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Who Is Paying the Price for Drug Coupons?

December 31, 2015

by Angela Sams

couponMany of us have probably at some time or another been faced with an expensive prescription that we wish we didn’t have to pay for, instead wishing for some kind of coupon or discount to help foot the bill. According to a recent article in Bloomberg Business, some pharmaceutical companies are providing just that, spending approximately $7 billion to generate discounts and coupons for patients’ drug co-payments.

Why are some prescriptions so wildly expensive? The short answer is that insurance companies want the drugs to be so unaffordable that patients won’t use them. Much to the chagrin of insurers, pharmaceutical companies have responded by paying for patients’ prescription co-pays, handing the rest of the balance right back to insurers. This is not allowed everywhere, however. Because the cost of a patient’s co-pay directly influences whether or not they will pay for their prescription, co-pay coupons are banned in the Medicare program, cited as an illegal inducement.

Drug companies see the coupons—distributed online, in magazines, and in doctor’s offices—as helpful to consumers. Holly Campbell of the trade group Pharmaceutical Research and Manufacturers of America states that “co-pay offset programs can play an important role in maintaining access to needed medicines, especially for patients taking specialty medicines or with chronic conditions.” But providing these coupons helps the drug companies as well. Indeed, they “can earn a 4-to-1 to 6-to-1 return on investment on co-pay coupon programs.”

Insurance companies are resisting the coupons by nixing drugs from their plans, and creating a rewards program that would give cash to patients who don’t use the coupons. United Healthcare has been leading the way in the fight against the co-pay coupons, in part due to the fact that the discounts can keep patients from seeking drug alternatives that are equivalent to the more expensive option. A spokeswoman for United argues that when consumers choose a pricier drug because they have a coupon, this can have a huge impact on healthcare costs overall. The battle between insurers and drug-makers leaves consumers caught somewhere in the middle. And it leaves one to wonder, could the problem potentially be solved if drug prices were simply lowered?

Denialism vs. Skepticism

December 17, 2015

by Angela Sams

“You’re entitled to your own opinion, but not your own facts.” A common phrase indicating that everyone can have their opinion on any variety of matters, but when it comes to clear, objective facts, there’s really no point in arguing. Needless to say, there are plenty of opinionated people out there, and sometimes having an unsubstantiated opinion on unarguable facts can come at price.

Political arguments overwhelm our country as we read about the Paris climate change conference and prepare for elections next year. It takes a well-informed and discerning individual to separate fact from fiction (or, opinion), when sometimes one may be presented as the other.  As a recent Op-Ed article in denialNew York Times points out, “disbelieving science isn’t skepticism, it’s a form of willful ignorance.” Skepticism is something that is evidence-based. For example, we may read about a topic, but are not convinced enough by the facts to believe that whatever the article states is true. Denialism, on the other hand, is more about believing what we want to believe (“I don’t want climate change to exist, so I just won’t believe in it,”), pushing aside obvious evidence, and focusing on so-called “facts” that would help support our own opinions on the matter.

In order to avoid denial, it’s important to understand science. Science does not mean that there is only one answer, and it does not mean that if new evidence comes along it will not change the current understanding of something. Rather, it’s something that’s always evolving, something that is never “settled.” And while it may turn out that a theory is false, science’s “successful track record suggests that there is no superior competitor in discovering the facts about the empirical world.” Rejecting the current scientific evidence on a topic such as global warming is not just being in denial—it could also come at a price. Instead of pretending that something doesn’t exist, wouldn’t it be smarter instead to prepare for it or try to prevent it, until further evidence suggests that this is not necessary?

Could you be Paying for Someone Else’s Prescription?

December 10, 2015

prescriptionsby Angela Sams

You get what you pay for, right? Not necessarily. Whether Americans realize it or not, they may in fact be paying $124 or more for the expensive prescriptions of a neighbor, a family member, or a complete stranger!

A recent op-ed article in the New York Times discusses a drug that “is a new class of cholesterol-lowering agents called PCSK9 inhibitors” as an example of a medicine that may result in higher insurance premiums for all of us. This new inhibitor, just approved by the FDA in July, is thought to reduce bad cholesterol (LDL) by up to 60 percent more than a placebo. And, though there is no solid proof that the drug (and others like it) can prevent heart attacks, strokes, and deaths caused by heart disease, researchers are still optimistic.

So what’s the problem with a drug that could potentially improve quality and length of life? The hefty price tag. The companies who create these drugs have disclosed that a prescription will cost more than $14,000 per year, per patient. Multiply this by the number of years that a patient must take that drug, and the number quickly becomes unfathomable. Those costs will then fall to insurers, and eventually trickle down to the rest of us. Policymakers and academics have a couple of proposals that could help save patients money, “such as separating out deductible limits for drugs from deductibles from other health benefits and limiting co-pays for these drugs to $100 to $250.” However, this won’t get rid of the fact that the drugs cost a certain price. That price must still be paid, even if it falls to the insurance company.

Here is where the idea of value comes into play. Are we really getting what we pay for? And how is one to determine the value of a particular medicine? Other items in our economy (think cars, phones, or TVs) are purchased by consumers, depending on whether or not that consumer thinks it’s a good “value.” In the case of medicine, value could potentially be determined by measuring the improved quality of life it gives to patients. Since we are all affected by the rising costs of these prescriptions, it is up to us as a society to determine the value of these medications, and how much they are worth, monetarily.

Dangerous Risks of Using Opioids to Treat Pain

December 7, 2015

opioidsby Angela Sams

Have you ever been prescribed a painkiller to help with surgery recovery or maybe for back pain that just won’t go away? Even if not, it is likely that you know someone who has been on a painkiller medication at some time or another. That likelihood rose steadily between 1999 and 2010, as doctors began turning to a “quick fix” that will treat their patients in an aggressive manner. But, as patients cooperatively swallow their prescribed pills, it is important to consider the downsides of opioids on an individual and societal level.

A recent opinion article in the New York Times indicates that while there has been a “steady increase in the mortality rate of middle-aged white Americans since 1999,” this is not the case in other age and ethnic groups, or even with people in the same age group who live in other countries. Consider this disturbing statistic: “In 2013 alone, opioids were involved in 37 percent of all fatal drug overdoses.” It is clear that opioid overdose is quickly becoming an epidemic, and a major shift in attitude is a key to the problem.

At one time, opioids were used mainly for pain caused by terminal illnesses or as a short-term fix for pain after surgery. However, during the 1990s, drug companies began marketing to doctors, encouraging them to “be proactive with pain and treat it aggressively.” Afraid of being seen as uncaring or reprimanded for not treating a patient’s pain to the best of their abilities, doctors fell for the marketing scheme and began prescribing powerful opioids such as OxyContin.

Though opioids may relieve pain and help a patient recover more comfortably, evidence suggests that they should only be used for short-term treatment, not long-term treatment of nonmalignant pain.  There are also many downsides to taking such a medication. This type of painkiller is extremely addictive, may affect mental health, lead to unemployment, and cause poor health in general, to name a few risks. Ironically, using these drugs can also make a patient more sensitive to pain.

So what is the solution to this problem? Should people suffer in pain, rather than take the risks associated with opioid drugs? Actually, the answer may be as simple as taking an over-the-counter medication. In one study, researchers found that when Motrin and Tylenol were combined, they were actually more effective than opioids, not to mention safer. While opioids are still very readily available to patients who are in pain, small steps towards a solution have been taken. For example, the Food and Drug Administration issued a Risk Evaluation and Mitigation Strategy, ensuring that opioids now contain warning labels. The makers of these drugs must also give training and education that will help doctors prescribe them safely. Certainly, patient awareness is helpful, but only time will tell if physicians can turn this shift in attitude back around, and work towards other, safer solutions for pain management.

Transforming Big Medicine

November 24, 2015

roxane-medical-cup-cakeby Jen Jenkins

When this fascinating article by surgeon and public-health researcher Atul Gawande made an appearance in the New Yorker, it posed a very interesting question: Does healthcare need a makeover similar to what casual-dining, big-chain restaurants have done? Gawande juxtaposes the medical and restaurant industries, using the Cheesecake Factory as an example. Although, for obvious reasons, the two industries are incredibly different, they both still seek a similar goal of delivering “a range of services to millions of people at a reasonable cost and with a consistent level of quality.”

The format of medicine delivery in America is changing. Instead of community-based hospitals, there are now large conglomerates formed between hospitals and clinics; physicians who were once self-employed or working in small private-practice settings are now predominantly joining said conglomerates. In Gawande’s comparison to the big-chain restaurant industry, health systems have turned into chains and physicians have become employees.  Hospitals and medical groups used to pose mainly as landlords. Now, due to health-care reforms, they have taken a radical interest in how physicians conduct their business. Why? Clinical performance is becoming linked to financial rewards and can mean the difference between hospitals keeping or losing tens of millions of dollars. Unfortunately, this shift has not necessarily meant an improvement in the way healthcare is delivered on a mass scale.

“Good medicine cannot be reduced to a recipe”

In the article, Dr. Gawande does a spectacular job of bringing a typical Cheesecake Factory kitchen to life. You feel as if you are there as he describes the different roles, the precision, and the necessary steps to bring a food order from the menu, to plate, to table. Also fascinating is the forecasting models he describes. In order to have an almost psychic-worthy accuracy for purchasing groceries to avoid spoilage and food waste, chain restaurants have developed forecasting models using computer analytics. “Chain production requires control, and they’d figured out how to achieve it on a mass scale.” The medical industry, although it has taken on a similar format, has had a difficult time finding a way to obtain similar control and have it trickle down.

Dr. John Wright is among those attempting to inspire change. Following something very similar to this “Cheesecake Factory model” as Dr. Gawande calls it, Dr. Wright began researching what the best people in the industry are doing and how, then he standardized it. Now he is attempting to get the rest of the industry to follow suit. Unlike the Cheesecake Factory, there are certainly many more components that must be woven in and, when exercised, it is much more difficult to persuade clinicians to follow a standardized plan, whereas restaurant employees do it without question. To articulate this process, Dr. Gawande shares a story of his mother’s knee replacement and working with Dr. Wright’s team, who did exactly as what is described above; something called “systematic care.” The results were outstanding in the case of Dr. Gawande’s mother, all due to having someone (Dr. Wright) responsible for the total experience of care, including the costs and the results.

There will always be those who are skeptical of change, yet slow transformation seems almost unavoidable. Dr. Gawande believes that reinventing medical care could produce hundreds of innovations; most significantly, a way to put someone in charge of overseeing the healthcare process from start to finish and ensuring that it is “coherent, coordinated, and affordable.” The Cheesecake Factory model is a very interesting one and, according to Gawande, possibly the best prospect for change in medicine.

Restoring Sight to the Poor

November 19, 2015

eyeby Angela Sams

Can you imagine a life without sight? Those who are blind face many challenges on a daily basis—challenges that probably don’t even occur to those who can see. Enter Dr. Sanduk Ruit, a Nepali ophthalmologist who is on a mission to help the blind see, using a procedure called the “Nepal Method.” A recent article in the New York Times delves into his miraculous work.

Living blind in a country that is poor presents its own unique challenges, as access to healthcare may not even be an option. Dr. Ruit is pushing past these barriers by offering a cataract microsurgery to patients for only $25. It is a technique that he developed, and it is now being taught to medical students in the United States.

For the powerful impact the microsurgery has on its recipient, you would think it wouldn’t be so simple. That could not be further from the truth. The entire process takes about five minutes, and involves removing the cataract on a patient’s eye and replacing it with a new lens. A procedure that was once seen as something that could only be done with expensive machines, Dr. Ruit’s procedure is just as effective. The big difference is that it is much more affordable.

The cure for blindness extends beyond Nepal. A charity called the Himalayan Cataract Project helps ensure that other countries such as Ethiopia and Ghana can also benefit. The charity was started by Dr. Geoffrey Tabin, another eye specialist who has been working next to Dr. Ruit in Nepal.

In addition to removing the cataracts of the blind, Dr. Ruit founded the Tilganga Institute of Ophthalmology, which includes “hospitals, outreach clinics and training programs and an eye bank, using fees from better-off patients to support impoverished ones.” Approximately 30,000 patients will receive eye surgery from the institute annually.

It seems that the success in Nepal is just the beginning of something great. Stories such as this give us reason to believe that blindness can eventually be eradicated, one eye at a time.

 

Healthy Eating: Just a Fad?

November 12, 2015

ways-to-eat-healthier

by Angela Sams

Have you fallen for the latest trend of kale smoothies or chia seeds? It’s difficult to avoid, especially with all of the recent media hype about various Superfoods. If you’ve found yourself shopping more frequently in the produce section than the frozen dinner aisle, you may not be the only one changing your eating habits – it has become a nationwide phenomenon. According to this New York Times article, more and more consumers are moving away from big food manufacturers, even as those companies are attempting to change their ingredients in order to become more appealing. General Mills is nixing artificial colors and flavors from its cereals, and Hershey’s is focusing on “simple and easy-to-understand ingredients.” But will these changes be enough?

The numbers are a bit discouraging, at least from these companies’ point of view. Both soda and orange juice sales are down, as are cereals and frozen dinners. Instead, consumers are buying more fresh prepared food than ever – sales have grown almost 30 percent since 2009.

The trend also extends to the younger population. The article indicates that “sales of raw fruits and vegetables are also growing – among children and young adults, per capita consumption of vegetables if up 10 percent over the past five years.” A recent survey indicated that almost half of the millennial generation doesn’t trust big food corporations, and it is clear that drastic action will need to be taken if these companies want to win consumers back.

The solution will no doubt be challenging. It will need to involve more than just removing an artificial dye here or an antibiotic there. Companies will likely need to completely change how they approach food production. This may include large amounts spent on investment, and a “complete overhaul of their supply chains [as well as a] major organizational restructuring.” A challenge, yes, but not necessarily impossible.

Fresh, healthy food is in, and processed food made of ingredients most of us can’t even pronounce is out. Evidence suggests that this is more than a fad – it’s a lifestyle that is here to stay.

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