I don’t want to need it.
That is a thought that has been all too familiar to me when I venture on the patient side of health care, an industry that I study as a scholar as well with the distance of one investigating a foreign land in which they do not intend to become entrenched.
It is a thought that has been all too familiar as I see added to my daily regimen new medications, some of which I trust, others of which I am skeptical after reading reports on the industries that brought them to the market. I am, after all, familiar with the pharmaceutical industry and, while well aware that many have been able to manage well their conditions thanks to their products, am also not without cynicism as to their profit-based motivations.
“I don’t want to need it,” is not a mature response to a debacle. It does not remedy the need, nor does it even truly acknowledge the need. It merely resents the medical treatment, the need of which remains in doubt. What it does not ignore is the problem, and the prescription for its solution, whether that prescription is proper or not.
I have been on countless medications over the last five years. What has surprised me more than the prescriptions for various medications — some of which I had never heard of previously, and others of which I had heard of through direct-to-consumer ads, which I dislike on principle — is the business aspect of these pharmaceutical companies with which I have been confronted in a way that I have seen discussed precious little: copay savings cards.
I was pleased at first. My otherwise $300 (with insurance!) sleeping medication got promptly knocked down to $30, which almost made me forget that this particular doctor seemed to engage quite frequently with representatives from the pharmaceutical company pushing the drug. Almost, but not quite.
A couple of months later, a new medication got added to the mix to address a chronic parathyroid disorder. When seeing the price of $80 show up (post-insurance) on the pharmacy website made me wince, I did some research on the company website and other sources to weigh the (literal) costs and benefits of the medication. Lo and behold, the distributor Amgen provided a prescription savings card that knocked the price from $80 to $5. For $5, I’ll take my chances with the medication and see if it works for me.
Some research confirmed that these savings cards are not totally anomalous, and I have encountered them — sometimes in advance of filling prescriptions, and alas sometimes after the fact — with respect to other medications prescribed to me. And while it is normatively desirable to curb the rising costs of prescription drugs, what is striking about these savings cards is the limited information as to their very existence. My doctors did not point me in this direction. Nor did the pharmacist at Walgreens. I don’t expect that their failure to do so was in any way nefarious — they get no benefit from my paying $5 versus $80 per month — but it is unfortunate that their use depends on the patient being fastidious in their research prior to filling a new prescription.
Such an assumption may not be met given many individuals’ trust in, and deference toward doctors’ decision making, with 70 percent of Gallup survey respondents confident in the accuracy of their doctor’s medical advice and only 29 percent viewing it necessary to do their own research (though some research does support a decline in the public’s trust in physicians). Moreover, within this field in which there is ample information asymmetry — with the general public typically not as familiar (or for that matter, capable of becoming so) with the specifics of the medical decision making and potentially unlikely to research the cost-benefit analysis of prescription drugs and other medical treatments. The (even more) cynical part of me is left wondering whether prescription drug companies price their drugs higher than necessary to account for the use of such savings cards, akin to accounting for future “sales” in regular product pricing.
There is the additional concern that those who are engaging in that research are not the ones most in need of prescription savings. If — as I suspect — those who do conduct their own research on medical treatments are those who are more highly educated and, relatedly, higher on the income ladder, then benefits are not being distributed appropriately. Sure, people of all income levels enjoy their tax breaks. But those who need the money are not those of higher socioeconomic status, but rather those living paycheck to paycheck and for whom the price of prescription drugs impacts adherence to medication regimens. The failure to adhere to such regimens can come with additional costs, given that chronic diseases (for which many prescriptions are written) are responsible for 7 out of 10 deaths annually along with 86 percent of health care costs in the United States.
Indeed, 20 to 30 percent of medication prescriptions are never filled, and 50 percent of medication prescriptions are not continued as prescribed, with medication adherence dropping after the first six months of following a given regimen. I am the first to confess that I contribute toward these numbers, partly out of frustration of several-times-a-day reminders of a need that I resent, and often out of financial concerns that trump medical concerns.
To be clear, these figures are not all attributable to prescription drug costs. Some may be attributable to skepticism, denial about the need for a given treatment, or a frustration with particular side effects that accompany the given drug. But it is difficult to imagine that prescription drug costs are a negligible contributor toward these numbers, which is particularly distressing given that non-adherence carries an economic cost of an estimated $100 to 249 billion annually as of 2009, while improved self-management of chronic diseases is estimated as having a 1:10 cost to savings ratio. It can literally pay to better incentivize adherence (at least setting aside the many questions as to whether we are being systematically over-treated in the American health care system).
That drug manufacturers provide greater savings to patients is doubtless advantageous in making it more feasible to treat illnesses without causing as much financial burden. As someone at the relatively unusual intersection of high education and low income (lucky me), I am also, I suspect, at the relatively unusual intersection of conducting extensive medical research and benefiting immensely from any financial savings that come my way as a result. But were I less skeptical about the industry with which I interact all-too-much, I would not likely know to reap this reward.
It is unclear whether it is nefariously intentional on the part of prescription drug manufacturers that such savings be more in theory than in practice, relying on unrealistic expectations of consumers to do their own research on the medical and financial costs and benefits that they can expect, or whether this is simply a problem of information dissemination (or rather, lack thereof). To be sure, drug manufacturers stand to gain through their use relative to the financial losses incurred from consumers’ shifts to generic drugs instead. But physicians whose patients’ progress is monitored, and as the numbers above suggest, the American economy as a whole, all stand to gain as well. Increasing physician awareness of, and communication about, copay savings for prescription drugs will go a long way toward reducing reliance on consumers’ own savviness to do so, and in turn enhancing adherence to treatments prescribed.
Miranda Yaver is a postdoctoral researcher.
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