What do drugs like albendazole, digoxin, doxycycline, pravastatin, and divalproex have in common? The answer, it turns out, isn’t pharmacologic but economic. These drugs (and dozens more) are generics that have experienced price increases of anywhere from 100% to more than 1,000% virtually overnight.
What’s going on?
A recent Drug Topics article [“Rising Rx prices front and center in presidential campaign,” Mark Lowery, September 24, www.drugtopics.com] discussed this phenomenon in light of two highly publicized price increases for products that have been on the market for decades. These moves brought not only public but political criticism to bear on what some call a national epidemic of skyrocketing generic prices.
The article quoted Bernie Sanders (I-Vt) and Elijah Cummings (D-Md), who said in a statement, “The enormous, overnight price increase of Daraprim is just the latest in a long list of skyrocketing price increases … Americans should not have to live in fear that they will die or go bankrupt because they cannot afford to take the life-saving medication they need.”
A New England Journal of Medicine article from November 2014 addressed this issue, tracing the astronomic price increases on some generics such as captopril (for blood pressure) and clomipramine (for OCD and/or depression) between 2012 and 2013. In the article, the authors identified some of the common culprits that have contributed to this problem, including “drug shortages, supply disruptions, and consolidations.”
As a practicing pharmacist and business manager, I have both seen and felt the impact of these increased prices. Though the causes of this situation sometimes involve complex economics, it nevertheless creates very practical and personal problems for patients and pharmacists alike.
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The impact of this situation has sometimes lead to frustrating interruptions in or omissions of therapy when the product was simply unaffordable. Often the impact of these price hikes has been hidden from patients until they realize they have entered the dreaded “coverage gap” earlier than expected. The result has sometimes forced patients to switch to less effective or poorly tolerated alternatives.
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With respect to pharmacists, these increases have sometimes had a very negative impact on their bottom line. A PBM will reimburse pharmacies based upon usual and customary pricing along with maximum allowable costs. But when prices increase rapidly, pharmacies are forced to purchase these drugs at much higher prices than the going reimbursement rates. The net effect is that they often lose money on these prescriptions, a consequence that no business model can sustain.