While it may be easy to focus on pharmaceutical and insurance company pricing practices, it is also interesting to examine the consumer side of this equation as well. It strikes me as odd that $53 is a tipping point for compliance to a medicine that is literally saving the life of the person taking it. That seems like a fair price to pay to stay alive every month. In contrast, we don’t hesitate to pay $100 for our cell phone bill or $150 for the cable TV bill or $75 per month to fuel our Starbucks habit. While there is blame on the corporate side of this equation, there is also a problem with how we value medicine relative to important, but discretionary, spending.
4
Eric. Check your privilege. Not all people can spend the money on discretionary services in the way you describe. Thus the pill splitting.
4
@Dianne You're right that not everyone can afford the discretionary spending, but I know many people who will pay $30,000 for a car and will not pay for medicine. There are two groups -- the ones who really do not have the money to pay for medicine and the ones who choose to spend their money on other choices.
4
It is sadly ironic that America's For Profit Health Care System does not cater for or protect at least 10% of citizens as well as so many others who already pay for it, depend on it and yet in the end still do not profit from it at all with some even dying due to their inability to afford a full or correct course of life saving medicines that they must pay additional contributions over and above those they already pay.
At this rate , the for profit Health Care System will no longer profit most of the people who are supposed to profit from the cures, treatment, recovery, medication or procedures that they will need or must have in order to continue.
Then of course, the only profit of the entire system will eventually only be the money to be made by some regardless of the outcomes it provides for those that pay for and fund it.
Thus becoming something extremely unhealthy to those whose health will one day depend on it for their life.
That's sick.
1
As long as insurer/payer costs from doctor visits, emergency room visits, or hospitalizations due to non adherence don’t exceed the savings in pharmaceutical costs, copays are good for payers, and payers will continue to impose and, indeed, increase them.
People keep mentioning the Canadian healthcare system and it's FREE. If you want to wait months for treatment. Canadians or their employers buy supplemental insurance to see doctors faster.
3
Making people pay discourages them from doing something. Why is this surprising? I assumed this was by design it is so obvious. Not that it makes it any less evil.
5
Our system is too cpmplicated and too expensive. You must figure out how much co pay you owe on certain drugs, how much deductible you need to meet. You need to know if they're on the insurers approved list, and if the generic version is accepted but not the name brand. In most countries you don't have to be an insurance person or a pharmacy manager to understand what you are getting. There are no surprise fees and price hikes, and there are no bankruptcies due to overwhelming medical bills. You walk in, see your doctor walk out with your prescription, get it filled all covered under your national universal healthcare plan.
9
The hard-heartedness of some of the comments here, is simply appalling. Seems that many folks still jump to the "blame the victim" gambit right off the bat - most especially when it comes to impoverished or marginalized groups. Its like when President RayGun painted the image of some young black "buck" using his food stamps to buy sirloin steaks. Here its either 1) These folks aren't REALLY poor: they can all afford cell phones, cigarettes and beer, right? or 2) They shouldn't be complaining: some government help is better than nothing, and who can't afford a $20 co-pay.. then there's the "If we made things free then they would be abused and overused." blanket assertion. Being poor in the USA is INDEED a thing, and a) Nobody CHOOSES to be impoverished, b) 99 out of 100 poor folks would gladly take employment they could handle, so they wouldn't be dependent upon others (ie, despite popular opinion, most people WANT to be able to stand on their own two feet and provide properly for their family), and c) the reasons for poverty are many - physical or mental illness, learned hopelessness, poor education levels for many reasons, children they have nobody that they can turn to to help take care of, a sick parent that requires a lot of attention at all hours..... the list is NOT short. People without compassion need to stop and think for a moment about all the possible reasons the persons they are picking on and complaining about, might have gotten to the place they are now.
15
@Joseph Ross Mayhew ,
Well said!
3
Arguably, there are benefits if a substantial number of lower-wage earners cannot afford their drugs and skips them. The skippers will die sooner, and they will be processed out of government benefits. High drug chargers therefore help the US patriotic ideals!
3
I will bet these same people do not skip their mobile phone payments, cable payments, nights out with the boys, sports tickets, restaurant outings. Just saying. We all have our priorities.
5
@Mary Rivkatot My experience agrees with yours. I've had to show the seniors around the Thanksgiving table who cry poverty just how large their SS raises are compared to the youngsters just starting out, as well as how much they have left aftertax due to their exemptions and subsidized health care. Taking one cable package lower than what they have, or selling the second home would cover the copays for a long period of time. I feel for the youngsters -- they do need help with their med payments and they do need to understand what that beer is doing to the insulin pump algorithm.
1
@Mary Rivkatot
Furthermore, the skippers will die sooner, and they will be processed out of government benefits. High drug chargers help the US patriotic ideals!
1
The people being described in this article do NOT own two homes; are not on expensive cell phone plans if they even have one; and do not get benefit raises annually that are more than copays.
You are both blaming the victim.
Read more and educate yourselves!
4
Co-pays and deductibles were added to American health insurance to prevent over-utilization and reduce the price of the monthly premium, often at employer insistence.
As costs continued to rise, the deductibles skyrocketed, the pre-authorizations for care were instituted and payments for some medical diagnoses and conditions were excluded.
Eliminating profit from healthcare would help, eliminating competition of rival hospital insurance companies and health systems would also help to rationalize the large investments in duplicate facilities and ensure provision of hospital services in rural and under-served areas.
Canada does it pretty well, at lower cost, and the Canadians live about 2 and 1/2 years longer than us Americans. No Canadian suffers medical bankruptcy or goes without needed medication.
9
I pay a copay of $60 a drug for some drugs. MVP Gold. Every month its $160 total. Insurance is $887 going up to $940. It has bankrupt me and I'm going on Medicaid. All my savings gone. Thanks America.
11
I do think any Medicare for All plan should include a small sliding scale copay ($1-5) per doctor visit to reduce costly visits due to hypochondria or social neediness. But a copay for drugs is misplaced. These statistics are valuable.
Thank you so much for being the judge and jury on whether a copay is "modest" or not. Clearly you have better coverage than many of us. The whole idea of "modest" is subjective, and can only be determined by each patient's own individual situation, not on your elitist opinion.
7
In the 1970s, when a SC "welfare" family of four received $104 a month plus food stamps, there were discussions about making them pay a small copay for medication. At the time, an average middle-class family was taking home about $1900 a month. Fortunately, the idea didn't fly. Around the same time, a young cousin of mine died of leukemia at age 8 because treatment did not work for him.
Most people would rather take less medication than more--and they'd like to be able to take their medication and pay their bills and put food on the table, all at the same time.
People should not have to choose between their health and their shelter, food and clothing.
17
Dough! Not eating or being homeless can be even worse for your health. When your back's against the wall, difficult choices are mandatory.
4
Wish the author had delved deeper. Patients have always been non-compliant, even when their meds are 'free.' A co-pay of $20 should not stop anyone from getting their meds. The truly poor are on Medicaid and pay nothing. And those with limited funds still find a way to have cable and the latest iphone (priorities).
It's the person living on limited funds (elderly and some young) that have to pay hundreds - not a co-pay, but a medication that either has no generic or one that is is lucrative enough that generics are over-priced. The latter is much more common under the ACA implementation by HHS as it dictates generics must be used, and will be reimbursed by the government for those on government plans (i.e. creates the floor price).
Co-pays are reasonable. Just because we get sick and need medicine doesn't mean it's all free - nothing is free.
PS of the 3 diabetics I know, all skip their meds and do things that are not recommended. All have the money. Again, non-compliance runs about 20% across the board, just ask doctors.
4
@Ma
Many people fall between the cracks. They are not eligible for Medicaid and don't earn enough to be eligible for the ACA either. In my state, unmarried adults with no children cannot even get temporary aid when they have no income. $20 is a lot of money for these people. (They may get cellphones through an assistance program for free.) I suggest you learn more about these people before you assume that all but the poorest can afford copays.
20
Not providing care that a patient paid for via premiums is the main feature of the American free market insurance industry. The best financial position for an insurance company is to collect premiums and then minimize paying out claims. Maximum in, minimum out. Nice work if you can get it. Great for managers and shareholders. High co-pays and deductibles disincentivize patients from seeking care that they paid for. By comparison, in England if you're over 60 or have cancer, your prescriptions are free:
https://www.nhs.uk/using-the-nhs/help-with-health-costs/get-help-with-prescription-costs/
13
Are the people who can’t afford copays able to afford full price for their pet’s drugs or their favorite supplement?
2
Many of those who have gold-plated health insurance and/or possess the resources to easily cover co-pays and deductibles have expressed strong opposition to a system of universal healthcare. They complain that if the less affluent are able to obtain all the heath care they need, they will "overuse" healthcare, thereby increasing wait times to see a physician for those who now have all the medical care they need. Yes, I can see the scenario. The healthy lower income individual who has a day off from work asks, "Shall I use my day off to take my children to the park or should I spend my time at a doctor's office keeping patients from getting medical care?" I don't know what overuse even means.
That is such an arrogant, condescending attitude, and is yet another manifestation of the wealthy elite's claims of special privileges at everyone else's expense. Unless we as a society adopt a policy that everyone is entitled to the medical care they need, and that everyone needs medical care, the problems described in the column will continue to fester.
26
So well put! I don’t understand what the “overuse” argument is supposed to mean either—do they believe that people will want pricy surgery, or chemotherapy, or dialysis, because they don’t have to pay out of pocket? Clearly not. Ridiculous.
7
So what? Are not people expected to pay their own way through life? Are we to make everything free for everyone? Someone has to pay. People have to take the responsibility of their own life and pay for it.
6
@Hardhat72 But in many situations we already use our social conscience to see to it that everyone in our society benefits from government policy. Examples include police and fire departments that we all pay for thru our local taxes and from which we all benefit. We all pay payroll taxes to ensure that current social security recipients get their benefits and expect that when we retire other younger workers will pay their payroll taxes so we can receive our benefits. The list is long.
Expecting people to pay for their own individual health care is a short sighted policy. Doing so would drastically reduce our national life expectancy and make for a much sicker work force. Do we want that?
9
@Hardhat72
So a waitress who needs a cancer drug that costs $5000 a month is expected to pay her own way?
14
@Craig Willison
Well, yes, that is the Libertarian logic. She should have majored in finance or other high paying job, like drug running or stripping, perhaps.
11
Has anyone noticed all the drug ads on TV? More money is spent on those to convince you that you NEED this drug whether or not you really do than on research. I have friends who were struggling to pay for their insurance because of “preconditions “. Some were not old enough for Medicare other were on Medicare but needed additional insurance due to MS, etc. They are covered by “Obama Care”. Remember much depends on what state you live in because the state has control on the insurance industry.
5
In my case, thank god for the VA.
One shouldn't have pay more a dollar over the cost of manufacturing all drugs.
7
Human nature being what it is, even a small co-pay will cause some people to scrimp on needed care, just as no co-pay will cause some to over utilize. Which is worse? Skipping needed care makes us sicker, have worse outcomes and eventually higher cost. Over utilization drives up costs and by clogging the system paradoxical decreases access. There must be some middle point which balances this out as best as possible.
1
What is “overutilization”. My doctor is hard to see. I just made an appointment for an annual exam (unable to get an appointment until February). She checked a breast lump and referred me to another doctor and ordered a mammogram. She gave me a flu shot.
I can’t easily see my doctor without a good reason.
What doctor that you know sets appointments for minor reasons or prescribes for all visits.
Your concierge doctor’s practice? Definitely not my very busy doctor, where regular appointments are about 3 weeks out.
10
My son was diagnosed with Type I diabetes at the age of 9, in the 1990's. Our family was fortunate enough to have "good" insurance, yet our copays for insulin and test strips usually exceeded $100/mo. It did put extra strain on the family budget, but it was not as if we had the luxury to decide whether or not to buy that insulin. My heart ached for mothers without "good" insurance every time I wrote those checks. Copays have done nothing but go up in the years since, and now constitute a real impediment to obtaining live-preserving drugs.
28
it seems that the more things insurance helps pay for, the more expensive these things become. When insurance started paying for doctor visit, the cost of a doctors visit ballooned. when insurance started paying for prescription drugs the cost ballooned.
I am not saying that insurance shouldn't cover these things, but it is interesting how the possibility of more $$ drives costs up.
6
@Cantaloupe
My Lantus Insulin goes up every year. Last year it was $255/ This year it is $337.
Why?
6
That knowing the cost of and contributing to paying for medications somehow make patients more responsible is a right wing trope. Medications are not like varieties of fashion. They are life and death. People who need them should be able to take them.
19
Nice comments but it is important to remember that 80% plus of Americans are "extremely happy" with their health care. It basically costs you nothing if you work and have coverage and Medicare Advantage is almost free unless you leave the network.
1
@Norwichman - if you work, it's costing you a raise. Advantage plans are a for-profit ripoff of taxpayers with very limited provider networks. Most people are only happy with their private insurance until they need it, and discover it ain't what they thought. Go to newimprovedmedicareforall.org for some actual facts.
17
@Norwichman I expect that in Del Mar ($122,563 median income) 100% are happy with their healthcare. Where you got the 80% figure for the rest of the country is beyond me, and indeed a perfect example of 1% insularity.
12
@Norwichman
Medicare and Medicare Advantage are not "free".
Part B premiums are taken out of Social Security benefits. Medicare Advantage plans are paid through the Part B premiums. Those who do not use a Medicare Advantage plan are required to have a Part D drug plan and usually have a supplement to cover copays.
11
I take 16 different prescriptions with varying co-pays. Four of those drugs are eye drops for glaucoma. I run out of the drops sooner than expected because of spillage due to shaky hands. When I ask for more, my mail-order prescription company basically says something like "tough luck" or "too bad." And the co-pays are nothing to sneeze at either. My husband and son also have large co-pays due to diabetes, hypertension and other chronic conditions. I now regularly choose between food and medicine. So what am I supposed to do? Go blind?
26
@george - "So what am I supposed to do? Go blind?" That's exactly what Ayn Rand's GOP disciples would have you do. Support Medicare for All, which can solve this and save everyone money.
12
The complex and cruel American healthcare system cannot be justified or sustained. 85M people either have no insurance or can't afford to use what they have due to deductibles, co-pays and co-insurances. That's 25% of Americans not getting healthcare. Just give the people the healthcare they need. We already spend more than enough to cover it. Enhanced Medicare for All.
11
I am a family doctor. What I get out of this data is that about 15% of patients will not taker their medications, no matter what. Co-pays, no copays....I spend my days trying to understand this phenomena.
8
@bpaskiet I think that the roots of the phenomena are cultural - we value health and vitality (or a convincing appearance of such). Having to take pills daily reminds you that you are 'not well', that you have a chronic condition that will not 'go away' - and might get worse. The other aspect is that meds to manage chronic conditions work by delaying/preventing disease symptoms, so there is no immediate negative feedback loop if you 'forget' your pills.
6
@bpaskiet My thought also - I am not a doctor, so my observances are strictly anecdotal. (And I understand this point was not covered in the article - but I wish it were.)
My mother-in-law distrusts hospitals, doctors, etc. She will only go to the doctor if she is ok, and even if very ill, will say to doctor, "I'm fine" and omit info about her symptoms and OTC self-dosing. When prescribed a diuretic for her swollen legs and high BP, she stopped taking it when she "thought" her legs looked better.
My sister (who definitely knows better) had been on Metformin and Lexapro. She stopped taking both because "the prescriptions ran out." Unfortunately her anxiety severely rebounded, and her A1C skyrocketed (over 14). Fortunately, the doctor gave her a serious talking to and she is now compliant - but needs to take daily insulin, and Ozempic.
My husband was prescribed blood pressure meds almost 20 years ago. Tried them for a week or so, stopped because they made him feel ill (he was taking them on an unnecessarily empty stomach - "SO EAT SOMETHING!" I said. He still hasn't taken anything.
Human nature?
1
I've cared for MANY patients on ten medications or more, including oral diabetes meds +/- insulin, antihypertensives, diuretics, on and on. The vast majority of these patients were retired and receiving Medicare. A "modest" co-pay for one medication might seem like not much, but a "modest" co-pay for ten medications on a monthly basis can be life and death. So long as we allow pharmaceutical companies to charge what the market will bear, we refuse to regulate insurance companies (and allow them to choose which medications they cover or don't, or "tier" medications), and refuse to allow CMS to negotiate prices for drugs, this will continue.
I'm a physician. I was prescribed eyedrops for allergies, and amusingly had an allergy to the over-the-counter drops. My health plan (a "good" one) initially covered the eyedrops for a $50 copay per month, then dropped coverage and the cost of the medication out of pocket was $150/mo (I calculated it to $6 a drop, I believe). I can live without them, so I just don't take them. The harder you make it for people to take medications ("cost-sharing" ie making them pay for them, limiting access, swapping for generics or similar meds), the less they'll take them. This isn't rocket science, it's greed, I mean capitalism.
45
@anniegt Also, many MDs are not comfortable with the idea of 'de prescribing' medications that may not be needed. Drugs to prevent osteoporosis and statins are 2 categories where the data shows that after a period of treatment, continued use does not provide increased protection and is not needed.
4
"There’s a logic to out-of-pocket medical payments. They’re supposed to make patients think twice before spending money on unnecessary health care."
Do you really think there is "unnecessary health care" in America? In a country with epidemics of diabetes, obesity and heart disease, it doesn't look like people are overusing health care. Maybe with lower co-pays and deductibles they could afford the care they need. These people need more access to doctors, not less.
22
@Craig Willison There have historically been cases of people with good insurance simply visiting their doctor(s) every week. I don't have facts in hand, but I recall that this was happening among retirees in Florida. I would call this a "needless use of resources." This is very different from people who need medical care. It looks like there is no "one size fits all" for how we deal with payment for medical services and drugs.
3
@Craig Willison We need to look beyond copays and deductibles for answers to the problems of obesity, diabetes, and heart disease. More (or less) access isn’t the solution.
@James. In the standard right-wing attack model, they find 1 or a few individuals who are "abusing" some system, and use that to convince us to believe that most people are behaving that way. The facts never support those tropes.
The goal is to get us to support punishing the other 99% for the supposed sins of a few.
As you said "I don't have the facts at hand" - - in most cases the facts don't actually exist. Feelings over facts.
13
Rapidly rising deductibles and co-pays have helped insurance companies deal with the fact that healthcare inflation is out of control and they are unable to stop the rise.
8
@SAO. Let's not forget that employer - based private insurance is a partnership between the employer and the insurer. The employer sets their budget and the insurer tells them what they can get for that amount.
1
@Concerned Citizen There is zero actual data that supports this statement.
16
What is "modest?" With the stagnant wage growth we have seen over the past 20 years, one man's floor is another man's ceiling. There is no rhyme or reason for drug pricing. The strategy is often "whatever the market will bear." This is a disgrace in the richest country in the world The media clowns in DC who used to be legislators now spend their time yelling at one another rather than actually governing.
21
One of the drugs I take for diabetes is a brand name drug which was supposed to go generic this year or next but that has been delayed, most likely because the manufacturer has paid off the generic maker to delay its release. In the meantime, I have been hitting the "donut hole" mid-year because of a necessary drug (for which gratefully, I am getting help with the co-payments). The co-payments on my diabetes drug range from $188/mo to $20/mo when I hit catastrophic coverage at the end of the year. I really need this drug to keep my disease in check, but I cannot afford 3 figure co-payments on my social security income. Splitting pills worked for a while but no longer does. The drug company does offer financial help but the application for it explicitly states that I must sign away all privacy rights. I take a number of other drugs as well, all of which are generic. I am using my modest savings to pay the co-payments and the insurance premiums. Even with that I have stopped taking one drug to save money.
29
Too many Americans take too money drugs but isn't that what big Pharma wants?
The average American …
A study published by Mayo Clinic a few years back reveals that 70% of Americans take at least one prescription medication. The same study shows that 20% of Americans are on five or more medications.
We need to quit thinking that a pill will solve all of our medical issues. Reading these comments below - how many people are obese, too fat, sedentary? Get off your couch and exercise, eat right, lose weight and a lot of the pills can go down the toilet. I take no drugs other than Motrin. I am not young. GET OFF THE COUCH. LOSE WEIGHT. GET OFF DRUGS that you don't need.
6
@Sarah99 Oh, thank you so much for your wise and compassionate advice. If I'd only known that my MS could have been avoided/cured by running more 5Ks....! P.S. Down the toilet is a very dangerous way to dispose drugs.
15
@Virginia
Yes, I really wish that exercising more could make my essential tremor, restless leg syndrome and blepharitis (severe eye condition) disappear.
So helpful of you Sarah99. Thanks greatly!!
8
@lydia davies Me too! Sarah99 please tell my Leukemia and thyroid cancer that it is all my fault!
1
Negligence, arrogance, cost. Don't get sick here. Don't die either.
15
"This is mainly an American problem."
Unless we elect Warren or Sanders. Medicare for All is the only way to solve the travesties of our broken healthcare system.
21
This is the "Great American Con" being perpetrated by drug and insurance companies. Why should we pay through the nose for any drug that's been an affordable price for decades and now has a jacked-up price due to avarice?
Recently, I was prescribed a 5 ounce tube of ointment for shoulder pain. With a straight face, the pharmacist told me it would be $1000 for the medicine. I laughed in her face and told her to give me a price on the generic ointment. Suddenly, the cost was $1.25.
Oh, really. So, be forewarned. It's imperative you know what your insurance covers and if the price is too high, seek alternatives elsewhere and never be afraid of walking away.
I refuse to be exploited or cheated by these dishonorable, money-grubbing companies.
46
@Pamela L.
Your response was appropriate and the only way to control costs. I also left a $600. tube of cream at the pharmacy. This is the same mechanism that results in lower prices in European countries. Those governments are willing to walk away from a drug contract if the price is not reasonable. US citizens will not stand for that approach. They want everything and they want someone else to pay. Enlisting the government to pay for the medicine, however, will only result in $2000. tubes of cream. A more constructive use of government money would be to subsidize drug trials. That way a vested interest is not controlling the human trials so there would be a better estimation of a drug's effectiveness.
7
Interestingly, I was just reading another New York Times article about the idea to create a nonprofit consortium to further develop Artificial Intelligence technology; for-profit companies would more likely insert harmful biases to underscore their bottom line.
Perhaps there should now be a global consortium of nonprofit pharmaceutical developers that focus much more on efficacy and safety than simply making money. As we all know, healthcare should NOT be a for-profit endeavor and is too important to the smooth functioning and happiness of our society.
6
@Andre Hoogeveen I'm surprised that no one has mentioned the outrageous salaries of pharmaceutical company executives. There are articles in the NYT today discussing how to "redistribute" the ridiculous wealth of the extremely wealthy. Not allowing greed to persist is critical to the survival of our democracy, even if some choose to call it socialism.
7
This is a result of rising prescription costs and gets worse daily. Even with coverage as basically healthy elder with a common heart issue (afib) my drugs put me into the donut hole by June. I just picked up my latest round of meds for approximately $600. How many elders can do that and not begin to cut their pills or worse?
21
I am a well paid professional with employer provided insurance...and a co-pay so large that I try to spend entire years without seeing a healthcare professional. And I know I am far from alone. The medical care system in America is so broken I don't know how we fix it.
43
@Sue
Vote for Warren. She'll think things through and make a workable plan.
17
@Jennie Or not. Warren being nominated will give the Repubs the opening they need to defeat her. She wants to replace private, employer provided health insurance with 'Medicare for All'. Her proprosal will scare the bejesus out of millions of Americans who are, sadly, "happy" with their current insurance despite it's escalating deductibles and copays. Senator Warren needs to "think things through" before she speaks.
6
@sleepdoc she did. And does. Her plan is cheaper and better than what we have now. People care less about their plan than about their coverage. They are just not being told that.
7
I think it is really cute that Joe Biden thinks I can spend $200 on drugs every month. I am elderly and disabled, and am barely getting by. I do not take my phosphate binders (co-payment $700, now that there are generic versions), but get by on Tums (I have end stage renal disease). I take my baby aspirin, but not my statin (I had a heart attack and have a pacemaker). I do not take the medications I need for pain, even though I don't get effective medications prescribed. I don't take my thyroid medication. I take my antidepressant, because real snappish without it. I spend $35 a month on prescriptions. If I buy all my prescriptions, it is $178. My rent has gone up $200 in the past 2 years; my income can't keep up. I know I am not alone in this; everyone I know skips meds.
52
@Blueicap
You are one of the people Warren and Sanders are fighting for, those with insurance who cannot afford the co-pays and deductibles. Even if we get one of them for President though, we'll still have to fight the corporate middle to make them agree.
I am sorry we don't have a faster pathway to help you.
23
@blueicap We shouldn't have to choose between healthcare and housing, medications or rent. Sadly, your situation is all too common.
1
I think one of the big problems with assessing the value and consumption of prescription drugs began with Rx drug commercials in 1997. Drugs that treat many of the chronic diseases Dr. Carroll discusses in his article and much more compete for consumer demand using sophisticated marketing techniques that most in the medical profession dislike.
Advice about the drugs that are best for us should come from healthcare providers who (hopefully) are motivated by objective data and not profits.
14
Drugs that are better (more effective, fewer side effects) don't need advertising, so they don't get it. Most drugs that are advertised are being advertised to consumers because doctors are prescribing something else, which is just as good and probably cheaper.
4
@A Goldstein
Absolutely! Also the "Ask your doctor" is nonsense. Doctors don't want patients telling them what to prescribe. Do you listen to the disclaimers? The side effects are worse than the problem in many cases.
8
Another recent study in Canada showed that patients receiving medications at no charge had significantly higher adherence to treatment (JAMA Internal Medicine, October 7, 2019).
A health care financing system should make it easier for patients to receive essential care they should have. Cost sharing is a barrier to care and should be eliminated. A well designed single payer model of Medicare for All would do just that.
13
@Don McCanne Drugs are not currently covered under the Canadian model.
2
@Sarah99
Yes, he isn't saying they are, he's citing a Canadian study, not Canada as a whole.
5
There is no medical solution in the US that includes free maximum health care for everyone. That is a pernicious dream. We need BASIC health care for everyone. We don't have infinite resources, wealth, or Earth.
So we need to provide BASIC health care for those outside the insurance and medical business and we need to control costs by moving away from pay for services. Americans are gullible and naive to think we can have free premium care for everyone. We need to look at health care systems in other countries and craft a system that provides effective, efficient and BASIC health care as a safety net.
People will always die from something. We are mortal. There will be sad stories. Life isn't a bowl of cherries. So we need to do more (BASIC for everyone) and LESS ( limits are reality). We cannot keep tilting at windmills of perfection.
13
@Paul We are not gullible or naive. There are effective generic medications that are outside our ability to pay. More focus on preventative care and maintenance will go a long way toward reducing cost. More focus on the 10% of patients that use a lot of resources will also help.
5
@Blueicap Bluecap, you may not be gullible and naive, BUT when people are sick or don't feel well, they want deluxe medical. Max! And that is human nature. So don't polish the reasonable story cuz people when faced with sickness and death don't want rational. THey want deluxe. So while there a number of things to do to keep the price tag reasonable, it will never be popular. We are faced with a humanity that has too many people and too little reason. We are heading for big trouble!!
Well, quite frankly, at 71, if I get terribly, terminally ill at this point, I don't think I will even seek medical help beyond diagnosis. The system is broken so badly that even when on Medicare it's entirely possible to go bankrupt only due to medical costs.
I'd rather our children inherit what little we have than turning it over to some oligarch-owned Big Pharma just to live another few (and probably miserable) months. I learned a lot from Atul Gawande in his book, Being Mortal...
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@Lynn Taylor
I agree (for older people), and if I haven't accomplished what I hoped to, by this time of life (work, travel, whatever), then I had a good long lifetime in which to do it.
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@Lynn Shame we have to make these kinds of decisions, but I don't blame you. Thanks for the book recommendation :)
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"Cost sharing is supposed to lower spending without sacrificing quality." I wish I could be so sure. For some, perhaps many of these patients the health insurer would be better off if the patient died. Do you think that hasn't crossed their minds ?
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We pay more in America to subsidize the rest of the world. Yes, drugs are cheaper in Paraguay, And Europe, and everywhere else. Big Pharma owns politicians here, and we pay exorbitant sums so the companies are profitable, and they can give the medications away more cheaply elsewhere. And as our health care premiums increase, and then our pay raises then get more scarce, we scratch our heads and wonder why.
There has to a component of patient responsibility for health care though, Or the converse to the article's title will be true. Usage will go up. If there is no deterrent to seeking health care, then people will use it with abandon. Why not? This is basic economics.
And in our clinic, almost none of our patients pay anything. Not a dime. So we give them thousands of dollars worth of medications each visit. Which is every four weeks. We give them expensive cold therapy machines (which we make 10,000% profit on). It's a beautiful thing. I highly recommend getting into a business where your customer doesn't have to pay for your service. Just think of the restaurant industry - they could give every customer a case of their most expensive wine with every meal - and they gladly take it because it's free. You'll have lots of repeat customers too. Everyone wins.
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@Donald Driver I agree that the US is subsidizing the rest of the world, but don't see the situation as nefarious. The risk-adjusted returns on pharmaceutical companies are inline with other industries (we see a survivor bias, some companies are enormously profitable when they have a good product, but if you invested in every company it would include those who go bankrupt due to unsuccessful development).
We live in a time when HIV isn't a death sentence, it is a chronic illness. Alzheimers may be cured soon. Cancer treatment is rapidly advancing with genetic-based treatments.
The US is rich and can afford to subsidize the rest of the world, I suppose. I would rather pay a lot for a drug that will keep me or my loved ones alive then pay nothing for existing drugs, but advancement on the next cures grinds to a halt.
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@Donald Driver
Your knowledge of economics is a bust. People in all medical systems in developed countries use about the same amount of medical care. If your hypothesis was correct people with more access to medical care would use more than they need, statistically they don't.
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I bought a drug in New York for $500,00 ( I had no insurance coverage there). I now buy the exactly same drug, with the same number of pills, of the same brand and the same manufacturer, in Paraguay for $ 100.00 (I have no insurance coverage here either)... How can there be so large a difference?
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From the article,
"This is mainly an American problem."
Quelle surprise!!
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Carroll claims: "Canada’s single-payer system is sometimes held up as the preferred “other” model to the American status quo. But its drug coverage isn’t so good compared with the rest of the world."
Yet he admits that the percentage of patients skipping drugs is 17% in the United States, double what it is in Canada.
So the truth is that if Canada's single-payer system "isn't so good" relative to the rest of the world, America's for-profit system absolutely stinks.
The question then, given that our system is broken, is why The Upshot continues to maintain a black-out on any and all writers supporting single-payer universal healthcare for America? Isn't this lack of balance just plain wrong?
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@Sean
That's a weaselly-worded statement from Carroll. Canada's drug coverage may not be as good as "the rest of the world" but it's still better than ours. That only means that we are even further behind the rest of the world than we are behind Canada.
Bottom line is we're still behind everyone else in the civilized world.
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You have to be careful here.
While I agree that America's health system is de facto criminal as opposed to our peer countries here is how to do it.
Establish like these peer countries a national, quality, affordable health system but don't completely eliminate co payments or deductibles or paying for the system.
If you do that, you have hypos and other abusers of the system going to doctors or taking every drug known to man.
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@Paul Please cite any studies that prove your assertion.
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@Paul
It would be better to identify hypochondriacs and get them the treatment they need than to force people to forgo drugs they need.
Mental health needs to be covered too.
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@MLChadwick -Thank you for you reply. Common sense and living 70 yrs and history are the reasons for my view.
Some friends and family that are know that have the best health plans are hypos and are in the doctors office 24/7 wasting trillions of dollars of tax payer insurance money.
Same with totally free universal higher education. They tried it in circa 1970 in NY and other cities and it almost destroyed the City University system.
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How does the pharmaceutical industry justify jacking up prices for drugs that have been in the market or over 3 decades? Medications for blood pressure, asthma, steroidal anti inflammatory drugs and many more, are not frivolous prescription drugs. These are tried and true medications that do not require huge financial outlay for research. These drugs are available in other countries for less. But in the US, patients pay to the hilt.
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@veefbe How does the billionaire Walton family justify paying their employees so little that they have to provide them with a free food pantry since most of them are living at below poverty level? It's the out of control greed in this country and, unless we want to continue the slide into full-on oligarchy, we need to vote for people who cherish and work on behalf of those who labor and still can't get ahead.
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@veefbe If the drug companies were using most of the profits from established drugs to pay for research into new drugs, it would be easier to justify some med prices. But in most if not all cases, pricing is based on what the drug companies think they can get away with in the open market, and a lot of the profit goes towards expensive marketing aimed at patients and doctors and executive bonuses.
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@veefbe Other countries have single payor health systems - so they're better positioned to negotiate with pharmaceutical companies, whereas we don't have a leg to stand on.
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Annual deductibles are also a problem. If one enrols in Medicare Part D near the end of a calendar year, the entire annual deductible will be in force only to renew at the beginning of the next calendar year. Policies like that lead to the counting of pills.
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My new arthritis medication costs $4600 per month. My private insurance pays half. The manufacturer pays the rest of the copay up to $14000 a year. Once that copay limit is reached I will have to stop taking that prescription.
My last drug had a cost of about $4000 per month. My copay was about $400. The manufacturer covered the copay. Unfortunately the drug stopped working.
In a year I will be on medicare. As I understand it, once I’m on Medicare I will not be eligible for copay help from a drug manufacturer. Unless I can afford a policy that severely lowers these copayment, this type of medication, biologics, will no longer be affordable to me.
I am currently still working. Make what I thought was a decent salary. Employer health insurance. I put off doctor visits and tests because I cannot afford all the copays and deductibles. I’m lucky. My illness is not life threatening. Once I can no longer afford these medications I will no longer be able to work and my life will be filled with physical pain. The good news (?)... the opiate drugs I will need would have small copays.
All this begs another question. Drug companies have been willing to absorb, to me, extraordinarily high copays. Do we believe that they’re making a profit on the remaining payment covered by insurance?
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I am fortunte to take only 1 med. it is a daily dose.
$45 copay for 3 months via my health insurance. $10 cash for 3 months at Walmart.
OK, the $10 doesn't count towards my deductible. But why does my insurance company force me to pay $180/annually when i can get the same drug (and it is, same manufacturer) for $40? I'd rather have the $140 in my pocket, even though big medicine and big insurance are not happy with me.
I can see why folks give up - the health care system is arcane, dysfunctional and expensive.
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@elise
Exactly correct. The reason they price the drug that way is because they undoubtedly know that many if not most people won't know to ask about the cash price.
Always ask for the cash price when filling a prescription, because you may be surprised how often it's cheaper than what you'd pay through your insurance, especially if you haven't met your deductible/copay/co-insurance yet. Especially for older medications.
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@elise My wife had the same experience with two of her meds. Cheaper just paying cash than the copay through insurance.
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There needs to be more data here. What kind of co-pays are we talking about? $5? $150? More? Is this situation caused by our drug prices being too high? Likely in some cases? But birth control pills are not expensive. Is this situation here because we Americans think health care should be "free?" Even in progressive Canada most people pay into the healthcare system, even low income people. If we are going to move to a single payer system Americans need to realize that all of us will have to pay for it. All of us.
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Everyone should pay into a single payer or universal healthcare system. However, the amount of they contribute should be scaled fairly to their income/wealth.
I would like to think that most people do NOT expect a completely free healthcare system; we should all contribute to the extent that we can.
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