Indiscriminate drug price hikes saddle patients with higher medical costs, cause them to skip doses of their medications, split their pills, or force them to abandon treatment altogether. The distorted marketplace for prescription drugs allows for drug prices to increase without warning or justification.
Many patients rely on generic drugs as an affordable option for their medication needs. They expect when a generic version becomes available for a brand name drug, its price will be lower and continue to offer them cost savings over time. In reality, generic drug prices can shoot back up, sometimes surpassing the cost of the brand name medication.
The expectation of generic drugs being inexpensive relies on reasonable competition in the marketplace. When one-third of generic drugs are produced by three or fewer manufacturers, there is nothing stopping pharmaceutical companies from indiscriminately raising the price, even for generic drugs that have been available for decades.
Consumers expect pharmaceutical companies to compete with each other to offer the best price. Yet, patients face the harsh truth that prices for some of their prescription drugs are at record highs, even when there are multiple brands available on the market.
Take insulin for example. Insulin products from various drug makers have undergone frequent and nearly simultaneous price increases in recent years. Patients are left without alternative, affordable treatment options, and their health can suffer. As a result, physicians and patients are left wondering if this is how the market is supposed to work.
Developing new drugs is a time-consuming, expensive process filled with years of clinical trials and monetary risks for pharmaceutical companies. The alternative: Acquire existing drugs and reap the profits without the risk. This easy, low-investment strategy threatens to divert attention from discovering new, innovative treatments that could save thousands of lives. The focus now is on cost savings for the company and profits for shareholders, but what about patients?
Some companies have significantly increased drug prices following an acquisition. Patients are disproportionately harmed by unexpected and excessive costs while investors only see the upside – profits. As this business strategy becomes more common and more lucrative, patients have access to fewer treatment alternatives and are stuck footing the bill.
Pharmacy benefit managers (PBMs) insist that the deals they strike behind closed doors between pharmaceutical companies and health insurers save patients thousands of dollars. They call it their “secret sauce.” But, their recipe for cost savings leaves out the fact that PBMs are private businesses seeking to turn a profit on every deal they close.
PBMs negotiate discounts on the prices of prescription drugs and rebates based on volume of sales with pharmaceutical companies. In turn, health insurers determine which drugs to cover and how much patients pay. PBMs charge fees and make profits all the way down the pharmaceutical supply chain, while insisting that they pass on savings to patients from the deals they strike. But, how do we know if that’s true? Since PBMs refuse to act transparently, there is no way to know if these deals lower prices or require patients to pay more.
When a physician treats a patient, they have a lot of information available at the point-of-care. Medical history, notes from past visits, current prescriptions and more are easily accessible using an electronic health record (EHR). But, one very critical piece of information is often missing or hidden: Costs of prescription drugs based on the patient’s health insurance plan. Only 11 percent of physicians find it is easy to access this data electronically.
This missing information at the point-of-care can make prescribing feel like a frustrating guessing game. Physicians frequently have little or no idea what a patient ends up paying for a particular drug until the prescription is processed by the insurance company. Even when a physician has information on how much a drug costs for one patient, the next patient who needs the same drug may pay a completely different price. Physicians need to have prescription drug cost information at the point-of-care so patients can afford and access the treatments they need. Importantly, this information needs to be available for every patient the physician sees—not just those covered by certain health plans.
You’re a physician with patients who all need the same heart medication. Find out what happens when each patient tries to fill the prescription using their insurance. Click prescribe to start.
A patient has been taking a certain prescription for several months or years and doing well. Their copay has always been $10 on their current health insurance plan. But suddenly, their routine pharmacy pick-up turns into sticker shock when their copay jumps to $50. Or even worse, they find out the drug is no longer covered by their health plan. They selected this specific insurance plan because their drugs were going to be covered and affordable. Their plan hasn’t changed, so how can the amount they pay for the drug increase in the middle of the year with no notice?
Unfortunately, this scenario is becoming more familiar to patients. Health insurers and pharmacy benefit managers (PBMs) are negotiating drug coverage and prices at their own will during the middle of the enrollment year – leading to higher copays or some patients being forced to pay retail price for a drug due to lack of coverage. This bait-and-switch not only frustrates patients but can cause serious negative health outcomes. When cost is a factor, 29 percent of adults report not taking their medicines as prescribed. The result? Among this group, three in ten say their condition got worse.
