On prescription drug costs

Medrants has written on the “Canadian solution” that many are advocating to contain the costs of prescription drugs. As he puts it so eloquently, it’s like treating a deep abdominal wound with a band-aid:

We need higher level thinking to better understand pharmaceutical costs and our resultant expenditures. The “wonder drugs” are not created by spontaneous combustion. They result from expensive research.

Physicians need to understand newer drugs very well. We need to understand when an expensive drug is a better alternative, and when a cheaper generic works as well.

We need the NIH (and associated Institutes) to sponsor important drug studies. Relying on the pharmaceutical industry to fund drug studies seems cost effective in the short run, but from a long term perspective, such studies are rarely designed to answer the important cost questions.

As I have written before, generic medications do not have the marketing muscle that the more-expensive name brands do. For instance, I have written previously that in cases of sinusitis and hypertension, studies have shown that the majority of cases can and should be treated with generic medications.

Galen has also chimed in on this. He writes:

With the advent of drug coverage, the true cost of medication is hidden from the patient, and they have no incentive to look at cost/benefit ratios regarding medication choices. Now the question is, what’s the best medication I can get my hands on for my co-pay.

By this point, there’s a lot of finger wagging going on at doctors. They should be prescribing the most cost effective medicines, not falling under the evil sway of those perky little pharm reps. That’s absolutely true, if you want to spend all of your time fighting with patients. When someone comes in requesting a certain medication, I can either write the prescription or spend 10 minutes of my schedule arguing about it, either angering or outright losing a paying customer.

That’s right. We’re a service industry, and without customer satisfaction we’ll quickly be out of a job.

I agree that we are indeed in a service industry, and “customer” satisfaction is paramount. However, the solution to the problem that Galen brings up is a tiered prescription drug plan – which is pretty much the norm in my area of practice. With co-pays for generic medications being $20-30 lower, there is certainly incentive on the patients’ part to request generic medications. As physicians, we should be more than happy to comply.

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