With the advent of drug plans, fewer patients are refusing to take common medications because of cost. The problem has also declined, as more and more blockbuster drugs are now generic. But as more of these common drugs become generic, fewer companies are producing them. This has led to an abrupt rise in the cost of generics that could cause significant health care inflation in the future. In the past few months, the cost of digoxin (a drug that has been used for over 50 years) increased from $4 to $54 for a months supply. Similarly, costs of levothyroxine, prednisone, codeine and doxycycline have dramatically increased.
The impact of rising prices for generic drugs could be enormous based on the huge number of prescriptions written each year. The problem is compounded by the explosive costs of brand name drugs, particularly for those with no major alternatives.
To me, the most frustrating is the medication Abilify. For many patients with major depression, the addition of Abilify to therapy with an antidepressant often leads to truly dramatic improvements, particularly if the patient is willing to participate in psychotherapy as well. But the cost is overwhelming. One month’s supply of the commonly prescribed dose is $717. Virtually none of my Medicare patients can afford the cost and yet, thanks to commercial insurance and those who can pay, Abilify sales rank first of all brand name drugs in the USA raking in $2.7 billion in the fourth quarter of 2013. If they cut costs by 80 percent, profits may well be the same, as so many patients could afford the drug.
Another example of the way in which pharmaceutical companies try to derive more profit from blockbuster drugs is to make changes within a year of a drug going generic. A good example was Forest Laboratories that produced the antidepressant Celexa. About a year before Celexa went generic, they released Lexapro, which was said to be more effective with fewer side effects. Thanks to a great marketing campaign and because, at that time, the drugs were essentially the same price, the vast majority switched to Lexapro. The differences between these two drugs are inconsequential, but Forest Labs has collected billions as physicians continued to prescribe the brand name Lexapro.
And then there is the fiasco with Alzheimer’s drugs. The most commonly used is Donepezil (Aricept), which is now generic. The dose is 10 mg daily. Soon before Donepezil went generic, a study indicated that 23 mg of Aricept protected against memory to a greater degree than 10 mg. Of course, they did not use 20 mg, as it was too easy to give two 10 mg tablets. The evidence that 23 mg is much better than 10 mg is highly questionable.
The Attorney General of New York State is suing Actavis, the pharmaceutical company that owns Forest Labs, for discontinuing the production of Memantine (Namenda), as it is about to go generic. Instead, they have told physicians to switch their patients to a once a day Namenda XR for which they will hold a patent for many years. The attorney general Eric Schneiderman stated “A drug company manipulating vulnerable patients and forcing physicians to alter treatment plans unnecessarily, simply to protect corporate profits, is unethical and illegal,”
The costs of drugs and the ability of companies to charge as much as the market will bear creates an enormous economic burden that affects the viability of our health care system. The more serious and life-threatening an illness and the more vulnerable the patient, the more we are willing to pay for life-prolonging treatment. The drugs prescribed to help cure cancer often cost hundreds of thousand of dollars, as are the new biologicals that dramatically improve patients with illnesses such as severe rheumatoid arthritis, Crohns disease and ulcerative colitis.
In many countries, drug prices are rigidly regulated. This is often given as a reason why we Americans must pay more in order to provide the research and development funds to discover new breakthroughs. But we remain hostage to an avaricious medical industrial complex that makes our health care system the most expensive in the world. This, in turn, leads to many who go without the best available care, explaining, in part, why the health of Americans ranks last of any developed nation..
Dr. David Lipschitz is the author of the book “Breaking the Rules of Aging.” To find out more about Dr. David Lipschitz, visit www.drdavidhealth.com