The cost of medications isn't always inflated at the pharmacy. Although the medications discussed in the last section can be used to treat at least eighty percent of the medical problems I encounter each day, there are still many diseases for which no inexpensive treatments exist. If a pharmaceutical company still has a patent on a medicine, it can (and will) charge whatever it wants. And the pharmaceutical companies will often find ways to stagger the patents so one takes over when another expires (for example, they might patent the drug right away, and the delivery system later). Then, when a medication first loses its patent the price only drops slightly because, for the first six months to a year, one company gets exclusives right to the GENERIC version, and they can charge almost as much as the name-brand version.
A full list of the prices pharmacies pay for every preparation of nearly every prescription medication they buy is here
Also, certain medications are just expensive to produce. There are no inexpensive medications for asthma and insulin has no generic version. (The cheapest brand of insulin cost the pharmacy about $60 per vial but, for some reason, hospitals are able to purchase it for about $16 per vial!?!). And if the disease is rare, or there are a number of alternative medications, then each medication is essentially a "niche market" and so most generic suppliers don’t see a profit in providing them. Paradoxically, increased demand tends to drive the price of generic medications down not up.
A FEW WORDS ABOUT FREE SAMPLES:
You've heard that nothing in life is free. Pharmaceutical companies would not provide free samples if they didn’t know that it brought them more money in the long run. Of course, this ends up costing you more (either directly or through your insurance premiums). The purpose of free samples is to make it far too easy for physicians to pass them out rather than considering inexpensive alternatives that will do EXACTLY the same thing.
And remember that most doctors have no idea what most medications cost, so they don't think to consider cost when prescribing. Does this mean they are giving you the best possible medication for your condition independent of cost? Not necessarily. The newest drug will often be the most expensive, but it's not necessarily better. It might not even be as good (more on this later). It's just that it's too convenient to hand you a box of pills from a shelf overflowing with free samples and if there is no consideration of cost, convenience wins. Physicians have really busy days.
So far the medications discussed can be classified into two broad categories: Those that are easily affordable to almost anyone and those for which the price is high ($100-$200 per month for each medication) but not so prohibitively high that a single medication would overwhelm the average individual. Now we’ll discuss the medications that are priced well beyond these.
YOUR MONEY OR YOUR LIFE
A few years ago, a patient of mine who had recently been diagnosed with brain cancer, told me about a medication he was prescribed that was so expensive that he had to call several pharmacies before he could find one that would supply it. The medication is called Temodar. It cost $1400 for five pills and he needed to take 15 pills per course for a total of 13 courses. It actually cured his disease but, unfortunately, he died a couple of years laters as a result of the side effects of his treatment.
It’s understandable why pharmacies would be reluctant to carry a medication like Temodar. A single course cost $4200 and, if for whatever reason, the insurance denied payment, it would be a serious financial blow. This is especially true for small independent pharmacies that could not easily cover such a loss. Temodar is not unique in its price though.
Below is a list of relatively new and extremely high priced medications along with their price and indication. It should be noted that many of these medications are used to treat previously untreatable diseases such as advanced cancer, HIV, severe rheumatoid arthritis or to prevent the rejection of a transplanted organ. Some of these medicines have extended the lives of people for years. It should also be noted that most of them don’t actually cure any of the diseases for which they are indicated. Also, it doesn’t help that the patents on many of these medications have been extended (artificially) for decades.
In most cases, these medications are used along with other medications as well as surgery or radiation therapy that add substantially to the cost being given here. Also adding to the cost is the fact that many of these medications need to be given intravenously at an office or infusion center.
Multiple courses of these medications would be taken for months to years (if not indefinitely) making the eventual cost completely unaffordable to almost anyone. This list is by no means exhaustive. It’s simply a small sample of the dozens of medications that can easily cost tens of thousands of dollars per year. For some medications the exact dose (and therefore cost) varies for different diseases or different sized patients so a price range is given for the total.
1) Trastuzumab (Herceptin)
Used for certain types of breast cancer often in addition to surgery, radiation therapy and other chemotherapy agents
Price: $600 per 100mg. dose to be given weekly for one year
Total cost of drug alone: about $32,000 (in addition to the cost of infusion as well as the other necessary therapies)
2) Rituximab (Rituxan)
Used for lymphomas, chronic leukemia and severe rheumatoid arthritis
Price: $3,300 per 500mg dose. 6 x 500mg. to 1,000mg. infusions required (average)
Total cost of drug alone: about $28,000-$38,000.
3) Imatinib (Gleevec)
Used primarily for chronic leukemia
Price: $5,800 for 30x 400mg pills to be given daily indefinitely
Total cost of drug alone: About $70,000 per year.
4) Erlotinib (Tarceva)
Used for advanced (terminal) lung and pancreatic cancers
Price: $4,238 for 30 x 100mg. pills (for pancreatic cancer) $4,736 for 30 x 150mg pills (for lung cancer)
Total cost for three month supply of drug (which is optimistic) $12,700 for pancreatic and $14,200 for lung cancer.
5) Cetuximab (Erbitux)
Used for head, neck and colorectal cancers (along with other chemotherapies and radiation)
Price: $550 per 100mg. Dose of 600-800mg. followed by 400-500mg weekly doses until it stops working
Total cost of drug alone: $25,000-$32,000 for about 3 months (again, this is optimistic)
6) Voriconazole (Vfend)
Used for invasive fungal infections
Price: $4,135 for 120 x 200mg pills. Dose: Two pills twice daily for 3 months (for cure).
Total cost of drug alone: $12,400.
7) Maraviroc (Selzentry)
Used for HIV
Price: $1,050 for 60x 300mg pills to be given twice daily indefinitely.
Total cost of drug alone: $12,600 per year.
8) Atripla (a combination of 3 anti HIV drugs)
Used for HIV
Price: $1,752 for 30 pills to be taken daily indefinitely.
Total cost of drug alone: $21,000 per year.
9) Ataznavir (Reyataz)
Used for HIV
Price: $1,067 for 60 x 200mg. pills. Dose: Two pills daily indefinitely.
Total cost of drug alone: $12,800 per year.
10) Etanercept (enbrel)
Used for severe rheumatoid and psoriatic arthritis.
Price: $475 for 50mg. to be injected weekly until remission.
Total cost of drug alone: $25,000 per year.
11) Adalimumab (Humera)
Used for severe Rheumatoid arthritis, psoriatic arthritis and Crohn’s disease
Price: $2,015 for 40mg. to be used every other week until remission.
Total cost of drug alone: $56,000 per year.
The majority of the medications in this truly unaffordable category are for conditions that are either rare or unusually severe cases of a more common disease. (There are specialists who will use some of these medicines as first line treatment which is probably very inappropriate.) A notable exception is HIV which is somewhat common and almost always fatal if untreated. This is because any uninsured patient who contracts HIV will automatically qualify for Medicaid so the taxpayer gets the bill. In virtually all cases the patient needing any of the above medications will die very soon without them (in some cases they won’t live long with them either). The pharmaceutical companies know that this is a “your money or your life” situation and price their products accordingly.
Getting an insurance company to pay for an expensive brand named medicine (or anything else) is no easy feat. You would think, then, that they might be motivated to expose the deceptions in the industry. That would reduce their costs. But they won’t and here is why: It is never to your advantage to have a third party pay for anything that you could easily afford yourself. Insurance companies know this. But they make a lot of money by getting you to believe that they will pay for medications that, in reality, cost them nothing. They know that by keeping people in the dark about how inexpensive generic medications are and, at the same time, allowing the price of brand name medications to remain unaffordable, people will be frightened enough to buy expensive plans that cover ALL medications. Now you know that the majority of medications they cover cost them nothing, but that is a detail they would rather not discuss.
Insurance is necessary to cover any cost that people would have too much trouble covering themselves. Medical costs are among the most common reasons for bankruptcy in this country which underscores the need for health insurance. Knowing exactly how much insurance you actually need could save you thousands of dollars and that would decrease the insurance company’s profit by just as much. So the more confusing they make the system, the more they profit.
What You Can Do
(1) Never be afraid to ask your doctor how much anything he prescribes you costs. He probably won’t know but he can find out and, if enough people ask, he (or she) is likely to consider it more with each future prescription.
(2) Beware of free samples. These medications are VERY expensive. If you ever have to pay cash for one, it will cost you far more to buy one month’s supply than a whole year’s worth of another medication. Even the copay is likely to be many times the price of a generic alternative.
(3) Whenever you see a pharmaceutical representative at a doctor’s office you should consider two things: They are there to take time that the doctor could be spending with patients and their sole purpose is to drive up medical cost. Doctors have plenty of ways to learn about new medications. The attractive blonde from the pharmaceutical company is not there to teach, she's there to sell and you're the one who's going to pay.
(4) Remember, you are no more obligated to use your insurance to buy your medications than to drive everywhere just because you own a car. It’s a free country; walk if you like, and pay cash anytime you like. The pharmacies may not like this but it’s your money.