Why are my prescriptions so darned expensive?!
How many times have we all pondered this question? Why is it so incredibly expensive to get prescription drugs in the US, even with good insurance? Let’s take a look at what factors are at play in how these medications get priced and what we can do to fix it.
Lack of price regulation
When a new drug is released onto the market, you can bet there have been major bucks spent on research and development to ensure its safety and efficacy. All of that is federally regulated, and there’s really no way around it. However, the federal government has no say in how much the pharmaceutical companies charge for their products. As with any other for profit business, the goal of Big Pharma is to make as much money as possible, and if they’ve got a new drug out that nobody else has, they can essentially charge whatever they want for it.
Patents
When new drugs are developed, they are always patented. This means that for 20 years after the release of the drug, no other company can produce the same thing. So for any given drug, the developer has a complete monopoly on it for TWENTY YEARS. Unless other companies can come up with a very similar, but not exactly identical alternative, if you want that drug, you pay the price the company demands.
Lack of insurance coverage
Even if you have so-called “good insurance”, you can often find yourself paying exorbitant prices on meds, depending on what you’re taking. One reason for this is that insurance companies, like pharmaceutical companies, are for-profit businesses! They will often do anything in their power to refuse coverage for an expensive drug because, well, paying for expensive drugs hurts their bottom line. They’ll often require your doctor to try you on several cheaper alternative medications first and document failure before they’ll agree to cough up the cash for the one you really need. Insurance companies also make deals with pharmacies to pay certain prices for certain drugs, which can sometimes be higher than the cash price the pharmacy charges. Depending on your Rx benefits, copay, and deductible, you can wind up paying more for your medication with insurance than without it. Crazy, right?
Drugstore markups
Retail pharmacies are, you guessed it, for-profit businesses. Anyone noticing a theme arising here? They make money by marking up the prices of medications and selling them to you for more than they paid. I’m not saying there’s anything wrong with this, and every business has to make money. But it does raise the cost of your meds.
Ignoring generics
If your doctor is prescribing you name-brand drugs, chances are you’re paying a lot more than you need to. Sometimes there are good reasons for wanting the name brands, like if there’s no generic alternative. In very rare cases, the name brand may be a little more predictable to work with. An example of this would be the thyroid medicine, Synthroid. But in most cases, if there’s a generic available, it is every bit as safe, effective, and predictable as its name-brand counterpart. It is often the case that doctors are just so busy that they don’t have time to think about whether they are sending the script as a name brand or generic. They know you need Crestor, so they send Crestor. Nevermind the fact that a 30 day supply of the name brand drug is about $260 vs $15 for the generic. Unless you’ve got a good pharmacist who’s on the lookout for things like this, you’ll get charged the name brand price.
So what can we do?
As I mentioned earlier, the recurring theme in this discussion is that everyone at every step of the way needs to make a profit. Big Pharma, the insurance companies, the pharmacies. At New Leaf Online, we do our best to sidestep all these middle men and deliver the best value possible to our patients. In our practice, we dispense generic medications directly to our patients at wholesale cost. Instead of using expensive name brands, dealing with insurance company contracts, and paying retail pharmacy markups, our patients simply pay the actual cost of the drug and go on with their day. So instead of taking a Crestor script to the pharmacy, waiting for it to be filled, and paying $260 for it, we give it to them directly, right here in our office for about $2. Of course there are still some of those name brand meds that remain under patent, but we can often find ways to get those for our patients at dramatically reduced cost or find an alternative that works just as well.
Final note
In recent years, some grocery stores have begun offering certain common generic medications completely free. Even we can’t compete with free! Their idea is that if you come into their store to get your prescription meds, you’ll more than likely stick around and buy a few things while you’re there. It’s a good way for them to get customers into their building. So next time your doctor is sending your prescriptions, you may want to think about requesting generics, and have them sent to one of the grocery store pharmacies. Here at New Leaf Online, many of our patients choose to get those meds from us anyway, just because it’s so convenient to walk out of their doctor’s visit with meds in hand! Either way, we want to provide our patients with the best value possible.
-Kyle Adams, MD
