Excellent clinicians prescribe thoughtfully—pruning medication lists, advising patients on how to save money, and advocating for change.
Last month I read a lot about the challenges to healthcare in the US. Recognizing that the current cost of healthcare is approaching 20% of the GDP is not sustainable, I have focused my attention on one element of healthcare costs that we, as clinicians, have some degree of input on—drug prescriptions.
Medication costs constitute about 10% of the 2.5 trillion dollars spent on healthcare in 2017, and between 1997 and 2007, drug prices tripled, according to a study in Health Affairs. As of January 2020, the prices of 499 drugs increased literally overnight by an average of 5.2% as reported by researchers at GoodRx.
For one disorder, multiple sclerosis (MS), tremendous advancements have been made in disease modifying therapies. At the same time, annual Medicaid expenditures on MS DMTs have increased from $453 million in 2011 to $1.32 billion in 2017. This is in part due to the deployment of newer and more expensive drugs, but Hartung et al have identified other drivers of cost including “the existing price ecosystem, overall corporate growth, international pricing disparities, and supply chain–related distortion.” Generics have been developed for some DMTs, but have not had a significant effect to reduce costs and probably won’t until there are three to five generics for each brand name drug.
With this background, what can clinicians do?
1. Educate ourselves and our patients on the relative costs of generic and brand name drugs (goodrx.com is one site).
2. Prescribe thoughtfully, and prune medication lists regularly.
3. Join efforts to lobby Congress to control drug costs.
It seems that the Senate is most unlikely to pass a pending bill passed by Democrats in the House of Representatives in December 2019, which would empower the government to directly negotiate drug prices and cap prices at 1.2x their cost in other countries. Please attend the Society for Neuroscience Capitol Hill Day on March 5, 2020. ALL clinicians from ALL specialties are encouraged to attend.
4. Support and engage with efforts by state governments to control drug prices.
For example, Maryland just introduced a drug board that includes clinicians, pharmacists, and healthcare economists, charged with identifying prescription drugs whose costs rose by specific amounts over one year and thus could cause “affordability challenges” for patients and the state healthcare system.
5. Use our relationships with industry to put pressure to provide patient assistance programs for expensive drugs.
Biogen set an excellent example of setting up effective patient assistance programs with their life-transforming drug for spinal muscular atrophy, Spinraza™, which has a first year cost of $750,000 (website SMA360™). Essentially every patient who needed treatment was able to get it.
So please consider this your “call to arms.” Even small steps can make a difference. There is so much at stake for our patients.