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Wednesday Oct 05, 2016

Unreasonable Drug Prices Force Patients to Skip Meds

A patient, whom I'll call Herb, came to see me recently for routine followup. He's 67, retired and covered by Medicare. Herb has suffered from complications from diabetes in the past, and his most recent numbers -- including his A1c -- were poor.

I sat down to talk with Herb, but before I could say anything, he got straight to the point.

"I know it's not good," he said. "I can't afford my insulin. I haven't had it in six weeks."

Faced with an out-of-pocket cost of $400 a month, this senior on a fixed income was faced with a tough decision, and he opted not to adhere to recommended treatment. It's a scenario that has become all too common, not only in my clinic, but in exam rooms across the country. From insulin to EpiPens and so much more, too many patients flat-out can't afford medications that are vital to their health

Without corrective action, the problem is likely to get worse. According to the Kaiser Family Foundation, nearly one-fourth of U.S. workers enrolled in high-deductible plans their employers offered last year, up from 4 percent just 10 years ago. That's a troubling trend because we know that patients with high-deductible plans are more likely to delay or skip recommended care.

During the AAFP's recent Congress of Delegates, delegates adopted an amended resolution that took aim at the skyrocketing price of EpiPens. That resolution, which was co-sponsored by a dozen state chapters, directed the Academy to call on the FDA and Congress to "establish mechanisms to prioritize and fast-track competitive drug options for widely used life-saving or life-sustaining drugs that may be subject to monopoly power." Delegates also referred to the Board a resolution advocating for prescription drug cost-saving measures for Medicare.

Clearly, family physicians are concerned about this complex patient care issue, and the Academy is exploring a multipronged advocacy approach to address it. This week, AAFP officers are in Washington to meet with representatives from the White House, CMS and America's Health Insurance Plans, as well as with several congressional staff members, to discuss a wide range of issues, including implementation of the Medicare Access and CHIP Reauthorization Act, the Medicare physician fee schedule, chronic care management and funding for important primary care programs.

Our first stop, however, was an Oct. 3 meeting with representatives from the Campaign for Sustainable Rx Pricing, a coalition of organizations representing physicians, employers, hospitals, nurses, patients, payers and pharmacists that seeks to address the causes of high drug prices through increased transparency and competition.

According to a recent Kaiser Family Foundation poll, nearly 90 percent of Americans think drug companies should be more transparent about how they set prices, more than 80 percent think the federal government should be allowed to negotiate with manufacturers for better drug prices for Medicare beneficiaries, and nearly 80 percent think prescription drug prices are unreasonable.

We agree, and we look forward to working with Congress and other stakeholders to find a solution that will allow our patients affordable access to the medications they need.

Michael Munger, M.D., is president-elect of the AAFP.


I am so pleased the Academy is taking this step. The blatant profiteering that is currently running rampant in our health care system is nothing short of criminal. The pharmaceutical industry, medical device industry and large health care systems are following a business model that does not always align well with patient care needs. Along with balooning drug costs, patients also face rising premiums, higher deductibles and co-payments and increasingly narrow networks. All the while we in primary care are seeing shrinking bottom lines as more and more resources are being funneled toward the unnecessary administrative costs of running a practice.

Posted by Andrea DeSantis DO on October 09, 2016 at 07:22 PM CDT #

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