Pharmacists Trapped in the Middle of Drug Price Wars

June 27, 2018

High drug prices are caused by a variety of forces-but pharmacists always seem to get caught in the crossfire.

About a dozen pharmacists in my town gather each month for a pharmacy roundtable as part of  “Operation Our Town,”  which is an initiative formed by business people who want to remove the scourge of drug abuse in our community. A couple of years ago, our local state representative in Harrisburg joined us. John McGinnis, who has a PhD in economics, listened intently while we pharmacists discussed the rescheduling of hydrocodone from Scheule III to Schedule II, and the dramatic price increases we saw. McGinnis asked why the price escalated so much in a brief time, and one pharmacist gave her opinion: Corporate greed.

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McGinnis responded that he’s an economist-and didn’t buy that answer. He said blaming such dramatic price increases on corporate greed is like blaming an airplane crash on gravity. He used the Wright brothers as an analogy. When they built their first airplane, McGinnis pointed out that they and every builder since then must factor in gravity, a constant force, into the equation of flying an airplane.

Yes, gravity brings it down, he noted, but something failed to allow gravity to take over. McGinnis explained that what he was describing is government interference that caused such price increases. He declared that corporate greed is always a constant, just like gravity. He asserted that corporate greed took over when government interference was present, just like gravity takes over when a malfunction occurs on an airplane bringing it to the ground.

When I see dramatic increases in generic prices on creams and ointments, I’m sure government interference plays a role. The U.S. government spent $328.6 billion dollars on prescriptions drugs in 2016, which is 10% of the total national healthcare expenditure, according to CMS

With a pot of money this large, is there any wonder that the price of clobetasol-E cream rose from $10.42 for a 60g tube to $110, a tenfold increase! Remember when we could buy colchicine 0.6-mg tablets for $6 per hundred, and now we pay $6 per tablet? A 100-fold increase thanks to an FDA ban on unapproved colchicine products. 

The one question we pharmacists are most likely to get is, “Are the generics as good as the brand name?” My answer is a resounding yes, with virtually no exception.

Last week, I pulled a bottle of quetiapine XR 400mg that cost the pharmacy around $82 for 60 tablets. I still have a partial bottle of the brand name Seroquel XR 400 mg, which costs $1,500. Upon further examination I saw that both were made by AstraZeneca, the company that marketed the brand! Both bottles had tablets with the same markings, the same type and shape bottle, only the label differed. There is absolutely no way anyone from AstraZeneca can explain how a label on the bottle can account for a price difference of more than $1,400.

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I was almost nose-to-nose with the head of endocrinology from an area health system, discussing the efficacy of Synthroid versus levothyroxine. The endocrinologist said the brand products are more consistent, which I disagree with. I asked him when he has a patient on Synthroid, does he ever have to change the dose?  He said, “Don’t be ridiculous, of course we manipulate doses all the time.” So I said, “You’re telling me the patient is the variable, and not the pills!” He smiled and said, “I guess we will agree to disagree.” If a patient takes their thyroid supplement with food-or worse yet, a calcium or iron supplement-absorption will be impaired whether it is brand or generic levothyroxine. The pharmaceutical manuacturers have gotten into the heads of many prescribers!

As Rep. McGinnis stated, “Corporate greed is a constant, just like gravity.”