. But the drug company got a hold of it and did a small study to figure out the optimal dose, which we already knew, and they got an exclusive patent from the FDA,” Smith said.
Suddenly, the cost went from 9 cents a pill to $5 per pill, Smith said. His patient, who was uninsured, could no longer afford the medication.
“This kind of jacking up the price of an old generic that we’ve had around forever is inexcusable greed on the part of the pharmaceutical companies and it makes patients suffer,” Smith said.
Wagner has also seen the impact of high prescription costs on patients.
He recalled one 70-year-old gentleman who had a Medicaid/Medicare combo insurance plan. He had been taking insulin in the form of a once a day, long-lasting injection via a pen that simply required a turn of the dial for the proper dose before injecting.
The man was forced by his insurance company to change to a twice daily, short-acting insulin, Wagner said.
The man, Wagner said, was a non-English speaker and had poor eyesight, the new insulin required him to draw the right amount into the syringe and then inject it.
“He’d wind up not taking his medication for three to four months at a time,” Wagner said. “Next time I see him, he’s coming from surgery. He had developed gangrene and needed a toe amputated.”
Because he was on a fixed income, there was no way he could afford to switch back to the long-lasting medication, Wagner said.
In Connecticut, prescription prices are changed every six months, Wagner said, adding that prices are changed at different times.
As a result, providers often don’t find out until several weeks or months later, he said.
HB 7174 is needed because so much goes on behind closed doors and there is no way for the public to find out and the bill provides transparency, Wagner said.
“It really addresses the drug pricing issue, the affordability issue,” Wagner said. “And this is really the right thing to do.”
For both Smith and Wagner, as well as Padilla, the need to regulate prescription drug costs is long overdue. And they all agree on the reaosn it has yet to happen.
“It’s very simple, the cost-saving on the patient side are the profits on the drug-making side,” Smith said.
Added Wagner, “Pharmaceutical companies don’t have an interest in lowering prices. In my opinion there are so many interested parties there is no priority to get this under control.”
The difficulty in getting legislation passed lies in all the money involved in health care, especially in medicine, Padilla said.
“There is so much money in drugs, that the incentives to fix these problems become very weak because they (pharmaceutical companies) have a lot of power over elected officials,” Padilla said.
Added Smith, “People’s lives are at stake and I think the government has a right and obligation to make sure the medications are affordable.”
Editor’s note: CTLatinonews has endorsed HB 7174 and partnered with AARP Connecticut to support passage of the bill.