Drug Prices

As we advance in our healthcare system and continue to find cure for the deadly diseases we are also faced with prescription drug prices rising much faster than they were a few years back. Drug prices are increasing at an unmaintainable rate without any sign of reduction. People who are heavily affected by this rise are mostly elderly citizens and also the poor of this country because they can barely afford these expenses. These people either have no money to pay for their copays or no health insurances at all.

The prices of prescription drugs in the United States are by far the highest in the world. [1] On average, Europeans pay 40% less than Americans for the same medications. [2] Consumers have been resorting to several ways, sometimes putting themselves in harm’s way, to alleviate the burden of high prescription drug costs. Some buy their medications online or cross the borders to neighboring countries so they would be able to afford buying their needed medications. Others have resorted to the illegal act of selling their unused medications in online forums just to recover part of their expenses. Many factors contribute to the increased drug prices in the United States including research and

"In the past two decades or so, health care has been commercialized as never before, and professionalism in medicine seems to be giving way to entrepreneurialism," commented Arnold S. Relman, professor of medicine and social medicine at Harvard Medical School (Wekesser 66). This statement may have a great deal of bearing on reality. The tangled knot of insurers, physicians, drug companies, and hospitals that we call our health system are not as unselfish and focused on the patients' needs as people would like to think. Pharmaceutical companies are particularly ruthless, many of them spending millions of dollars per year to convince doctors to prescribe their drugs and to convince consumers that their specific brand of drug is needed in

The current debate over the Mylan Company’s near monopoly of the epinephrine market through its EpiPen shows what can happen without monopoly regulation. While the cost to produce an Epipen is around $30, the price to the consumer is around $300 each. The economic implications for a family that needs to keep the device on hand to save a life can be excessively high, the emotional results of not having one when you need one are debilitating. This monopoly is further enhanced by state-enforced regulations requiring that schools keep EpiPens in stock and the, so-called, EpiPen law enacted in 2013, which leave little incentive for other pharmaceutical companies to develop their own technology for fast-acting emergency devices. (Bartolone, 2016) Breaking Mylan’s monopoly will not only lead to new product development but lower prices for consumers for a life-saving delivery

Finally, in a February 2012 proposed regulation, CMS proposed that state Medicaid agencies reimburse pharmacies for retail drugs based on actual acquisition cost. CMS recognized, however, that states may not be able to determine the actual price paid by a pharmacy for a drug billed to Medicaid, so it suggested that states survey pharmacies or rely on other data to calculate an average acquisition cost for drugs purchased and billed by retail community pharmacies. The article reviewed the association between benefit caps, prescription drug use, and the costs associated. It also detailed drug cost sharing, additional medical costs, and specific health outcomes. Using observational data, the studies analyzed the changes and did a cost comparison of outcomes at two points of time, before and after the pharmaceutical benefits changed. The article detailed the impact of pharmaceutical drugs was often difficult to analyze because some data analyzed utilization while others analyzed actual pharmaceutical spending. The data surrounding utilization compared as many as five factors such proportion

In 2010, the Affordable Care Act created a $250 rebate if the Medicare beneficiary was in the coverage gap. It also expanded coverage to the discounts given on brand name prescriptions. With reforms and improvement comes disadvantage to others. Beneficiaries and patients will be able to start saving more money, but it comes with a decline for the drug providers. According to Health Capital Consultants, “over ten years, closing the coverage gap may ultimately cost approximately $32 billion” and the pharmaceutical industry will be forced to take on most of this burden. These companies are paying for the flexibility they’re been given by MMA. They can “set their premiums, design their own formularies and are free to use cost management tools” and Medicare will reimburse plans for a “share of their drug costs.” (Guterman & Huynh ,

The pharmaceutical and biotech industry agreed to contribute billions of dollars to healthcare reform. Having agreed early in political negotiations to contribute any-where from an estimated $80 billion to $105 billion in fees, rebates, and discounts to help move the legislation forward (Nussbaum, 2010). By agreeing to support healthcare reform with their money and policies, they were able to avoid issues that had plaques their industries for years such as drug importation and the ability to negotiate drug prices for Medicare D. In return, the pharmaceuticals and biotech firms would agree to discount drugs purchased by Medicare beneficiaries, affected by the doughnut hole, of the Part D program by 50 percent (Spatz, 2010). Congress also proposed additional government subsidies to be added to the discounts that would further shrink the gap; beneficiaries will pay 25 percent copayment

Lynas, K. (2010, November/December). Canadian pharmacists journal: Universal pharmacare could cut up to $10.7 billion from Canada’s annual drug bill. Notes, 143(6), 262. doi: 10.3821/1913-701X-143.6.262

With the continued transformation of the healthcare system, an increased emphasis on consumerism and quality-based reimbursement will be observed. This could lead to challenges for all managed care stakeholders. One example of an industry change that might occur is that patients’ out-of-pocket costs could increase. The cost of healthcare continues to rise faster than inflation, generating increased incentives for insurance companies to offer plans with high deductibles and small networks. In the article “The Top Changes MCOs Should Expect in 2016” Joel Brill (2015) states that:

Patients that are unable to follow prescriptions as ordered, related to lack of coverage, escalate stress on the health care system; increasing physician and emergency department visits, which may have been avoidable if the medications were covered for all Canadians (Lexchin, 2017). There are various socio-political barriers to implementing a universal drug coverage plan in Canada. Primarily, the federal government’s Patented Medicine Prices Review Board (PMPRB), controls prescription and non-prescription prices by making comparisons of across seven selected Organization of Economic Co-Operation and Development (OECD) countries (Tang, Ghali, & Manns, 2014). However, these OECD comparative countries have higher medication prices. In fact, four of the seven OECD countries have the most expensive prices worldwide; consequently increasing Canadian prescription pricing. According to Morgan and Boothe (2016), another barrier to universal drug coverage in Canada stems from “pharmacare’s initially low place on the policy agenda” (p. 249). Healthy public policy development requires synergy between the public, policy makers, and institutions alike. If universal drug coverage has “less attention than other health policy debates” a political change is less likely to occur (p. 251).

Prescription drug prices are on the rise in the United States. Currently, the United States does not implement a price control on prescription drugs. Every day the supply and demand for prescription drugs fluctuates. Pharmaceutical companies produce drugs that are necessary for survival. Therefore, it is necessary for research and development to continue in the United States. Those suffering the effects of exorbitant prices must do so until a generic form of a prescription drug is produced. Once approved by the FDA, new drugs will make their appearance on the market and patients will no longer suffer financially. Until then, it is necessary for pharmaceutical companies to price their drugs based on the idea of supply and demand. This produces the profit used to fund research. Price controls discourage innovation. If a price control were set in place, of course the price of prescription drugs would decrease. However, the development of new drugs decreases with it. Today’s generation would benefit from lower prices, while future generations would suffer from the loss of drug innovation.

Between 2001 and 2011, the average patient’s out-of-pocket (OOP) cost for brand-name prescriptions rose by more than 80% (Tungol, et al., 2012, p. 691). The increasing OOP costs have contributed to a decrease

Anyone who has purchased prescription medications has probably wondered why they cost so much, and rightfully so. Medication prices in the United States have been on a steady increase for decades, however, prices have been drastically increasing as of recent. Pharmaceutical companies have tried to justify these price increases due to the demand, the high cost of research, and the high costs of development and approval. Notwithstanding, the extent to which the prices have increased is not justifiable. Americans should be against these high medication prices and take action because pharmaceutical companies are taking advantage of our health care system in order to capitalize from the sick. In order shed some light on this issue, we must examine the magnitude, scope, and consequences of these rises in price.

Anna Wilde Mathews and Jonathan Rockoff authored Megadeal Unites Drug Rivals in a published WSJ.com article of July 22, 2011. The article addresses the merger of two pharmacy benefits companies, Express Scripts Inc. and Medco Health Solutions Inc., along with the merger’s ramifications on the health care industry. This strategic merger is expected to impact the pharmacy benefit manager (PBM) market in conjunction with influencing drug costs and channels and possibly raising anti-trust concerns.

Recently, there has been a debate about the high prescription drug prices in the United States. Accounting for 9.7% of the national health expenditure, $329.2 billion was spent on prescription medications ($931 per person) in 2011 (Linton, 2014). So what exactly is the average American getting with their $931? Well, because there is an extraordinary amount of time, effort, and energy that goes into creating, manufacturing, and distributing a new drug, it’s no wonder the prices are so high. But what other costs are folded into the prices of your prescribed medications? This review looks beyond just the research and development costs needed to take a new drug from idea to shelf by examining several journals and other credible, secondary sources, to shed some light on how much pharmaceutical companies are spending to develop, advertise, and sell their drugs.