Reformulate, remonetize - and let the patient beware

David StaneyThe medical assistant was waiting on the line. I had never heard of the drug she was phoning in, and I wanted to make sure it was something I could order. Unfortunately, it was.

“Why would anyone write for that?” The words slipped out of my mouth when I realized that Cambia, the mystery med, was simply powdered diclofenac - and that a drug selling for less than $20 in tablet form would bring its manufacturer more than $400 when left as a powder.

I had momentarily forgotten the medical assistant was still there.

“It’s what the doctor prescribed,” she said coldly. To which I replied, “I hope the patient has good insurance,” and let her go.

“Or stupid insurance,” I thought to myself.

Simple vs. $$$

Setting aside the fact that diclofenac is what Pharmacist’s Letter calls a “three-strikes” NSAID, more toxic to the liver, cardiovascular, and gastrointestinal systems than other meds in its class, why would a doctor think the theoretical benefit of a few minutes’ faster absorption worth several hundred dollars, when the simple alternative of liquid ibuprofen is available?

Most of us would come up with a similar answer to that question: Because those hundreds of dollars are someone else’s money, and “simple” is not a word that’s in fashion in today’s medical world.

At first I felt bad about my slip of the tongue, but the more I thought about it, the less remorseful I felt.

An entire ecosystem

We all know there exists an entire sub-industry of incredibly overpriced pharmaceutical products that contribute nothing to the advancement of medicine.

There’s Duexis - nothing but ibuprofen combined with famotidine. Or Solodyn - a strength of minocycline just different enough that it can’t be substituted for the generic that costs hundreds of dollars less. Or Treximet - simply sumatriptan and naproxen.

The list goes on and on, and there seems to be a new addition every week. It’s an entire economic ecosystem that depends on pulling the wool over the eyes of prescribers.

Well it’s time their eyes were opened, and stereotypical pharmacists - those polite, quiet, sheepish professionals who hold their tongues unless spoken to - are not going to get that job done.

1 Rx vs. 10 flu shots

The amount of money the health system spends on a single prescription of Cambia would provide 10 influenza immunizations or a month of health insurance to a young person currently going without. That’s a price well worth paying for ruffling the feathers of someone phoning in an Rx.

In the case of that Cambia prescription, the patient’s insurance provider wasn’t good enough, or foolish enough, to cover the cost. I looked at the rejection on my computer screen for a second and marveled at the situation that had made me a temporary ally of the pharmacist’s arch enemy, the pharmacy benefits manager, even if it had added the waste of everyone’s time to the cost of the Cambia.

I wondered whether the patient would believe me if I explained that liquid Motrin from the OTC section was likely do a better job than the wallet-emptying option recommended by her doctor, or whether she would go back and tell the prescriber what that crazy pharmacist had suggested.

Part of me hoped for the latter - hoped that that doctor might be inspired to do a little research, and maybe, just maybe, might be inspired to call me and ask what I thought, the next time a sales rep showed up to tout the latest wonder drug.

With apologies to John Lennon, you may say I’m a dreamer, but I can’t be the only one.