Drug Costs: Is it all a Scam?

By: Deidra James and Michelle Mitchell

Pharmaceutical tycoon Martin Shkreli sparked outrage when he raised the price of the antimalaria drug Daraprim from $13.50 per pill to $750 per pill, a five thousand percent increase. The media heavily scrutinized Shkreli for this decision. This led to a government investigation that resulted in the eventual arrest of Shkreli for his illegal activities at another company.

However, Shkreli’s case is not unusual; price spiking is a common practice among pharmaceutical companies here in the United States. These spikes often occur without warning or cause, placing substantial financial burdens on millions of Americans.

The reason for this is the lack of federal government regulation. Unlike most countries around the world, the United States does not regulate drug prices or how pharmaceutical drugs determine the price of drugs. This lack of regulation leads to a 5,000 percent increase in the case of Daraprim or the delayed care of patients in the case of Sovaldi.

In addition to the lack of regulation, there is little to no competition for most pharmaceutical companies. This allows for them to set prices that insurance companies and patients either accept or do without medication.

Like Daraprim, the drug Sovaldi, which helps to treat and cure Hepatitis C, has also raised dramatically over the years. If left untreated, Hepatitis C can cause damage to the liver and lead to liver cancer.

With the timely treatment of Sovaldi, patient outcomes are promising. However, accessibility to the drug has become difficult over the years. One 400mg pill of Sovaldi costs around $1,000. Couple the price with the recommended dosage of one pill a day until the disease resolves, and the bill quickly adds up.

Because Sovaldi is so expensive, most doctors only prescribe Sovaldi if the patient has liver damage. Delaying treatment, however, causes more pain and expenses to the patient.

With this view, the media and the public can easily demonize pharmaceutical companies. Many of their practices have made it difficult for patients to receive quality healthcare. However, Brianna Mosby, a third year-pharmacy student at Mercer University, shines light on the situation.

“The profit margin is going to drive how much the medications are,” said Mosby, “but there are many variables that drive that gap.”

“Quality assurance, the different measures that they have to go through to set up the clinical trials, to make sure that the medication is efficacious, to make sure that they’re safe,” explained Brianna, “All those things are going to factor into how the medication prices are going to be, how they fluctuate, how they are going to be reflected to us as consumers.”

With this information, the dramatic costs increase seems warranted, but for patients with chronic conditions such as diabetes and high blood pressure, the information does not ease their financial burden.

Insulin, for example, aids in the treatment of diabetes a disease that affects 29.1 million Americans.

Insulin brands such as Humulin R “have increased in wholesale price by more than 160 percent in the past five years,” says Allison Tsai, the feature writer and web editor at American Diabetes Association.

One of the reporter’s grandparents provided insight on the high cost of Humulin R, however they requested for their names to be changed for the recording of their story.

Albert, an army veteran who fought in the Vietnam War, has struggled with diabetes for the last seven years. He uses Humulin R and eats a balanced diet in order to maintain optimum health. Like many diabetics, if Albert does not receive proper insulin dosages he will become hyperglycemic (too much sugar in the blood) requiring him to be transported to the hospital via ambulance.

“It’s very hard,” said his wife Julie, “With bills piling up, we can barely afford his insulin.”

Julie states that they are struggling to pay for the ambulance bills along with Albert’s insulin. Julie is finding it difficult to maintain her husband’s health and make ends meet with their retirement money.

Unfortunately, Albert and Julie are experiencing what many retired Americans are experiencing. Mosby sheds light on why the elderly and retired are the most affected patient group.

“A lot of them are on fixed incomes and they have transportation issues getting to and from the pharmacy ”said Mosby, “trying to get transportation to the pharmacy or wherever they are acquiring their medications that’s an additional costs that they have to pay.”

The most detrimental, and obvious, part pharmaceutical costs play into patient care is the treatment plan of patients. Health care providers must change their treatment plan in order to accommodate the patient’s insurance.

“For patients that have insurance,” wrote Erin Stewart, the Director of Public Relations and Social Media at the Georgia Hospital Association (GHA), “determine whether they try other less costly drugs before trying the one in question.”

For many patients, this means receiving the generic form of a prescription drug. While this does save the insurance companies and patients money, not all generic medications are equal to brand name drugs.

“A lot of those medications aren’t interchangable,” said Mosby, “If someone starts on the brand name then they need to continue on the brand name. Some patients don’t respond to generics.”

“When you’re talking about the difference between generic and brand medications the primary components of those medications are consistent,” added Mosby, “but when we talk about fillers or things that make up the weight of the medication that’s when it changes.”

Many patients may be allergic to the filler and dyes used in generic medications or simply do not respond to them at all.

Despite this concern of generic drugs, many programs headed by hospitals and chain pharmacies are providing reduced or free generic forms of prescriptions for patients. For example, Publix Pharmacy offers 90-day supply of generic forms of maintenance medications such as Metformin, a diabetes treatment drug, or common antibiotics such as Amoxicillin.

These programs are ways the healthcare system is trying to cut costs for patients.

Both Mosby and Stewart mentioned contacting the manufacturers for coupons or discounts as ways to reduce the costs.

With the Republican’s failed attempt to repeal The Patient Protection and Affordable Care Act, pharmaceutical regulation has been shelved again. However, many patients could use protection and safeguards from the government in order to be able to maintain their health and budget.