- Email: [email protected]
Escalating Cost of Medications May Influence Prescribing
Editorial
Escalating Cost of Medications May Influence Prescribing
W Marilyn W. Edmunds PhD, G/ANP, FAANP
www.npjournal.org
e are pleased to offer our readers a special issue focusing on pharmacology. This topic was suggested by our editorial board because some significant changes and new information are influencing drug prescribing. One big issue we did not explore fully is that nurse practitioners (NPs) will continue to confront the escalating cost of medications for their patients. Medicare D was supposed to limit the amount of money patients had to pay for medications. This plan has had some success but at the cost of moving many patients from drugs they had taken for years to those available on a more restricted plan formulary. Medicare D was handicapped because of congressional legislation, making it impossible for the federal government to negotiate lower prices with pharmaceutical companies for covered drugs. The Affordable Care Act is also intended to control medication costs. All health plans in a marketplace must include prescription drug coverage, but the medications that are covered differ, depending upon the state and its specific drug formulary. Consequences of the new ACA health care plans are twofold. First, generics previously made up 80% of all drugs sold in the US and were so much cheaper than prescription medications, which was a cost savings for consumers and a way to limit rising health care costs. However, now the price of many generic drugs has skyrocketed. For example, the University of Utah’s Drug Information Service reported that isoproterenol hydrochloride cost $50 a vial 2 years ago. Now the cardiac drug sells for $2,700 a vial.1 Two years ago, amitriptyline, an antidepressant, cost 4 cents a pill; now the price is $1.04 (an increase of 2,475%). The antibiotic tetracycline cost 6 cents a pill in 2013; the same pill costs $4.06 today, an increase of 7,567%.2 Drug-makers say that competition helps drive up drug costs. Second, many pharmaceutical companies, anticipating the passage of the ACA and controls on drug prices, implemented a substantial proactive increase in drug costs for many products. Current evaluations of the cost of some medications varies dramatically between drugstores from state to state (with the East Coast having average higher costs than the Midwest and West), and there is substantial variance between different drugstores within the same state and city.3 These price increases will impact what we prescribe if we wish our patients to be able to afford the drugs we want them to have. More than ever before NPs need to make sure to ask their patients about whether they are able to afford their medications or if they are omitting or cutting doses because of cost. Patients need to feel that we understand their problems and will try to assistant them as much as possible. Help enroll your patients in pharmaceutical company’s reduced rate help plans when possible. Patients need to know you are working with them. Advocate for your patients as possible with pharmaceutical representatives in your offices and at conferences.
The Journal for Nurse Practitioners - JNP
A17
The takeaway seems to be that NPs should encourage their patients to call drugstores or use a phone app for drug pricing information4 before having their prescriptions filled. Other information about comparative drug pricing is becoming available to patients such as that included in a recent Consumer Reports article.3 As many drug prices seem to have been increased because companies could, maybe patients and providers should start complaining about the cost of medications so drug companies learn what they shouldn’t. References 1. Hospitals feeling the pinch of high drug prices. Algorithms. http://healthsciences.utah.edu/innovation/blog/2015/ erinfoxtestify.1215.php Posted Dec 9, 2015. Accessed 1-6-2016. 2. Silverman E. How much? Some generic drug prices are skyrocketing: analysis. Wall Street J. http://blogs.wsj.com/ pharmalot/2014/08/14/how-much-some-generic-drug-prices-are-skyrocketing-analysis. Accessed 1-6-2016. 3. Save money on meds: 6 tips for finding the best prescription drug prices. Consumer Reports. http://www .consumerreports.org/drugs/6-tips-for-finding-the-best-prescription-drug-prices. Accessed 1-6-2016. 4. Can a phone app help you find cheaper drugs? Consumer Reports. http://www.consumerreports.org/cro/2012/05/can -a-phone-app-help-you-find-cheaper-drugs/index.htm. Accessed 1-6-2016.
Marilyn W. Edmunds, PhD, G/ANP, FAANP Editor in Chief
1555-4155/16/$ see front matter © 2016 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2016.01.002
A18
The Journal for Nurse Practitioners - JNP
Volume 12, Issue 3, March 2016
Escalating Cost of Medications May Influence Prescribing
W Marilyn W. Edmunds PhD, G/ANP, FAANP
www.npjournal.org
e are pleased to offer our readers a special issue focusing on pharmacology. This topic was suggested by our editorial board because some significant changes and new information are influencing drug prescribing. One big issue we did not explore fully is that nurse practitioners (NPs) will continue to confront the escalating cost of medications for their patients. Medicare D was supposed to limit the amount of money patients had to pay for medications. This plan has had some success but at the cost of moving many patients from drugs they had taken for years to those available on a more restricted plan formulary. Medicare D was handicapped because of congressional legislation, making it impossible for the federal government to negotiate lower prices with pharmaceutical companies for covered drugs. The Affordable Care Act is also intended to control medication costs. All health plans in a marketplace must include prescription drug coverage, but the medications that are covered differ, depending upon the state and its specific drug formulary. Consequences of the new ACA health care plans are twofold. First, generics previously made up 80% of all drugs sold in the US and were so much cheaper than prescription medications, which was a cost savings for consumers and a way to limit rising health care costs. However, now the price of many generic drugs has skyrocketed. For example, the University of Utah’s Drug Information Service reported that isoproterenol hydrochloride cost $50 a vial 2 years ago. Now the cardiac drug sells for $2,700 a vial.1 Two years ago, amitriptyline, an antidepressant, cost 4 cents a pill; now the price is $1.04 (an increase of 2,475%). The antibiotic tetracycline cost 6 cents a pill in 2013; the same pill costs $4.06 today, an increase of 7,567%.2 Drug-makers say that competition helps drive up drug costs. Second, many pharmaceutical companies, anticipating the passage of the ACA and controls on drug prices, implemented a substantial proactive increase in drug costs for many products. Current evaluations of the cost of some medications varies dramatically between drugstores from state to state (with the East Coast having average higher costs than the Midwest and West), and there is substantial variance between different drugstores within the same state and city.3 These price increases will impact what we prescribe if we wish our patients to be able to afford the drugs we want them to have. More than ever before NPs need to make sure to ask their patients about whether they are able to afford their medications or if they are omitting or cutting doses because of cost. Patients need to feel that we understand their problems and will try to assistant them as much as possible. Help enroll your patients in pharmaceutical company’s reduced rate help plans when possible. Patients need to know you are working with them. Advocate for your patients as possible with pharmaceutical representatives in your offices and at conferences.
The Journal for Nurse Practitioners - JNP
A17
The takeaway seems to be that NPs should encourage their patients to call drugstores or use a phone app for drug pricing information4 before having their prescriptions filled. Other information about comparative drug pricing is becoming available to patients such as that included in a recent Consumer Reports article.3 As many drug prices seem to have been increased because companies could, maybe patients and providers should start complaining about the cost of medications so drug companies learn what they shouldn’t. References 1. Hospitals feeling the pinch of high drug prices. Algorithms. http://healthsciences.utah.edu/innovation/blog/2015/ erinfoxtestify.1215.php Posted Dec 9, 2015. Accessed 1-6-2016. 2. Silverman E. How much? Some generic drug prices are skyrocketing: analysis. Wall Street J. http://blogs.wsj.com/ pharmalot/2014/08/14/how-much-some-generic-drug-prices-are-skyrocketing-analysis. Accessed 1-6-2016. 3. Save money on meds: 6 tips for finding the best prescription drug prices. Consumer Reports. http://www .consumerreports.org/drugs/6-tips-for-finding-the-best-prescription-drug-prices. Accessed 1-6-2016. 4. Can a phone app help you find cheaper drugs? Consumer Reports. http://www.consumerreports.org/cro/2012/05/can -a-phone-app-help-you-find-cheaper-drugs/index.htm. Accessed 1-6-2016.
Marilyn W. Edmunds, PhD, G/ANP, FAANP Editor in Chief
1555-4155/16/$ see front matter © 2016 Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2016.01.002
A18
The Journal for Nurse Practitioners - JNP
Volume 12, Issue 3, March 2016