Can drug manufacturers change their philosophy?

If healthcare reform is to become a reality, there will have to be cost controls. All players will have to participate, including physicians, hospitals, the insurance industry, and the drug manufacturers.

In my community pharmacy practice, I have been asked numerous times by customers with little or no prescription insurance, “Why are these drugs so damn expensive?” And for many years I have defended the manufacturers, telling customers that drugmakers have invested millions in the research and development of each and every drug product on the market. I told them that it takes time and money to discover new drugs and to produce the raw materials to make the new drugs that will help combat disease states such as arthritis, diabetes, and hypertension, and that will slow the progression of cancer and AIDS.

In my career I have seen not only new drug entities, but new drug classifications, new drug-delivery systems, new indications, new unlabeled uses, and new agents to treat disease states for which no previous drug treatment was available.

Lately, however, when I’ve had to ask patients/customers for $120 for 10 days’ worth of prescription medication, I have had more empathy.

I believe drug manufacturers can lower their prices considerably and not take a loss by following these three measures:

• elimination of direct-to-consumer advertising of prescription drugs
• packaging drug products more cost-effectively
• ending production of the brand-name agent once the patent expires

Let’s look at each of these money-saving measures.

Direct-to-consumer ads are just plain ineffective and unnecessary. And ads for ethical products are often misleading.

How does a person know whether he or she is a candidate for a certain prescription product?

Can one self-diagnose hypertension, diabetes, high cholesterol, GERD? Is it really overactive bladder or merely a UTI? Is it really acid reflux disease or is that pain gall-bladder disease that may go untreated?

Diagnosing remains the work of the physician.

By all means, encourage members of the public to see medical providers regularly, but do not put ideas into their minds by blasting them with print ads and TV and radio spots about drugs that can help a certain medical condition and then list all the unwanted side effects and adverse reactions, which almost kills the credibility of the drug product.

The disclaimers are longer than the product indication. I doubt if I would want to take a drug to handle my one complaint if I had to experience headache, dry mouth, constipation, upset stomach, muscle weakness, nausea, and other serious side effects.

I hope I can have the opportunity to discuss the pros and cons with my physician for each drug that he or she wants me to take.

By all means advertise the drug in medical, pharmacy, and nursing trade journals. That is one way we healthcare professionals learn about the newer agents. But weekly magazine and daily newspaper print ads, and radio and television commercial spots for prescription drug products? Forget about it!

Secondly, thanks to the safety caps on prescription bottles, manufacturers are causing each and every retail pharmacist to experience carpel tunnel syndrome. The unit-of-use 30-count bottles with safety caps are fine, but I have never dispensed 500 ibuprofen 800 mg on one prescription, so why should there be a safety cap on the manufacturer’s bottle? I don’t think there are any pharmacists out there under the age of 5.

If it is an FDA regulation to have safety caps on all manufacturer’s packaging, then let’s lobby to change it. (My feeling is that the FDA should be headed by a pharmacist, but that is the subject of another conversation.)

Drug packaging has to be changed. Unit-of-use 30s can remain for the very popular drugs with once-daily dosing regimens. All other drug products should be packaged in bottles of 100, 500, and 1000. Do away with 90- and 120-count idiocy.

Most high-volume chain pharmacies have automatic counting machines such as Baker Cells and ScriptPro to do the counting. So instead of a large-volume pharmacy purchasing 500 sertraline 100 mg tablets and receiving 16 bottles of 30s, the store can receive one bottle of 500 tablets. Fewer plastic bottles needed, less shelf space occupied, less waste!

After a drug has been on the market for, say, 3 years, stop gluing those package inserts to the bottles. Every pharmacy has access to the Physicians Desk Reference - the book of package inserts. Did you ever try to peel a package insert off a bottle without ripping it? I throw away over 100 package inserts a day. Another waste! If it is an FDA requirement to have a package insert on each bottle, then it is time to change this policy as well.

Lastly, drug manufacturers can save boatloads of money by stopping production and distribution of all drug products 1 year after the expiration of its patent.

We all know that most AB-rated generic versions are made by the companies that marketed the brand-name product. Therefore, once the generic version is available, the drug company should cease making the brand-name drug.

Most third-party prescription plans do not cover brand-name drugs if the generic is available. The co-pays are higher. PBMs want the patient to use the generic drug. The manufacturer does not detail the drug anymore. Advertising the drug is over. So just stop making the brand name. There will be no reason for any customer to say “I don’t want the generic.” The generic will be the only version available.

I admit I will miss telling the patient who demands the brand-name drug that “the drug receptor sites in your body cannot distinguish the difference between brand and generic versions, so stop throwing your money down the toilet.” If I owned my own pharmacy, I would never carry in my inventory a brand-name drug when a generic version is available, and I would make it a point to inform my customers of this cost-saving measure.

I realize these ideas are extreme, but they can reduce waste and save money. By implementing these measures and changing their philosophy, drug manufacturers can reduce the prices of their ethical products and pass the savings onto the consumer.

In this era, when the drug manufacturers have been getting so much bad press with product recalls and drugs being pulled from the market because of side effects, implementing these measures will be well received by the consumer.

Bob Spera is a community pharmacist and a hospital pharmacist, and a writer for pharmacy trade journals. He can be reached at druggist37@comcast.net.